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Cardio-Oncology Fellowship Training and Education

  • Michael G. FradleyEmail author
Cardio-oncology (M Fradley, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cardio-oncology

Abstract

Purpose of review

With the rapid development of novel cancer therapeutics and the growing number of cancer survivors, there is significant demand for cardio-oncology experts to care for these patients. As such, it has become increasingly necessary to develop formalized training in the field of cardio-oncology. This review will focus on the current state of cardio-oncology education, with recommendations for the development of dedicated cardio-oncology fellowships.

Recent findings

Cardio-oncology fellowships should be affiliated with high-volume centers that have established cardio-oncology clinical and research programs with dedicated cardio-oncology faculty. Several recent publications have proposed recommendations to develop uniform cardio-oncology training standards, core curricula, and evaluation metrics.

Summary

With the rapid evolution of the field and the support of various profession organizations, the number and quality of dedicated cardio-oncology fellowship programs is expected to increase significantly. The adoption of defined training requirements and evaluation standards to measure competency will be essential to ensure the legitimacy and success of the field.

Keywords

Cardio-oncology Fellowship Cardiotoxicity Education 

Notes

Compliance with Ethical Standards

Conflict of Interest

Michael G. Fradley is a section editor for Current Treatment Options in Cardiovascular Medicine.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271–89.PubMedCrossRefGoogle Scholar
  2. 2.
    Armstrong GT, Liu Q, Yasui Y, Neglia JP, Leisenring W, Robison LL, et al. Late mortality among 5-year survivors of childhood cancer: a summary from the childhood cancer survivor study. J Clin Oncol. 2009;27(14):2328–38.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    •• Barac A, Murtagh G, Carver JR, Chen MH, Freeman AM, Herrmann J, et al. Cardiovascular health of patients with cancer and cancer survivors: a roadmap to the next level. J Am Coll Cardiol. 2015;65(25):2739–46 Important paper examining the multidisciplinary nature of the field with a paticuarl emphasis on the need to increase cardio-oncology education.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    • Johnson MN, Steingart R, Carver J. How to develop a cardio-oncology fellowship. Heart Fail Clin. 2017;13(2):361–6 Significant publication addressing the esssential components and potential challeges in developing cardio-oncology fellowship.PubMedCrossRefGoogle Scholar
  5. 5.
    Fradley MG, Brown AC, Shields B, Viganego F, Damrongwatanasuk R, Patel AA, et al. Developing a comprehensive cardio-oncology program at a cancer institute: the Moffitt Cancer Center experience. Oncol Rev. 2017;11(2):340.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Okwuosa TM, Barac A. Burgeoning cardio-oncology programs: challenges and opportunities for early career cardiologists/faculty directors. J Am Coll Cardiol. 2015;66(10):1193–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2014;27(9):911–39.PubMedCrossRefGoogle Scholar
  8. 8.
    Liu J, Banchs J, Mousavi N, Plana JC, Scherrer-Crosbie M, Thavendiranathan P, et al. Contemporary role of echocardiography for clinical decision making in patients during and after cancer therapy. JACC Cardiovasc Imaging. 2018;11(8):1122–31.PubMedCrossRefGoogle Scholar
  9. 9.
    Lopez-Mattei J, Iliescu C, Durand JB, Hassan S, Kim P, Sierra-Galan L, et al. The role of cardiac MRI in cardio-oncology. Futur Cardiol. 2017;13(4):311–6.CrossRefGoogle Scholar
  10. 10.
