Cardiotoxicity risk factor screening in breast cancer
Proposer: Beatrix Hospital, Gorinchem
Implementation: 1 January 2019
Cardiovascular disease is the leading cause of death in the Western world. Cancer treatment can also have cardiotoxic effects on cardiac function and cardiovascular structures, creating a risk of cardiovascular complications. Breast cancer patients have a 10% chance of developing cardiotoxicity following surgery and (neo)adjuvant therapy. To identify this issue early, and respond to it quickly, all patients at the Beatrix Hospital in Gorinchem are screened, following breast cancer diagnosis.
The cardiovascular risk factor is determined firstly through patient-related risks, taking account of any heart issues, and the patient's medical history and lifestyle. Treatment-related risks are then mapped out and factored in. The cardiovascular risk factor can be low, medium, high or very high.
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Patients with a low risk factor are given an explanation of how the figure was derived, and receive advice on healthy living. Patients at average risk also receive this, and are referred to their GP for annual check-up in accordance with cardiovascular disease risk management (CVD management). Patients with high or very high risk factors undergo functional tests of the heart and additional blood tests before, during and after treatment, and are also discussed in the onco-cardio multidisciplinary team meetings. They also receive self-management support for coping with stress, managing their condition and nutrition when living with cancer. All patients receive information about the initial and later effects of the treatment and how they can identify these factors.
Impact on the healthcare professional
Healthcare professionals can become familiar with a new area of knowledge and apply that knowledge in everyday practice. One important development is promoting multidisciplinary cooperation between different specialists (oncologists, surgeons, radiotherapists, cardiologists and nurses) and departments during onco-cardiology multidisciplinary team meetings. Collaboration between first and second line healthcare professionals is also encouraged, through referring patients to the GP CVD risk management programme. It is also an opportunity for healthcare professionals to disseminate and share knowledge.
Healthcare providers having both cancer and cardiology experience are scarce; onco-cardiology does not yet feature in the medical studies curriculum. The number of professionals who perform heart function examinations is limited, as are locations offering this. Generating mutual consultation and support for this subject costs time and effort.
Impact on healthcare institution
The hospital provides breast cancer patients with remarkable care.
This project is having a very positive impact on how the hospital is used and perceived by patients and their loved ones. Looking forward, investment in additional time (FTEs) and space (for consultation) is needed for this. The electronic patient file also needs to be updated with a specific multidisciplinary team meeting record form. Finally, there is a desire to record videos and produce information materials for sharing interactively with breast cancer patients.
Beatrix Hospital Gorinchem
4204 AA Gorinchem
Project contact person:
Marry Boes - Van Laar (clinical nurse specialist, surgery)
Other project team members:
Mirjam Mulder (cardiologist)
Marjan Davids (oncologist)
Annelies Stuij (cardiac nurse)
Tanja Frakking (surgeon)