Disclosure I am a cardio-oncologist in the United States - - PowerPoint PPT Presentation

Cardio-oncology Fellowship Training What Does the Future Hold?

Joseph R. Carver, MD, FACC Bernard Fishman Professor of Clinical Medicine Abramson Cancer Center 30 September 2016

Disclosure

I am a cardio-oncologist in the United States ¡

¡

More Cancer Rx Options Better Survival More “Double- Hits” Increasing potential for

cardiac toxicity

Cardio-oncology: A Human “Tsunami”

More Cancer Rx Options Better Survival More “Double- Hits” Increasing potential for

cardiac toxicity

Cardio-oncology: A Human “Tsunami”

Our goal is to improve care and outcomes

What’s The Problem?

In a 2015 nationwide survey of 444 adult and pediatric cardiology division chiefs and cardiovascular fellowship program training directors we recognized a growing trend toward establishment of cardio-

• ncology services and a gap in

training and perceived competency

Barac A et al. JACC 2015;65: 2739

Cardio-oncology Landscape

• 27% reported having no established,

specialized cardio-oncology program

• 39% did not feel confident handling

cardiac care specific to patients with cancer

• 65% thought access to consultants

with specialized training in cardio-

• ncology would provide an

advantage in cancer patient care

Barac A et al. JACC 2015;65: 2739

Cardio-oncology Landscape II

Barac A et al. JACC 2015;65: 2739

Cardio-oncology Landscape III

• 43% of programs offered no formal

training in cardio-oncology

• 25% expressed need for training,

curriculum, educational materials and dedicated meetings

What’s The Solution?

More Cancer Rx Options Better Survival More “Double- Hits” Increasing potential for cardiac toxicity

Our goal is to improve outcomes

Cardio-oncology: A Human “Tsunami”

TRAINING & EDUCATION

What I Am Not Talking About Today

• Definitions
• Numbers
• Specifics of core

competencies

• Level I, II, III training, goals

and curriculum

¡

How Do We Get There?

Heart Failure Training: A Call for an Integrative Patient-Focused Approach to an Emerging Cardiology Subspecialty Marvin A. Konstam for the Executive Council of the HFSA J of Cardiac Failure 2004;10 (5): 366

What Can We Learn From History?

“Heart failure [CANCER] is a growing epidemic in the United States, owing to the aging of our population and the increasing survival of patients presenting with large myocardial infarction [MALIGNANCY]… Over the past decade, we have seen an explosion of new treatment options for patients with heart failure [CANCER], with documented benefit on clinical

• utcome…

Numerous new approaches are being explored and are likely to markedly increase the complexity of optimal care during the coming decade… The subspecialty of heart failure [CARDIO- ONCOLOGY] should focus on the patient and the disease, incorporating a deep and broad understanding of all available diagnostic and treatment modalities…

The expanding patient population, coupled with rapid growth in information and treatment options demands the recognition of heart failure [CARDIO- ONCOLOGY] as an essential and well-defined sub- specialty of cardiology. A highly specialized clinician will be needed to master the care of the heart failure patient [CANCER PATIENT WITH CARDIAC COMORBIDITY].

The U.S. Heart Failure Experience

2008 ¡ ABIM ¡ Approves ¡ Subspecialty ¡ 1990s Cardiologists Focused on Heart Failure 2001 HFSA Established 2004 HFSA Training: Call For Subspecialty

The U.S. Cardio-Oncology Experience

2008 ¡ ABIM ¡ Approves ¡ Subspecialty ¡ 1990s Heart Failure Cardiologists 2001 HFSA Established 2004 HFSA Training: Call For Subspecialty 1990s Cardiologists Focused on Cancer 2005-2006 Cardiology- Oncology Partnership, ICOS CCON (2111) 2014-15 ACC C-O Working Group Approves C-O Council 20?? ABIM Approves Subspecialty

• f C-O

The U.S. Cardio-Oncology Experience

2008 ¡ ABIM ¡ Approves ¡ Subspecialty ¡ 1990s Heart Failure Cardiologists 2001 HFSA Established 2004 HFSA Training: Call For Subspecialty 1990s Cardiologists Focused on Cancer 2005-2006 Cardiology- Oncology Partnership, ICOS CCON (2111) 2014-15 ACC C-O Working Group Approves C-O Council 20?? ABIM Approves Subspecialty