    •• Lenihan DJ, Hartlage G, DeCara J, Blaes A, Finet JE, Lyon AR, et al. Cardio-oncology training: a proposal from the International Cardioncology Society and Canadian Cardiac Oncology Network for a new multidisciplinary specialty. J Card Fail. 2016;22(6):465–71 Seminal publication addressing the critical need for cardio-oncology education with specific recommendations for the development and integration of dedicated traning programs.PubMedCrossRefGoogle Scholar
  11. 11.
    Sinha SS, Julien HM, Krim SR, Ijioma NN, Baron SJ, Rock AJ, et al. American College of Cardiology Fellow-in-Training Section Leadership Council COCATS 4: securing the future of cardiovascular medicine. J Am Coll Cardiol. 2015;65(17):1907–14.PubMedCrossRefGoogle Scholar
  12. 12.
    Fuster V, Halperin JL, Williams ES, Cho NR, Iobst WF, Mukherjee D, et al. COCATS 4 task force 1: training in ambulatory, consultative, and longitudinal cardiovascular care. J Am Coll Cardiol. 2015;65(17):1734–53.PubMedCrossRefGoogle Scholar
  13. 13.
    Gillebert TC, Brooks N, Fontes-Carvalho R, Fras Z, Gueret P, Lopez-Sendon J, et al. ESC core curriculum for the general cardiologist (2013). Eur Heart J. 2013;34(30):2381–411.PubMedCrossRefGoogle Scholar
  14. 14.
    Guha A, Armanious M, Fradley MG. Update on cardio-oncology: novel cancer therapeutics and associated cardiotoxicities. Trends Cardiovasc Med. 2019;29(1):29–39.PubMedCrossRefGoogle Scholar
  15. 15.
    Bhatia N, Santos M, Jones LW, Beckman JA, Penson DF, Morgans AK, et al. Cardiovascular effects of androgen deprivation therapy for the treatment of prostate cancer: ABCDE steps to reduce cardiovascular disease in patients with prostate cancer. Circulation. 2016;133(5):537–41.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Moslehi JJ, Deininger M. Tyrosine kinase inhibitor-associated cardiovascular toxicity in chronic myeloid leukemia. J Clin Oncol. 2015;33(35):4210–8.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Kim TD, Rea D, Schwarz M, Grille P, Nicolini FE, Rosti G, et al. Peripheral artery occlusive disease in chronic phase chronic myeloid leukemia patients treated with nilotinib or imatinib. Leukemia. 2013;27(6):1316–21.PubMedCrossRefGoogle Scholar
  18. 18.
    Sawaya H, Sebag IA, Plana JC, Januzzi JL, Ky B, Tan TC, et al. Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab. Circ Cardiovasc Imaging. 2012;5(5):596–603.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Cardinale D, Sandri MT, Colombo A, Colombo N, Boeri M, Lamantia G, et al. Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation. 2004;109(22):2749–54.PubMedCrossRefGoogle Scholar
  20. 20.
    Chen J, Long JB, Hurria A, Owusu C, Steingart RM, Gross CP. Incidence of heart failure or cardiomyopathy after adjuvant trastuzumab therapy for breast cancer. J Am Coll Cardiol. 2012;60(24):2504–12.PubMedCrossRefGoogle Scholar
  21. 21.
    Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer. 2003;97(11):2869–79.PubMedCrossRefGoogle Scholar
  22. 22.
    Slamon D, Eiermann W, Robert N, Pienkowski T, Martin M, Press M, et al. Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med. 2011;365(14):1273–83.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Richards CJ, Je Y, Schutz FA, Heng DY, Dallabrida SM, Moslehi JJ, et al. Incidence and risk of congestive heart failure in patients with renal and nonrenal cell carcinoma treated with sunitinib. J Clin Oncol. 2011;29(25):3450–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Siegel D, Martin T, Nooka A, Harvey RD, Vij R, Niesvizky R, et al. Integrated safety profile of single-agent carfilzomib: experience from 526 patients enrolled in 4 phase II clinical studies. Haematologica. 2013;98(11):1753–61.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70(6):776–803.PubMedCrossRefGoogle Scholar
  26. 26.
    Shah S, Nohria A. Advanced heart failure due to cancer therapy. Curr Cardiol Rep. 2015;17(4):16.PubMedCrossRefGoogle Scholar
  27. 27.
