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Cardio-Oncology in Poland

Looking to the future with 10 years of experience



Introduction

The year 2019 marks 10 years since the initiation of the Cardio-Oncologic activities in Poland. We have seen the birth of Polish expert groups and task forces, several scientific conferences,  publications of  textbooks  and increase in the availability of cardio-oncology services. Nowadays its available in all regions of the country.

Recommendations

In 2009, Grzegorz Opolski, Polish National Consultant in Cardiology, and Maciej Krzakowski, Polish National Consultant in Clinical Oncology have appointed a first Task Force bringing together specialists from both fields in order to prepare two expert documents dedicated to cardio-oncology [1,2]. In 2014, Edyta Płońska-Gościniak suggested to publish the expert consensus statement of the Polish Clinical Forum for Cardiovascular Imaging on the diagnostic imaging in patients with cancer [3]. In 2016, at the initiative of Maciej Krzakowski, the expert paper was prepared regarding recommendations for liposomal doxorubicin in treatment of patients with metastatic breast cancer [4], at the initiative of Marek Wojtukiewicz, the summary on prevention and treatment of thromboembolic complications in clinical oncology was elaborated [5], at the initiative of Tomasz Sacha from the Polish Adult Leukemia Group, the expert document was prepared regarding personalized treatment of patients suffering from chronic myeloid leukemia [6].

Expert and Research Groups

In 2012, at the initiative of Wojciech Jurczak, the Polish Lymphoma Research Group (PLRG) established the Cardio-Oncology Section within its structure. The first successive coordinators were chosen Adam Torbicki and Sebastian Szmit. The section focuses on algorithms for diagnostics and prevention of cardiotoxicity based on Polish multi-centre studies [7,8,9,10].


The Polish National Oncology Network brings together 18 hospitals of oncologic profile. The aim of the organization is to develop optimum and comprehensive oncological care in Poland. In 2016, Stanisław Góźdź suggested to establish an Expert Group for Onco-Cardiology. Sebastian Szmit was elected for the position of President and Barbara Sosnowska-Pasiarska – vice-President. From 2016 three annual nation-wide Polish congresses was organized by this Group. Scientific patronage has been provided by Waldemar Banasiak and Adam Torbicki, former Presidents of the Polish Cardiac Society.
In 2017, Edyta Płońska-Gościniak and co-researchers published first results of the Polish multicenter study "ONCO-ECHO" performed as parts of scientific activities of the Echocardiography Section of the Polish Cardiac Society [11,12].

Education

The Centre of Postgraduate Medical Education (CMKP) is a Polish medical academic institution responsible for preparation of programmes and conducting as well as coordinating postgraduate medical education in Poland. The Cardio-Oncology educational activity of CMKP includes: „Oncology in Cardiology” - obligatory courses within specialty program in cardiology (the current scientific director of the course is Sebastian Szmit) and „Basics of Cardio-Oncology” – obligatory lectures during introductory and summarizing courses of the specialization in internal medicine and clinical oncology.
The 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity was translated immediately into Polish and presented on the Polish Heart Journal website two months after publication in the European Heart Journal [13]. This fact documents the promotion of cardio-oncology by the Polish Cardiac Society and coordination with European standards.
In the period of 2017-2018, three cardio-oncology educational books were published in Poland [14,15,16]. The latest is a unique, pioneer monograph, the world’s first compendium of knowledge on cancer patients with hypertension, co-written by a multidisciplinary and multi-centre team with great activity of experts of the Polish Society of Hypertension.

Figure 1 - Three educational books on cardio-oncology published in Poland in 2017 and 2018.

Three educational books on cardio-oncology published in Poland in 2017 and 2018.

 

Cardio-Oncology service

According to the updated data of the Polish National Oncology Network from 2018, the Cardio-Oncology (C-O) service is carried out by 50 cardiologists, working alone or within teams.
As part of research and development institutes, universities, regional cancer centers and smaller, private centers C-O services are available in 21 cities in each region of Poland for outpatient care and hospital consultations including public centers of the National Polish Oncology Network.
There are two main forms of C-O services organization:

  • Cardiology and Oncology departments are localized in the same Hospital / University (1 employer): 10 departments
  • Oncology Center is an independent institution cooperating with another local Cardiology Department usually University-based (two employers): 14 clinics

Future Trends 

On March 27th, 2019, the National Council of Oncology at the Ministry of Health proposed to implement the following solutions for the development of Cardio-Oncology in Poland:

  • Financing of "one-day hospitalization" including basic cardiac diagnostics (HOLTER ECG, ECHO,
    biomarkers, exercise tests) for patients with a history of cardiovascular events or reporting
    cardiovascular symptoms before or during anticancer treatment.
  • Inclusion of a cardiologist in a multidisciplinary care team for cancer patients with cardiovascular
    disorders.
  • Inclusion of cardiac rehabilitation among other rehabilitation services in cancer patients.
  • Organization of cardiology long-term observation after anticancer treatment.

