How to Design A Preventive Cardio-Oncology Training Emphasis - Article

How to cite this blog post:

Brown, S. How to Design A Preventive Cardio-Oncology Training Emphasis. http://www.cardioonctrain.com/blog; Accessed [Month, Year]. Please also read the Companion article tilted “How To Incorporate Cardio-Oncology As A Training Emphasis in General Cardiology Fellowship” available here. A toolkit for implementing concepts in this article is available here.  View Cardio-Oncology & Preventive Cardio-Oncology Training Emphasis Toolkit Series 

View Cardio-Oncology & Preventive Cardio-Oncology Training Emphasis Article Series

The time is now for a focus on prevention in Cardio-Oncology. Too long have we waited for cardiotoxicity to occur without taking aggressive action. Survivorship begins at the moment of diagnosis. I would argue that potential survivorship even begins at birth. We are all potential survivors of one form of cancer of another. Do not we all deserve an opportunity to try to avoid cardiotoxicity, even if we must choose to have cancer therapies? Of course, no shoe size fits all, and we have not yet begun to scratch the surface to try to understand why some individuals develop cardiotoxicity and some do not. We all see patients with low risk who develop cardiotoxicity anyway, and we see patients with high risk who do not develop cardiotoxicity. You’re right. We don’t have a crystal ball. If only we did! Nevertheless, there are known clinical variables that often associate with cardiotoxicity. Yet, oftentimes the variables that are modifiable are not aggressively addressed prior to initiating therapy. We are doing a fine job overall with secondary and tertiary prevention, as much as within our power. What about primary and primordial prevention? Who will make these two precarious forms of prevention their #LifeGoals? If you are one of the pioneers in PREVENTIVE Cardio-Oncology, I would love to hear from you (drbrowncares@gmail.com, @drbrowncares, @PrevCardioOnc)! For those of you who are not, it’s time to get on the bandwagon! No one will blame you for just getting on now, for the trail is just now formally being blazed. So I would love to hear from you too! So how do you prepare to emblazen Preventive Cardio-Oncology all across patient care, research, and education? MAJOR STEPS Determine how you will incorporate Cardio-Oncology into your training, then add in Prevention, or vice versa. That’s exactly what I did. I charted my course in Preventive Cardiology and in Cardio-Oncology, to bring the two training emphases together as one: Preventive Cardio-Oncology.  I designed a sample week that would allow me a breadth of relevant experiences to prepare me for independence in this emerging field.  My Sample Week therefore had a heavy emphasis on Cardiovascular Health (Preventive, Fitness, & Lipid) Clinic, Cardiac Rehabilitation, Cardiopulmonary Stress Testing, and Women’s Heart Clinic, along with Cardio-Oncology and Amyloid Clinics. This I planned over a handful of years with my mentors at Mayo Clinic in Rochester, MN, as they supported and guided my progress toward Preventive Cardio-Oncology (#PrevCardioOnc, @PrevCardioOnc). I think we all agree that it is time to channel much of our efforts towards primordial and primary prevention, and not only management or secondary or tertiary prevention, of cardiovascular toxicities from cancer therapies.  For the next several sections of this article I will focus on the Preventive Cardiology portion of the Preventive Cardio-Oncology training.  PATIENT CARE & TEAM LEADERSHIP I worked towards achieving competency (based on excellent faculty feedback) while seeing a variety of patients, diagnoses, and management plans.  As a team leader in training, I helped coordinate our care and plan for the patients as a Cardiology Health team, by communicating via phone, email, and in-person with the patients, as well as our nurses, dietitians, exercise specialists, and other members of the team.  EDUCATION, RESEARCH, & SCHOLARSHIP I attended local monthly preventive conferences, and presented research on multiple occasions in poster and oral format at the Annual Scientific Sessions of the American College of Cardiology, American Heart Associations, and the American Society for Preventive Cardiology (the latter as a Young Investigator Award winner). Of course, a great goal is to publish our research so others can benefit from it; I pursued that as well.  It was a great privilege for me to participate in the elite American Heart Association Ten Day Seminar in Tahoe on Epidemiology & Prevention on Heart Disease, one of five individuals fully sponsored by the American Heart Association, National Institutes of Health, and Sandra Dougherty Foundation, with sponsorship also offered by Mayo Clinic.  