    Mahmood SS, Fradley MG, Cohen JV, Nohria A, Reynolds KL, Heinzerling LM, et al. Myocarditis in patients treated with immune checkpoint inhibitors. J Am Coll Cardiol. 2018;71(16):1755–64.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Moslehi JJ, Salem JE, Sosman JA, Lebrun-Vignes B, Johnson DB. Increased reporting of fatal immune checkpoint inhibitor-associated myocarditis. Lancet. 2018;391(10124):933.PubMedCrossRefGoogle Scholar
  29. 29.
    Lee Chuy K, Oikonomou EK, Postow MA, Callahan MK, Chapman PB, Shoushtari AN, et al. Myocarditis surveillance in patients with advanced melanoma on combination immune checkpoint inhibitor therapy: the memorial Sloan Kettering Cancer center experience. Oncologist. 2019.  https://doi.org/10.1634/theoncologist.2019-0040.PubMedCrossRefGoogle Scholar
  30. 30.
    Ganatra S, Neilan TG. Immune checkpoint inhibitor-associated myocarditis. Oncologist. 2018;23(8):879–86.PubMedCrossRefGoogle Scholar
  31. 31.
    Hall PS, Harshman LC, Srinivas S, Witteles RM. The frequency and severity of cardiovascular toxicity from targeted therapy in advanced renal cell carcinoma patients. JACC Heart Fail. 2013;1(1):72–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Rini BI, Cohen DP, Lu DR, Chen I, Hariharan S, Gore ME, et al. Hypertension as a biomarker of efficacy in patients with metastatic renal cell carcinoma treated with sunitinib. J Natl Cancer Inst. 2011;103(9):763–73.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    McKay RR, Rodriguez GE, Lin X, Kaymakcalan MD, Hamnvik OP, Sabbisetti VS, et al. Angiotensin system inhibitors and survival outcomes in patients with metastatic renal cell carcinoma. Clin Cancer Res. 2015;21(11):2471–9.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Burger JA, Tedeschi A, Barr PM, Robak T, Owen C, Ghia P, et al. Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia. N Engl J Med. 2015;373(25):2425–37.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Abdel-Rahman O, ElHalawani H, Ahmed H. Risk of selected cardiovascular toxicities in patients with cancer treated with MEK inhibitors: a comparative systematic review and meta-analysis. J Glob Oncol. 2015;1(2):73–82.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Layoun ME, Wickramasinghe CD, Peralta MV, Yang EH. Fluoropyrimidine-induced cardiotoxicity: manifestations, mechanisms, and management. Curr Oncol Rep. 2016;18(6):35.PubMedCrossRefGoogle Scholar
  37. 37.
    Douxfils J, Haguet H, Mullier F, Chatelain C, Graux C, Dogne JM. Association between BCR-ABL tyrosine kinase inhibitors for chronic myeloid leukemia and cardiovascular events, major molecular response, and overall survival: a systematic review and meta-analysis. JAMA Oncol. 2016;2:625.PubMedCrossRefGoogle Scholar
  38. 38.
    Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Bronnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368(11):987–98.PubMedCrossRefGoogle Scholar
  39. 39.
    Iliescu CA, Grines CL, Herrmann J, Yang EH, Cilingiroglu M, Charitakis K, et al. SCAI expert consensus statement: evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of India, and sociedad Latino Americana de Cardiologia intervencionista). Catheter Cardiovasc Interv. 2016;87(5):E202–23.PubMedCrossRefGoogle Scholar
  40. 40.
    O'Neal WT, Lakoski SG, Qureshi W, Judd SE, Howard G, Howard VJ, et al. Relation between cancer and atrial fibrillation (from the REasons for geographic and racial differences in stroke study). Am J Cardiol. 2015;115(8):1090–4.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Brown JR, Moslehi J, O'Brien S, Ghia P, Hillmen P, Cymbalista F, et al. Characterization of atrial fibrillation adverse events reported in ibrutinib randomized controlled registration trials. Haematologica. 2017;102(10):1796–805.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Feliz V, Saiyad S, Ramarao SM, Khan H, Leonelli F, Guglin M. Melphalan-induced supraventricular tachycardia: incidence and risk factors. Clin Cardiol. 2011;34(6):356–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Outomuro D, Grana DR, Azzato F, Milei J. Adriamycin-induced myocardial toxicity: new solutions for an old problem? Int J Cardiol. 2007;117(1):6–15.PubMedCrossRefGoogle Scholar
