Cardio-Oncology has emerged as a new subspecialty in the United Kingdom over the last ten years. With the development of increasingly potent cancer therapies which improve cancer survival, but at the cost of cardiovascular toxicity, the demand for a specialist Cardio-Oncology services has emerged. The first dedicated Cardio-Oncology service was started at the Royal Brompton Hospital, London, UK, in 2011 by Dr Alexander Lyon and Dr Stuart Rosen. The rationale was based on the emergence of cardiology problems in cancer patients from the range of new targeted molecular therapies such as Trastuzumab (Herceptin), VEGF tyrosine inhibitors, Raf and MEK inhibitors, BCR-Abl inhibitors and Bruton’s kinase inhibitors. This is in addition to the recognised cardiovascular complications during and after Anthracycline chemotherapy, chest radiotherapy where the heart is within the radiation field, and fluoropyrimidines such as 5-fluorouracil and capecitabine. The Royal Brompton Hospital is a specialist heart and lung centre and is located next door to the Royal Marsden Hospital which is the national cancer centre in the United Kingdom, but has no inhouse cardiology service. Therefore we set up a dedicated Cardio-Oncology service to provide care to the Royal Marsden Hospital’s patients, and we now see patients from oncologists and haematologists both across the UK and internationally referred for specialist Cardio-Oncology care.
We recently published our first five year experience in the European Journal of Heart Failure including the development of a new classification for myocardial dysfunction during cancer treatment with the integration of cardiac biomarker and modern cardiac imaging in assessment (1). The most important conclusion of our study was that we could safely restart and complete cancer treatment in over 88% of cancer patients referred with a cardiovascular complication of current oncology treatment, and in addition to optimising their cardiovascular health, we believe that this will translate into an improvement in cancer survival.
In 2012 following a grant call from the medical research council for new consortia, the UK Cardio-Oncology Consortium was created, bringing together a small number of cardiologists with a special interest in Cardio-Oncology. The members of the UK Cardio-Oncology Consortium developed strategies for care and research collaboration over the following two years and created the British Cardio-Oncology Society known as BCOS BCOS was set up by eleven members of different secondary and tertiary cardiology centres from across the United Kingdom in 2014 (see table one), and now also includes several oncologists, haematologists and a specialist oncology pharmacist. Following discussions with the British Cardiovascular Society (BCS), the British Cardio-Oncology Society was formally provided “Associated Society” status as a partner of the BCS and has helped the BCS with educational initiatives in cardio-oncology in the UK.
The British Cardio-Oncology Society’s mission statement is “to promote research, best clinical practice and a wider understanding of the effects of cancer treatment on the cardiovascular system”, and details can be found at www.bc-os.org. In the last four years there has been an increasing presence of Cardio-Oncology lectures and sessions at the annual British Cardiovascular Society conference, with dedicated sessions now a common component of the programme.
In 2017 BCOS partnered with the International Cardio-Oncology Society to host the Global Cardio-Oncology summit at The Royal College of Physicians in London. 331 cardiologists, oncologists and haematologists from 31 different countries came to London and shared knowledge and experience at the two day meeting. It was a catalyst for the growth of Cardio-Oncology in the UK with trainees attending and expressing the desire to learn and train in Cardio-Oncology.
The demand for training has led to the creation of dedicated Cardio-Oncology Fellowships at least four centres in the United Kingdom, hosting both UK and international trainees who wish to study Cardio-Oncology with the aim of setting up services in the host institutions. At the Royal Brompton Hospital, we have now hosted fifteen international Cardio-Oncology Fellows as a growing global network of specialists develop.
In 2018 BCOS gained official charitable status, allowing a strategic new pathway for the society in the years to come.
Research has also escalated with increased applications and grant funding from the UK cardiology grant funding organisations including the British Heart Foundation. One leading research initiative is the creation of the first Virtual Cardio-Oncology Research Institute (VICORI) led by Dr David Adlam (cardiologist) and Professor Michael Peake (oncologist) from Leicester which utilises the large databases of cardiology patients (NICOR) and oncology patients (NICN) which exist from the hospital records available in the national health service in the UK. This allows research to explore both the future cardiovascular disease diagnoses in patients presenting with cancer and vice versa.
Advocacy is an important part of Cardio-Oncology in the UK. BCOS has supported the UK’s leading cancer charity, MacMillan Cancer, to develop the first detailed patient information booklet on heart health in cancer, with guidance on practical advice before, during and after cancer treatment and the symptoms and potential cardiovascular risks of which to be aware (see figure 1).
In addition, there is a second initiative to raise awareness with primary healthcare professionals, and the development of a focused information booklet entitled “Managing Heart Health During and After Cancer Treatment” focused for primary healthcare professionals, with a particular emphasis on long term survivors and to be aware of the potential cardiovascular consequences of prior oncology treatment (see figure 2).
On 7th June 2018 the first Cardio-Oncology patient awareness day in the UK was hosted at the Royal Brompton Hospital, specifically dedicated to cancer survivors who have suffered the long term cardiovascular complications from their cancer treatment. We had a varied programme with both healthcare professionals including doctors and nurses talking about the current understanding of the CV health problem in cancer survivors and how our services have arisen to address the growing need. There were also talks from patients about both their experiences and the roles they have played in national strategy. We had a talk from the current lead of NHS England Cancer Strategy for Living with and beyond cancer, a talk by a patient who has become one of the experts to several national Cancer grant funding charities, and an inspiring talk from Greig Trout regarding his experience during treatment and survival following two cancers, and the charity he has set up called 101 Things To Do When You Survive which is a source of inspirational for current and past cancer patients. More information is available at www.whenyousurvive.com.
In the last nine years, there has been a huge growth in the activity of Cardio-Oncology in the UK and BCOS looks forward to working together with the ESC Council of Cardio-Oncology and other international partners globally to help develop this new medical subspecialty.
Professor Alexander Lyon
Clinical Lead for Cardio-Oncology Service
President of the British Cardio-Oncology Society
Royal Brompton Hospital