The potential implications of coronary and aortic calcification on coronary CT were briefly addressed during my local Cardiovascular Imaging Grand Rounds presentation on The Role of Multimodality Imaging in 1) Ischemic Manifestations of Chemotherapy-Induced Cardiovascular Toxicities, and 2) Radiation-Induced Cardiovascular Toxicities.  A large focus of my presentation on Translation and Implementation of Precision Cardiovascular Medicine at Cardiovascular Grand Rounds was on risk stratification and prevention research efforts - past, present, and future! It was great to be able to present some of the work at the National Institutes of Health, and to publish several manuscripts (and a Cardio-Oncology poem) in high impact journals (references 2-5 below).  SOCIAL MEDIA As an ambassador for Preventive Cardiology and Preventive Cardio-Oncology offline and online, I was honored to be invited as a moderator of an American Heart Association Scientific Session on Leveraging Social Media in Cardiovascular Medicine, for which I created the hashtag #SoMeCVD! I also ensured that several of the international Cardiology leaders and late breaking clinical trialists I interviewed for the American College of Cardiology/Mayo Clinic FITs-on-the-go video blog on YouTube (www.youtube.com/fitsonthego) were in Preventive Cardiology! I must tell you that in the Fall of 2006, as an MD/PhD student, I (@drbrowncares) decided to pursue Preventive Cardiology (#cvPrev) as the foundation of my career. Then in the Fall of 2010, I further refined my #LifePlan and decided to pursue #CardioOnc from the perspective of #cvPrev. In a pioneering step and #LeapOfFaith in the Fall of 2018, as a physician scientist I created the Twitter account @PrevCardioOnc. It was in January 2019, at the American College of Cardiology Course “Advancing Cardiovascular Care of the Oncology Patient” in Washington, DC, that I saw the beginning of true realization of the field of Preventive Cardio-Oncology. There was a glimpse of it at the course in 2018, and also at the Global Cardio-Oncology Summit in recent years. However, in Winter 2018-2019, it was clearly time for the hashtag #PrevCardioOnc to be born! So I created the hashtag, formally launched @PrevCardioOnc, and invited all to join, for #TogetherWeCan FUTURE Now for the future...What will the future of Preventive Cardio-Oncology Training look like? For now this will likely remain as two separate programs being planned - one in Cardio-Oncology and the other in Preventive Cardiology. However, I would propose that joint training also become the normal, if we are serious about focusing on primordial and primary, and not just on secondary and tertiary, prevention in Cardio-Oncology. I hope that until formal Preventive Cardio-Oncology fellowship programs or tracks are available, the outline I have provided here may be a useful model. This potentially replicable model could be practically applied in any local institution with strong Cardio-Oncology and Preventive Cardiology clinical and research programs. This of course would be optimal at institutions with a tradition of excellent education in other Cardiology subspecialty fields.  CONTACT We have covered a lot together in this outline. Perhaps you have a lot to say about this topic too, or perhaps you would like to become engaged in someway. Feel free to contact me at anytime. I would be happy to have these discussions with you or your fellows or program directors. I’ll be more than happy to come and talk with your fellows or with your program about how to design a Preventive Cardio-Oncology training emphasis.  Of course, when we say “Preventive Cardio-Oncology”, we really in some sense mean “Preventive Cardio-Hem-Oncology” (#PrevCardioHemOnc)! #PrevCardioOnc #SurvivorAtDiagnosis (c/o @GiselleSA_MDPhD) #Day1Survivorship (c/o a survivor on Twitter) #TogetherWeCan (c/o Twitter!) @drbrowncares @PrevCardioOnc drbrowncares@gmail.com

References

1. Lenihan et al. Cardio-Oncology Training: …. J Card Fail, 2016;22(6):465-71.

2. Brown S, Sandhu N, Herrmann J. Systems biology approaches to adverse drug effects: the example of cardio-oncology. Nat Rev Clin Oncol, 2015; 12:718–731.

3. Brown S, Nhola L, Herrmann J. Cardiovascular Toxicities of Small Molecule TKIs: An Opportunity for Systems-Based Approaches. Clin Pharm & Ther, 2017; 101(1):65-80.

4. Brown S, Sandhu N. Proposing and meeting the need for interdisciplinary cardio-oncology subspecialty training. J Card Fail, 2016;22(11):934-935.

5. Brown S. Somebody Tell Me. The Oncologist, 2019;23:1.