Preliminary Results of A Cardio-Oncology Clinic - the Rabin Medical Center Experience

Background: A dedicated cardio-oncology service (COS) was established at the Rabin Medical Center in 2013 in order to address the management of cardiovascular concerns associated with cancer treatment.

Methods: Demographics, risk factors, cardiac status and cancer-related data were collected for patients between 5/2013 and 11/2015.

Results: Data from 450 patients was collected. Mean age was 64.8 (SD 13.4) years, 50.0% were males. These included patients with solid organ tumors ((breast 82 (18.2%), gastrointestinal 65 (14.4%), lung 32 (7.1%), genitourinary tract 48 (10.7%), other 95 (21.0%)) and with hematologic malignancies (lymphoma 53 (11.8%), cardiac amyloidosis 21 (4.6%), other hematologic cancers 54 (12.0%)). 348 patients received cancer-related treatment (anthracyclines 34.4%, monoclonal antibodies 25.6%, tyrosine kinase inhibitors 15.5%, another chemotherapy 24.5%). 72 patients (16.0%) underwent chest radiotherapy. Coronary artery disease was present in 76 (16.9%) patients. Other risk factors included: hypertension 159 (35.3%), smoking 54 (12.1%), hyperlipidemia 162 (36.0%), diabetes 66 (14.7%). Cardiotoxicity, defined as a reduction of LVEF to <50% or a decrease of 10 points from baseline normal LVEF, was observed in 16 patients (3.6%). 152 patients received cardiac medications.

222 of 281 patients receiving chemotherapy at the time of referral to the COS, successfully completed the treatment. Anthracycline treatment was discontinued/finished before cardiotoxicity was diagnosed (8/16 cases of cardiotoxicity). A decrease in LVEF was observed in 8/23 of trastuzumab-treated patients with recovery of LVEF in 7 of them. 3 cases of acute coronary syndrome developed after receiving 5-fluorouracil. As of November 2015, 48 patient died.

Conclusion: Cancer patients suffer from cardiotoxicity and active cardiac problems associated with treatment. Yet, a substantial number of them are able to complete anti-cancer therapy. A close collaboration between cardiologists and oncologists/hemato-oncologists is encouraged and might contribute to the improvement of patients’ outcomes.