A multidisciplinary approach for treatment choice in cancer patients with cardiovascular diseases: Experience of a large municipal hospital.

Abstract

e24022 Background: Cancer and cardiovascular diseases (CVD) competitive risks have to be evaluated during the choice of cancer treatment. Methods: At Initial phase of The Moscow Cardio-Oncology Center establishment was decided to limit referrals to a cardio-oncologist to two cohorts of patients. For all patients at very high risk of cardiovascular complications, if cardiotoxic cancer therapy is assumed, the choice of cancer treatment is carried out at a Multidisciplinary Consilium (MC) with the participation of the cardiologist. Further observation in the Cardio-Oncology center with cardiologist consultation as well left ventricular global longitudinal strain and cardiac biomarkers assessments is carried out for patients who have been prescribed anthracyclines, HER2/neu inhibitors, fluoropyrimidines or taxanes according to the approved schedule. The second cohort consists of patients who have developed signs of cardiovascular toxicity of cancer therapy. Results: Qver a 3-month period, multidisciplinary consultations were held for 236 patients, including 134 (57%) - gastrointestinal cancer, 42 (18%) - lung cancer, 24 (10%) - breast cancer, 36 (15%) - other localizations. A radical treatment program was implemented for 106 (45%) patients. The cancer therapy deescalation or symptomatic treatment due to the severity of CVD was the decision of the MC in 22 cases (9%), additional examination of cardiovascular system before cancer treatment - in 12 cases (5%). Before the start of cardiotoxic cancer therapy, echocardiography and ECG were performed in 236 (100%) patients, and the main risk factors were assessed. Target BP level was in 102 (43%), the target LDL-C level - in 17 (7%) patients. Among the cohort of MC patients 96 (41%) had coronary heart disease, 63 (28%) - myocardial infarction, 37 (16%) - stroke, 74 (31%) - atrial fibrillation, 73 (31%) - chronic heart failure, 224 (95%) – arterial hypertension, 65 (28%) patients - diabetes mellitus, 82 (35%) - chronic kidney disease. In the cohort of MC patients two fatal outcomes were registered, the therapy was docetaxel and paclitaxel + carboplatin, the cause of death in both cases was infectious complications, myelosuppression. One patient was hospitalized due to the development of paroxysmal atrial fibrillation, sinus rhythm was successfully restored, there were no other hospitalizations due to CVD. The cardiologists of Cardio-Oncology Center conducted 194 consultations in connection with the identification of cardiotoxicity triggers by chemotherapists during cancer therapy. Conclusions: Multidisciplinary Consilium with the participation of the cardiologist may be a useful tool in assessment of risk/benefit evaluation of cardiotoxic cancer therapy regimens in patients with CVD, Further cost-effectiveness research is needed to guide recommendations for implementation in healthcare practice.