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Cardio-Onco-Hematology in Spain

Cardio-onco-hematology (COH), the cardiovascular care of cancer patients, is a new born subspecialty worldwide. However organisational issues needed for patients' care and the development of dedicated COH services differ among European countries. In this article we summarise how COH has emerged an important issue in daily practice in Spain.



Although in recent decades different Spanish investigators have been interested in COH, the project came into clinical practice in our country in 2010, in Madrid, and it was extended nationwide by creating a national COH registry in 2014 (figure 1). The CARDIOTOX registry is a prospective multicenter project, leaded by La Paz Hospital in Madrid, and aimed to better understand the relationship between cancer, cancer therapy and cardiovascular diseases (CARDIOvascular TOXicity induced by antitumor drugs registry) (Clinical trials identifier NCT02039622). (CARDIOTOX registry database is currently being analysed)

Figure 1 - CARDIOTOX Registry Network (2014)

In 2015, the COH strategy expands to our national societies. This year the Spanish Society of Cardiology published the first European book on COH, in association with US experts (1). In 2016 the first Spanish Position Paper on Cardio-Oncology was written by expert representatives of the Spanish Societies of Cardiology (SEC), Medical Oncology (SEOM), Hematology and Hemotherapy (SEHH) and Radiation Oncology (SEOR). 

Understanding the need to promote the development of local multidisciplinary teams and to update continuous medical education, the Spanish Society of Cardiology approved the creation of a Cardio-Oncology Working Group in 2017. We conducted a nationwide survey aimed to analyse the perceived importance of the screening and management of cancer-therapy related cardiovascular complications and the institutional relationship among specialists involved in cancer patients care (3). The survey asked the responders to score the perceived importance of various key points related to cardiotoxicity. Although most of responders reflected that cardiotoxicity has a strong impact on cancer patients prognosis, few centers were  prepared to monitor cancer patients (12% of centers reported the existence of a COH unit; 15% of centers with a dedicated consultant cardiologist). The main barriers reported for the establishment of a COH unit were lack of funding and the absence of evidence-based guidelines and specialized training.

Thereafter we initiated an online learning program supported by SEC-SEOM-SEOR and SEHH (#COH18 ) as well as several symposiums and educational sessions during our national cardiac and onco-hematologic meetings.

Recently, we have started a new challenge by expanding the COH project to primary care physicians, to agree on daily practice surveillance protocols of long term survivors and patients with active cancer. (4, 5,6).

However, educating and motivating physicians is not enough. We need to involve patients in their own cardiovascular care. In collaboration with SEOM-SEOR and SEHH and patients associations we have created a specific online platform to promote healthy life habits during the cancer process.

After two years of hard work we have decided to conduct a new survey to explore what is going on in the real arena and, preliminary data (unpublished data) shown a great improvement in COH practices in our country as reflected by figure 2.

Figure 2

In February 2019 we officially presented the COH Spanish project and ongoing initiatives at the Presidency Ministry. (Atrial fibrillation in active cancer patients: Position Paper and Recommendations, in press at the Rev Esp Cardiol; #COH19 learning program; COH imaging learning program, primary care learning program on COH…)(Figure3)

As a conclusion, COH project is growing in Spain. We need COH multidisciplinary teams to integrate skills and to standardize the cancer care process. Future research is needed to promote and support our COH network. We have recently closed the CARDIOTOX registry database and we hope to provide new data to improve the COH strategy.

Figure 3

Acknowledgements

We want to thank the Spanish Society of Cardiology Team for their continuous and unconditional support, with special thanks to

Cristina Plaza, Scientific Affairs and Research Area

Fernando Fernández, TIC department director

Eva Sahis, Communications Director

Authors

López-Fernández T1, Martín-García A2, Mitroi C3, Mazón Ramos P4, Anguita M5.

On behalf of the Cardio-Oncology Spanish Working Group

  1. Cardiology department. Hospital Universitario La Paz, IdiPAZ, Madrid, Ciber CV. Leader of the Cardio-Oncology Working Group of Spanish Society of Cardiology
  2. Cardiology department, Complejo Asistencial Universitario de Salamanca (CAUSA), IBSAL, Salamanca, Ciber CV
  3. Cardiology department. Hospital Puerta de Hierro, Majadahonda, Madrid
  4. Cardiology department. Hospital Clínico Santiago de Compostela, Santiago de Compostela. CIBERCV
  5. Cardiology department. Hospital Universitario Reina Sofía. Córdoba, President of the Spanish Society of Cardiology

References

  1. “Cardio-Oncology”. Coordinators Juan Carlos Plana, Teresa López-Fernandez, José Juan Gómez de Diego, Miguel Ángel García Fernández. Sociedad Española de Cardiología, 2015. CTO EDITORIAL, S.L 2015. ISBN 9788416153930
  2. López-Fernández T, Martín García A, Santaballa Beltrán A et al. Cardio-Onco-Hematology in Clinical Practice. Position Paper and Recommendations. Rev Esp Cardiol (Engl Ed). 2017 Jun;70(6):474-486
  3. Martín-García A, Mitroi C, García Sanz R, Santaballa Bertrán A, López-Fernández T (On behalf of the Spanish Cardio-Oncology Working group). Current Status of Cardio-Oncology in Spain: A National Multidisciplinary Survey. Rev Esp Cardiol. 2017. https://doi.org/10.1016/j.rec.2017.11.002
  4. Barnadas A, Algara M, Cordoba O, Casas A, Gonzalez M, Marzo M, Montero A, Muñoz M, Ruiz A, Santolaya F, López- Fernández T. Recommendations for the follow-up care of female breast cancer survivors: a guideline of the Spanish Society of Medical Oncology (SEOM), Spanish Society of General Medicine (SEMERGEN), Spanish Society for Family and Community Medicine (SEMFYC), Spanish Society for General and Family Physicians (SEMG), Spanish Society of Obstetrics and Gynecology (SEGO), Spanish Society of Radiation Oncology (SEOR), Spanish Society of Senology and Breast Pathology (SESPM), and Spanish Society of Cardiology (SEC). Clinical and Translational Oncology 2017. DOI 10.1007/s12094-017-1801-4
  5. Sabater S, Montero A, López-Fernández T, González-Ferrer JJ, Arenas M. Management of patients with implanted cardiac devices during radiotherapy: results of a Spanish survey in radiation oncology departments. Clinical and Translational Oncology 2018 https://doi.org/10.1007/s12094-018-1893-5
  6. Virizuela JA, Martín-García A, de las Peñas R, Santaballa A, Andrés R, Beato C, de la Cruz S, Gavilá J, González‑Santiago S, López-Fernández T. SEOM clinical guidelines on cardiovascular toxicity (2018) Clinical and Translational Oncology 2019. https://doi.org/10.1007/s12094-018-02017-3