United Kingdom’s First Cardio-Oncology Service: 10-Year Experience

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In a research letter published by Andres et al in JACC: CardioOncology, staff from Royal Brompton Hospital, Guy’s and St. Thomas’ NHS Foundation Trust in London described their experience over 10 years in the UK’s first cardio-oncology service.

Study Details

The study involved data from the initial encounters of 1,499 patients at the Cardio-Oncology Service at Royal Brompton Hospital between February 2011 and December 2021.

Key Findings

Patients had a mean age of 60 ±15 years, and 60% were female. Over the 10-year period, the most common cancers were breast (n = 427; 28.5%), hematologic (n = 151; 10.1%), and gastrointestinal (n = 114; 7.6%). The average number of new referrals increased from 4.5 patients/month in 2011 to 23 patients/month in 2021.

Among all patients, 32.8% were referred for cancer therapy–related cardiac dysfunction (CTRCD), 22.3% for non–heart failure cardiovascular disease (non-HF CVD; including arrhythmia, chest pain, hypertension, pericardial disease, and myocarditis). Other patients were seeking referrals for pretreatment assessment (39.0%), intracardiac masses (3.0%), survivor screening (1.9%), and direct complications of cancer (0.9%).

Between 2012 and 2017, a predominance of CTRCD over non-HF CVD referrals was observed. Starting in 2018, non-HF CVD was observed as the more frequent referral indication, and referral of patients receiving anthracycline-based therapies declined.  

Compared with patients with non-HF CVD, those with CTRCD were more likely to be women (males with CTRCD = 28.2% vs males with non-HF CVD = 37.3%, P = .029), had a lower incidence of diabetes (CTRCD = 1.8% vs non-HF CVD = 7.2%, P < .001), and had lower prevalence of preexisting CVD (CTRCD = 9.8% vs non-HF CVD = 16.7%, P = .010). Breast cancer was more common in the CTRCD group than in the non-HF CVD group (36.3% vs 24.5%, P < .001); melanoma (5% vs 2.7%, P = .049) and lung cancer (5% vs 1.8%, P = .007) were more common in the non-HF CVD group than in the CTRCD group.

Use of anthracyclines (50% vs 29%) and HER2-targeted therapies (32% vs 12%) was more common in the CTRCD group. Use of tyrosine kinase inhibitors (9% vs 2%) and immune checkpoint inhibitors (20% vs 4%) were more common in the non-HF CVD group.

In multivariate analysis including age, sex, history of hypertension, diabetes, preexisting heart disease, dyslipidemia, obesity, smoking history, and oncologic drug groups, anthracycline use (odds ratio [OR] = 2.03, 95% confidence interval [CI] = 1.01–4.06, P = .046) and HER2-targeted therapy use (OR = 6.21, 95% CI = 2.81–13.71, P < .001) were significantly associated with referral for CTRCD, and fluoropyrimidine use (OR = 4.15, 95% CI = 1.45–11.80, P = .008) and immune checkpoint inhibitor use (OR = 7.84, 95% CI = 2.73–22.47, P < .001) were significantly associated with referral for non-HF CVD.

The investigators concluded, “In this study, we present data from a dynamic cardio-oncology service demonstrating a shift in the types of cardiovascular diseases referred driven by the emergence of new oncology treatments.”

Maria Sol Andres, MD, of the Cardio-oncology Service, Royal Brompton Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, is the corresponding author for the JACC: CardioOncology article.

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