• f C-O

Crit itical ical Steps eps: : Tact actics ics & Strategy

How They Did It: Tactics & Strategies

• HFSA advocacy
• Critical partnership with ACC
• Debated and defined core

competencies

• Established criteria and began

training programs

How They Did It: Tactics & Strategies

• Developed educational programs
• Grew a dedicated journal &

annual meeting

• Metrics that they improved care

& outcomes

• ACGME/ABMS recognition
• Perseverance, self-assessment,

remodeling

Basic Principles

• Build on basic fellowship skills with

subsequent dedicated “experience”

• Multiple levels of initial and ongoing

training

• Metrics (e.g., COCAT’s 6 competencies

& proficiencies)

• Patients to know that when referred to

a cardio- oncologist that the specialist has been rigorously trained and is proficient in the field

*medical knowledge/pt care and procedure skills/practice based learning and improvement/systems based

practice/interpersonal and communication skills/professionalism

Roadmap and Detours

• Short Term
• The three “Fs” (faculty, facility,

funding)

• The two “Cs” (competencies,

curriculum)

• Multiple “Ns”

¡

• “This is general cardiology”
• “This is Advanced Heart Failure

and Transplant”

• “All the arrhythmias and QT

prolongation belong to EP”

• “There are already too many

cardiology subspecialties”

Roadmap and Detours

• Long Term
• Metrics and program standardization
• The three “Rs” (COCATS ACGME ABIM)
• Work force training and access
• Disease management strategies for non-

cardio-oncologists to use

• Systems for referral
• Oncologist to cardio-oncologist
• General Cardiologist to cardio-oncologist
• Primary care to cardio-oncologist

¡

How WE are Doing It: Tactics & Strategies

• HFSA advocacy

CCON & ICOS ADVOCACY

How WE are Doing It: Tactics & Strategies

• HFSA advocacy

CCON & ICOS ADVOCACY

• Partnered with ACC

ACC ASCO and AHA

How WE are Doing It: Tactics & Strategies

• HFSA advocacy

CCON & ICOS ADVOCACY

• Partnered with ACC

ACC ASCO and AHA

• Debated and defined core competencies

ONGOING

How WE are Doing It: Tactics & Strategies

• HFSA advocacy

CCON & ICOS ADVOCACY

• Partnered with ACC

ACC ASCO and AHA

• Debated and defined core competencies

ONGOING

• Established criteria for training programs

ONGOING

How WE are Doing It: Tactics & Strategies

• Educational programs

WE ARE HERE

How WE are Doing It: Tactics & Strategies

• Educational programs

WE ARE HERE

• Dedicated journal http://

cardiooncologyjournal.biomedcentral.com

How WE are Doing It: Tactics & Strategies

• Educational programs

WE ARE HERE

• Dedicated journal

CARDIO-ONCOLOGY JOURNAL

• ACGME/ABMS recognition

EARLY DIALOGUE WITH COCATS 5

LEADERSHIP

How WE are Doing It: Tactics & Strategies

• Educational programs

WE ARE HERE

• Dedicated journal

CARDIO-ONCOLOGY JOURNAL

• ACGME/ABMS recognition

EARLY DIALOGUE WITH COCATS 5

LEADERSHIP

• Perseverance, self-assessment, remodeling

THE CORE OF OUR COMPETENCIES

Existing Non-accredited Fellowships

• Dana Farber
• London
• MD Anderson
• MSKCC
• Ottawa
• Penn
• Rush
• Tampa
• Vanderbilt
• ??

“In health care, as in industry, demand should define change. Based on the growing patient population and the growing complexity of diagnostic and treatment

• ptions, the time has come for establishing clear

criteria for cardio oncology training; for codifying cardio onoclogy as a patient-focused subspecialty of cardiology and oncology; and for encouraging cardiology and oncology trainees in this direction.”

Back To The Future (Modified from Konstam 2008)

“In health care, as in industry, demand should define change. Based on the growing patient population and the growing complexity of diagnostic and treatment options, the time has come for establishing clear criteria for cardio oncology training; for codifying cardio onoclogy as a patient-focused subspecialty of cardiology and oncology; and for encouraging Cardiology and oncology trainees in this direction.”

The future is now, it is time for world-wide collaboration for us to continue and complete the steps toward achieving these goals

Back To The Future

The future is now, it is time for world-wide Collaboration and for us to continue and complete the steps toward achieving these goals

If you are interested in being part of a working task group-give me your name and contact info after this talk

The Future

The Cardio-oncologist After Training

Take Home Message

• Without training and education, our

goals of improving care and patient access will not be achieved

• Without formal and official recognition
• f cardio-oncology by the “governing

boards” there will be no formal training/fellowship

• There is a workforce gap and we

intend to fill it

Daniel Lenihan CARDIO-ONCOLOGY

2025

2025 THROUGH 2035