  44. 44.
    Ganatra S, Sharma A, Shah S, Chaudhry GM, Martin DT, Neilan TG, et al. Ibrutinib-associated atrial fibrillation. JACC Clin Electrophysiol. 2018;4(12):1491–500.PubMedCrossRefGoogle Scholar
  45. 45.
    Guha A, Derbala MH, Zhao Q, Wiczer TE, Woyach JA, Byrd JC, et al. Ventricular arrhythmias following ibrutinib initiation for lymphoid malignancies. J Am Coll Cardiol. 2018;72(6):697–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Fradley MG, Moslehi J. QT prolongation and oncology drug development. Card Electrophysiol Clin. 2015;7(2):341–55.PubMedCrossRefGoogle Scholar
  47. 47.
    Naing A, Veasey-Rodrigues H, Hong DS, Fu S, Falchook GS, Wheler JJ, et al. Electrocardiograms (ECGs) in phase I anticancer drug development: the MD Anderson Cancer Center experience with 8518 ECGs. Ann Oncol. 2012;23(11):2960–3.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Armanious MA, Mishra S, Fradley MG. Electrophysiologic toxicity of chemoradiation. Curr Oncol Rep. 2018;20(6):45.PubMedCrossRefGoogle Scholar
  49. 49.
    Tartarone A, Gallucci G, Lazzari C, Lerose R, Lombardi L, Aieta M. Crizotinib-induced cardiotoxicity: the importance of a proactive monitoring and management. Future Oncol. 2015;11(14):2043–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Johnson DB, Balko JM, Compton ML, Chalkias S, Gorham J, Xu Y, et al. Fulminant myocarditis with combination immune checkpoint blockade. N Engl J Med. 2016;375(18):1749–55.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Zaremba T, Jakobsen AR, Sogaard M, Thogersen AM, Johansen MB, Madsen LB, et al. Risk of device malfunction in cancer patients with implantable cardiac device undergoing radiotherapy: a population-based cohort study. Pacing Clin Electrophysiol. 2015;38(3):343–56.PubMedCrossRefGoogle Scholar
  52. 52.
    Zaremba T, Jakobsen AR, Sogaard M, Thogersen AM, Riahi S. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review. Europace. 2016;18(4):479–91.PubMedCrossRefGoogle Scholar
  53. 53.
    Armstrong GT, Oeffinger KC, Chen Y, Kawashima T, Yasui Y, Leisenring W, et al. Modifiable risk factors and major cardiac events among adult survivors of childhood cancer. J Clin Oncol. 2013;31(29):3673–80.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Armenian SH, Lacchetti C, Barac A, Carver J, Constine LS, Denduluri N, et al. Prevention and monitoring of cardiac dysfunction in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2017;35(8):893–911.PubMedCrossRefGoogle Scholar
  55. 55.
    • Ganatra S, Hayek SS. Cardio-oncology for GenNext: a missing piece of the training puzzle. J Am Coll Cardiol. 2018;71(25):2977–81 Important publication focusing on the challenges associated with cardio-oncology training and education.PubMedCrossRefGoogle Scholar
  56. 56.
    Shelburne N, Adhikari B, Brell J, Davis M, Desvigne-Nickens P, Freedman A, Minasian L, Force T, Remick SC Cancer treatment-related cardiotoxicity: current state of knowledge and future research priorities. J Natl Cancer Inst 2014;106(9).Google Scholar
  57. 57.
    Narahari AK, Charles EJ, Mehaffey JH, Hawkins RB, Schubert SA, Tribble CG, et al. Cardiothoracic surgery training grants provide protected research time vital to the development of academic surgeons. J Thorac Cardiovasc Surg. 2018;155(5):2050–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Cardio-Oncology Program, Division of Cardiovascular Medicine, Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research InstituteUniversity of South FloridaTampaUSA

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