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Cardio-Oncology in Estonia

A growing number of oncologic patients with cardiac problems and a lack of knowledge on how to treat these patients, was the main reason why Oncocardiology Unit in Estonia grew out. When the first news on this topic was presented at ACC and ESC Annual conferences we understood that we need more information.

It was a good coincidence that during this time, the 4th International Conference on Cancer and the Heart was held in Houston, USA at the end of 2016. I was able to take part in this very educative event. Seeing how MD Anderson Cancer Center Oncocardiology Unit is built up and listening their excellent oncocardiologists presentations, was the trigger for starting the Oncocardiology Unit in Estonia.

We started with early stage breast cancer patients and looked, how often patients on trastuzumab treatment get ECHOs at our hospital. The reality was sad - most of these patients did not receive ECHOs as suggested by international guidelines. This data was presented as a poster presentation at Global Cardio-Oncology Summit in 2017. As North Estonia Medical Center is the biggest hospital in Estonia and one of three hospitals, which offer oncological treatment, we put together a small team- few enthusiastic cardiologists and an oncology resident.

We- me and one of my good colleagues - started with consultations for oncologic patients in an outpatient clinic, ensured best availabilty of echogardiographic evaluations for oncologic patients.  Within a few months our first guideline was accepted- for patients who have pacemakers and need radiation therapy. Within 2 years we have seen good cooperation between oncologists and rhytmologists.

During the first year we organized several meetings for cardiologists, oncologists and general practitioners and one Estonian Cardiology Society conference to introduce oncospecific therapy related cardiac side effects. At the same meeting we created Oncocardiology Working Group - it was in December 2017.

In 2018 we continued with lectures and two guidelines for breast cancer patients were implemented- patients treated with trastuzumab and anthracycline- cardiac side effects evaluation and management.

A year ago I had a great opportunity to learn from professionals at Memorial Sloan Kettering Cancer Centre Oncocardiology Unit. Dr. Richard Steingart and his colleagues have done a great job and I got confirmation, that we are doing the right thing. Our team is regularly participating in international oncocardiology conferences.

As we have two more hospitals in Estonia, which offer oncological treatment, it was necessary to expand to these centers as well. Also, we understand, that the incidence of cancer is increasing every year and the knowledge, how to treat cancer patients' cardiac problems, has to reach every cardiologist. So we started to educate ourselves and our colleagues. Breast cancer was the first topic which we introduced with our ESC working group members. We hope that both oncologists and cardiologists from different hospitals learned a lot during these meetings- we had lectures about breast cancer treatment options, their cardiac side effects and how to recognize and manage these effects.

Because of good feedback, we have already started preparation of the next meetings- thrombosis (arterial and venous). NOAC and venous trombosis, atrial fibrillation and anticoagulation therapy are frequent questions in everyday practice.

In the beginning of 2019, we have oncocardiology working groups in 3 largest hospitals in Estonia. Our hospitals' oncocardiology guidelines have also been implemented at Tartu University Hospital and East-Tallinn Central Hospital.

I am highly grateful to my colleagues with whom the journey has been interesting and we continue to do the best to serve our patients. We wish to engage oncologists even more - to achieve better adherence to current guidelines. We are sure, that this improves patients long term outcomes. Communication and cooperation with oncologists is very important -  cardiologists and oncologists are on the same side in the war with cancer.

To be honest, that journey has been and still is challenging. Although we really like this part of our work, we still have our regular work to do. So 24 hours sometimes is just not enough... We are at the beginning of the journey and a lot of work is still ahead.


Riina Vettus, MD

Head of 2nd Cardiology Department
North Estonia Medical Centre
Tallinn, Estonia

Leader of Oncocardiology Working Group
of Estonian Cardiology Society