click to edit master title style developing a cardiac oncology fellowship program asco june 2014...
TRANSCRIPT
Click to edit Master title style
Developing a Cardiac Oncology Fellowship ProgramASCO June 2014
Susan DentMedical OncologistThe Ottawa Hospital Cancer CenterOttawa, Canada
Click to edit Master title style
101112131415161718 Cancer Survivors (Million) 2012 - 2018
The problem
Click to edit Master title styleCancer Survivors (Million) 2012 - 2018
00.20.40.60.8
11.21.41.61.8
2
Click to edit Master title style
Brigham, MGH
MSK
U Penn
Medstar Washington
Louisville
Duke
Vanderbilt
MD Anderson
Stanford
Click to edit Master title style
Click to edit Master title style Why do we need Cardiac Oncologists?• N = 63 with LVSD (LVEF < / = 45%) post chemo • 67% symptomatic HF: 54% had Cardiology input (black) • Survival 71% vs 41% in no Cardiology input
Cardiovascular Management of Cancer Patients With Chemotherapy-Associated Left Ventricular Systolic
Dysfunction in Real-World Clinical PracticeJournal of Cardiac Failure, Volume 19, Issue 9,
2013, 629 - 634
Cardiology input = black
No Cardiology = white
All = grey
Click to edit Master title style
Yoon , Telli , Kao , Matsuda , Carlson , Witteles
Left Ventricular Dysfunction in Patients Receiving Cardiotoxic Cancer Therapies : Are Clinicians Responding Optimally?
Journal of the American College of Cardiology, Volume 56, Issue 20, 2010, 1644 - 1650
Why do we need cardiac oncologists ?
Click to edit Master title styleWhat is Needed !
Network / Collaboration
• Facilitate networking: ICOS NA , CCON
• Create WG and TFs – link
• Publicize Cardio-Oncology: websites, social media
• Facilitate Research Collaborations: invite participation – group efforts
Clinical
• Centralize existing resources, create white papers and guidelines
• Create a learning pathway
Training
• Develop a Fellowship program
• Standardized Curriculum
Click to edit Master title style Fellowship Training – what’s out there
• 7 Fellows in US / Canada
• No accreditation
• No internal funding
• No recognized structure to follow
Click to edit Master title style
Cardiac Oncologist?
HF Imaging Research
Consults Clinics
Cardiology Oncology
Click to edit Master title style
Should we develop a curriculum for cardiac oncology ?
Click to edit Master title style
GOALS OF THE CURRICULUM
Convey a knowledge base. Stimulate research.
Integrate into mainstream cardiology and oncology training programs
Reshape the mindset about traditional roles of cardiologists and oncologists .
Graduates expand best practices outside the cloistered “cardio oncology centers”, improve practice, lessen disparities in practice.
Richard M. Steingart MDChief, Cardiology Service Memorial Sloan-Kettering Cancer Center
Click to edit Master title style
use of chemotherapeutic drugs, biologic products, and growth factors; their mechanisms of action, pharmacokinetics, clinical indications, and
limitations, including their effects, toxicity, and interactions
cardiac tumors
Click to edit Master title style
Click to edit Master title style
Click to edit Master title style
Click to edit Master title style
• basic knowledge of cancer agents and their potential to cause cardiac damage
• Imaging strategies – basic knowledge on cardiac imaging in oncology patients
• Basic understanding of treatment strategies for cancer patients experiencing cardiac toxicities
Level 1 (Internal Medicine Residents)
Click to edit Master title style• For residents who wish to broaden their
exposure to cardiac oncology patients• More detailed assessment of patients• Intermediate knowledge base• More exposure to advanced cardiac imaging
eg. advanced echocardiography (strain/3D)• Understanding of the role of biomarkers in
early detection of cardiac toxicity
Level 2 (Medical/Cardiology Resident)
Click to edit Master title style• 12-24 months of dedicated fellowship
training• advanced knowledge of cancer agents and
potential toxicities • broad exposure to in- and out- patients• training in biomarkers, advanced imaging• actively involved in research
Level 3 (Cardiac Oncology Fellow)
Click to edit Master title style• Cardiologist stream• Principles of oncology care• Advanced knowledge of cancer
agents and potential toxicities• Training in biomarkers, advanced
cardiac imaging• Appropriate cardiac imaging
techniques • cardiotoxicity surveillance-
when/how long?• Evidence based treatment with
cardioprotective drugs• Actively involved in research
• Oncologist stream• Understanding cardiac imaging:
limitations and common techniques• Familiarity with principles of heart
failure, arrhythmias and hypertension
• Familiarity with principles of echocardiography , cardiac MRI and biomarkers
• Techniques of cardiac surveillance• Evidence based treatment with
cardioprotective drugs• Actively involved in research
Level 3 Cardiac Oncology Fellow (12-24 months)
Click to edit Master title styleHOW TO ACCOMPLISH THE ESSENTIAL INSTRUCTION?
Cancer therapies taught by cardiologists to cardiology traineesas life saving interventions with manageable toxicity.
Longitudinal Outpatient Cardio-Oncology Clinic• Adults currently receiving anthracyclines/trastuzumab.
– Continuum of benefit and risk.
• Surgical clearance of the cancer patient.• Childhood cancer survivors.• Adults receiving VSPI.
– Blood pressure, CHF and ischemia management.
Inpatient Consultation Service• Antiplatelet/anticoagulant risks and benefits.