Authors

Marek Kania

Opole Oncology Centre & University Hospital, Opole, Poland

Maciej Krzakowski

Maria Skłodowska-Curie Memorial Cancer Centre & Institute of Oncology, Warsaw, Poland

Sebastian Szmit

Centre of Postgraduate Medical Education & European Health Centre, Otwock, Poland

Grzegorz Opolski

Medical University of Warsaw, Warsaw, Poland

Adam Torbicki

Centre of Postgraduate Medical Education & European Health Centre, Otwock, Poland

 

References

  1. Opolski G., Krzakowski M, “Recommendations of National Team of Cardiologic and Oncologic Supervision on cardiologic safety of patients with breast cancer. The prevention and treatment of cardiovascular complications in breast cancer”. Publisher: Medical Education.
  2. Krzakowski M, Opolski G., Szmit S. “Recommendations of National Team of Cardiologic and Oncologic Supervision on cardiologic safety of patients with lung cancer. The prevention and treatment of cardiovascular complications in lung cancer”. Publisher: Medical Education
  3. Piotrowski G., Gawor R., Gawor Z., Szmit S., Kasprzak JD., Miśkiewicz Z, Opolski G., Torbicki A., Krzakowski M., Filipiak KJ, Szyszka A., Płońska-Gościniak E. Role of echocardiography in monitoring of cardiac toxicity of cancer pharmacotherapy. Expert consensus statement of the Polish Clinical Forum for Cardiovascular Imaging. Kardiol Pol. 2014; 72, 6: 558–575
  4. Szmit S, Filipiak KJ, Litwiniuk M, Opolski G, Wysocki P, Zaborska B, Krzakowski M. Liposomal doxorubicin in patients with breast cancer and concomitant cardiovascular diseases - interdisciplinary expert opinion. Kardiol Pol. 2016;74(9):1031-6
  5. Wojtukiewicz MZ, Sierko E, Tomkowski W, Zawilska K, Undas A, Podolak-Dawidziak M, Wysocki P, Krzakowski M, Warzocha K, Windyga J. Guidelines for the prevention and treatment of venous thromboembolism in non-surgically treated cancer patients. Oncol Clin Pract 2016;12(3):67-91.
  6. Sacha T, Szmit S, Zozulińska-Ziółkiewicz D, Prejzner W, Góra-Tybor J. Recommendations for assessment of co-morbidities and tyrosine kinase inhibitor choice in patients suffering from chronic myeloid leukemia. Acta Haematologica Polonica 2016; 47 (3): 184-196
  7. Jurczak W, Szmit S, Sobociński M, Machaczka M, Drozd-Sokołowska J, Joks M, Dzietczenia J, Wróbel T, Kumiega B, Zaucha JM, Knopińska-Posłuszny W, Spychałowicz W, Prochwicz A, Drohomirecka A, Skotnicki AB. Premature cardiovascular mortality in lymphoma patients treated with (R)-CHOP regimen - a national multicenter study. Int J Cardiol. 2013; 168(6): 5212-7
  8. Szmit S, Jurczak W, Zaucha JM, Drozd-Sokołowska J, Spychałowicz W, Joks M, Długosz-Danecka M, Torbicki A. Pre-existing arterial hypertension as a risk factor for early left ventricular systolic dysfunction following (R)-CHOP chemotherapy in patients with lymphoma. J Am Soc Hypertens. 2014; 8(11): 791-9
  9. Szmit S, Jurczak W, Zaucha JM, Długosz-Danecka M, Sosnowska-Pasiarska B, Chmielowska E, Joks M, Drozd-Sokołowska J, Knopińska-Posłuszny W, Spychałowicz W, Kumiega B, Charliński G, Morawska M, Słomian G. Acute decompensated heart failure as a reason of premature chemotherapy discontinuation may be independent of a lifetime doxorubicin dose in lymphoma patients with cardiovascular disorders. Int J Cardiol. 2017; 235: 147-153.
  10. Długosz-Danecka M, Gruszka AM, Szmit S, Olszanecka A, Ogórka T, Sobociński M, Jaroszyński A, Krawczyk K, Skotnicki AB, Jurczak W. Primary Cardioprotection Reduces Mortality in Lymphoma Patients with Increased Risk of Anthracycline Cardiotoxicity, Treated by R-CHOP Regimen. Chemotherapy. 2018;63(4):238-245
  11. Płońska-Gościniak E, Różewicz M, Kasprzak J, Wojtarowicz A, Mizia-Stec K, Hryniewiecki T, Pysz P, Kułach A, Bodys A, Sulżyc V, Braksator W, Szyszka A, Zaborska B, Gościńska-Szmagała A, Siński M, Kosior D, Szmit S, Kowalik I, Gąsior Z. Tissue Doppler echocardiography detects subclinical left ventricular dysfunction in patients undergoing chemotherapy for colon cancer: insights from ONCOECHO multicentre study. Kardiol Pol. 2017;75(2):150-156.
  12. Mizia-Stec K, Elżbieciak M, Wybraniec MT, Różewicz M, Bodys A, Braksator W, Gąsior Z, Gościniak P, Hryniewiecki T, Kasprzak J, Wojtarowicz A, Zdziarska B, Płońska-Gościniak E. Chemotherapy and echocardiographic indices in patients with non-Hodgkin lymphoma: the ONCO-ECHO study. Med Oncol. 2017; 35(1):14
  13. Zamorano JL, Lancellotti P, Muñoz DR, Aboyans V, Asteggiano R, Galderisi M, Habib G, Lenihan DJ, Lip GY, Lyon AR, Fernandez TL, Mohty D, Piepoli MF, Tamargo J, Torbicki A, Suter TM. [2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines]. Kardiol Pol. 2016;74(11):1193-1233.
  14. Olszowska M. Kardioonkologia (eng. Cardio-oncology). Publisher: ‘i-medica’
  15. Krzakowski M, Szmit S. Powikłania sercowo-naczyniowe u chorych na nowotwory (eng. Cardiovascular complications in patients with cancer). Publisher: PRIMOPRO.
  16. Filipiak KJ, Szymański FM, Szmit S. Hipertensjoonkologia – nadciśnienie tętnicze w chorobie nowotworowej (eng.Hypertension-oncology – arterial hypertension in cancer disease). Publisher: VIAMEDICA