Click to edit Master title style Starting a Cardio-Oncology Program - - PowerPoint PPT Presentation
Click to edit Master title style Starting a Cardio-Oncology Program Our experience in the Community setting Kibar Yared, MD FRCPC Director, Cardiac Imaging Medical Director, Cardio-Oncology Program Scarborough Health Network Clinical Adjunct
Kibar Yared, MD FRCPC Director, Cardiac Imaging Medical Director, Cardio-Oncology Program Scarborough Health Network Clinical Adjunct Professor of Medicine University of Toronto @kibaryared
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– Particularly compelling presentation by Dr. Juan Carlos Plana
– All cardiac investigations ordered and followed-up by Oncology – If abnormal then referral sent to first-available Cardiologist – Large discrepancies in
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– But there was established Heart Function Clinic, staffed with clerk and nurses
motivation – Established what type of patient should be seen in Cardio-Oncology – Agreed that we would “take over” cardiac investigations of patients at risk of cardiotoxicity
chemotherapy
complaints or previous abnormal cardiac investigations
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847474 (Rev.03/17) Page 1 of 1 847474OUTPATIENT CARDIO−ONCOLOGY HISTORY
Distribution: Chart CopyChemotherapy #1 ________________________________ Date ___________________________________________ # of Tx’s received _________________ Last Tx date_________________ Next Planned Tx date__________________ Chemotherapy #2 ________________________________Date ____________________________________________ # of Tx’s received _________________ Last Tx date _________________ Next Planned Tx date __________________ Chemotherapy #3 ________________________________Date ____________________________________________ # of Tx’s received _________________ Last Tx date _________________ Next Planned Tx date __________________ Chemotherapy #4 ________________________________Date ____________________________________________ # of Tx’s received _________________ Last Tx date _________________ Next Planned Tx date __________________ Previous childhood/adolescent malignancy Diagnosis ______________________ Date _________________ Treatment ___________________ Previous Cardio Toxicity: ❏ Yes
❏ No
Date:__________________________ Priamary Cardiologist ______________________
RN Signature ________________________________ Date____________________ Allergies/Sensitivities: Initial Weight: History Hypertension Dyslipidemia Diabetes PCI
❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No
CABG CAD/MI Smoker Etoh
❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No
Echo/CMR/MUGA Date:
2D/3D% GLS % Date:
2D/3D% GLS % Date:
2D/3D% GLS % Date:
2D/3D% GLS % Date:
2D/3D% GLS % Date:
2D/3D% GLS % Oncologist: HER2 #of Tx: Date: Radiation Date: Date Cancer Diagnosis: Surgical Date: 847474
OUTPATIENT CARDIO−ONCOLOGY HISTORY
Chemotherapy #1 ________________________________ Date ___________________________________________ # of Tx’s received _________________ Last Tx date_________________ Next Planned Tx date__________________ Chemotherapy #2 ________________________________Date ____________________________________________ # of Tx’s received _________________ Last Tx date _________________ Next Planned Tx date __________________ Chemotherapy #3 ________________________________Date ____________________________________________ # of Tx’s received _________________ Last Tx date _________________ Next Planned Tx date __________________ Chemotherapy #4 ________________________________Date ____________________________________________ # of Tx’s received _________________ Last Tx date _________________ Next Planned Tx date __________________ Previous childhood/adolescent malignancy Diagnosis ______________________ Date _________________ Treatment ___________________ Previous Cardio Toxicity: ❏ Yes
❏ No
Date:__________________________ Priamary Cardiologist ______________________
Allergies/Sensitivities: Initial Weight: Oncologist: HER2 #of Tx: Date: Radiation Date: Date Cancer Diagnosis: Surgical Date:
847474 (Rev.03/17) Page 1 of 1 Distribution: Chart Copy
RN Signature ________________________________ Date____________________ History Hypertension Dyslipidemia Diabetes PCI
❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No
CABG CAD/MI Smoker Etoh
❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No
Echo/CMR/MUGA Date:
2D/3D
% GLS % Date:
2D/3D
% GLS % Date:
2D/3D
% GLS % Date:
2D/3D
% GLS % Date:
2D/3D
% GLS % Date:
2D/3D
% GLS %
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847297 (Rev.03/17) Page 1 of 1 847297
OUTPATIENT CARDIO−ONCOLOGY NURSING ASSESSMENT
Distribution: Chart Copy
Oncology
Oncologist ____________________________________ Cancer Diagnosis_______________________ Dyspnea at Rest Dyspnea on Exertion Pillow Orthopnea
❏ Yes ❏ No ❏ Yes ❏ No ❏ 1 ❏ 2 ❏ 3 ❏ 3+ ❏ HOB Elevated ❏ Recliner/Chair ❏ Yes ❏ No ❏ Productive ❏ Non Productive Onset ❏ Yes ❏ No ❏ Yes ❏ No
Regular Exercise Diagnostics Echo EF ______________________ Date_________________ MUGA EF_________________ Date___________ Cardiac MRI EF_________________ Date _________________ RN Signature ________________________________ Assessment Date____________________
❏ 1 Visit ❏ Follow−up Visit
stSymptoms Lifestyle
❏ Yes ❏ No If yes, describe:
O2 Sat______________ Pulse______________ BP Sitting______________ BP Standing______________ Weight______________ Chest Auscultation______________________________________________________ Peripheral Edema
❏ None ❏ Trace ❏ 1+ ❏ 2+ ❏ 3+ ❏ 4+ Location______________________
Physical Assessment
PND: Cough
Patient Concerns: Teaching
❏ CHF Physiology ❏ Sodium Management ❏ Medication Therapy ❏ ER/Clinic talk ❏ Symptom Recognition ❏ Fluid Management ❏ Managing CHF ❏ Weight Diary ❏ Exercise Guideline ❏ Other
Palpitations Chest Pain
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– Patients cancelling, not seeing the need in follow up. Clinic fatigue.
– Steep learning curve. Keeping up to date with chemotherapeutic agents.
– Working as a team with oncology
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date – 87 Discharged – 24 Died – 14 Refused follow- up
dysfunction – 1 death (Amyloid) – 11 complete recovery – 2 recovery to low normal EF
1% 1% 2% 3% 3% 9% 15% 66%
Breast CA GI/GU Lymphoma Lung CA Multiple Myeloma Leukemia MDS Other
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AHA SCIENTIFIC STATEMENT
Cardio-Oncology Rehabilitation to Manage Cardiovascular Outcomes in Cancer Patients and Survivors
A Scientific Statement From the American Heart Association
Endorsed by the American Cancer Society
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Alternative access to care, reduced travel costs
Improved patient care and family/patient satisfaction
Program efficiencies, reduced wait times and no shows
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THANKS to Patricia Osgood Sarah Aiken, RN Margo Wells, RN Siva Punniasingam, RN MaryAnn Quilang Saul Miller, MD Nisha D’Mello, MD Andrea Rosenbloom, MD
Image courtesy of Duke Cancer Institute