Cardiovascular Rounds

How 2 health systems are reimagining cardio-oncology care

by Liam Frieswick and Daniel Roza

Editor's note: This story was updated on May 6, 2019.

Thanks to improvements in early detection and treatment, the number of cancer survivors is increasing. However, as cancer death rates decline, many more patients are developing other acute and chronic conditions—indeed, cardiovascular (CV) disease is now the second-most common cause of long-term morbidity and mortality among cancer patients. In light of these trends, systems need to plan strategically to identify and deliver high value care to patients in need of both cardiovascular and oncological services.

These service lines need to be just as responsive to meet the needs of cardiovascular patients who develop cancer. A recent study from the Journal of the National Comprehensive Cancer Network found that patients with coronary artery disease (CAD) who were also diagnosed with cancer faced disproportionately high costs. The findings painted a stark picture: The costs of CAD care were three times as much as pre-cancer costs for colorectal cancer patients, and twice as much for breast cancer patients. In comparison, CAD costs for patients without cancer remained stable.

These discrepancies suggest that there is room to reduce costs and improve care for patients who need both cardiovascular and oncology services. However, identifying and acting on such opportunities can pose a challenge. Read on to learn how two systems forged pathways to improve cardio-oncology patient management. 

Aurora Health Care creates risk stratification for patients with CV complications

Aurora Health Care, a 15-hospital health system in Milwaukee, Wisconsin, recognized the need for collaboration among cardiologists and oncologists. Leaders developed a cardio-oncology steering committee to support early identification and management of oncology patients at high-risk for CV complications, which in turn developed an automated EHR alert that ensures CV consults for high-risk cancer patients.

Specifically, when prescriptions for cardiotoxic drugs are ordered through the EHR, the oncologist is prompted to answer a questionnaire that stratifies patients based on risk of developing CV complications. High-risk patients receive a CV consult within 24 to 48 hours to develop a proactive treatment plan to reduce potential CV complications. By adding an EHR alert, Aurora managed to promote collaboration between cardiologists and oncologists to meet patient needs and ensure at-risk patients receive the consults they need.

Stanton Health develops a heart and cancer facility designed on Hospital Campus

Stanton Health, a pseudonym for a large system in the northeast, is currently building a 125,000-square-foot HOPD facility that will collocate outpatient oncology and CV services to help integrate outpatient care and boost collaboration across the CV and oncology care teams.

Ninety-five percent of the center is dedicated to clinical space and will house prevention services, diagnostic and non-invasive labs, and a HF clinic under one roof. A pedestrian bridge connects the facility to the hospital's main campus to facilitate patient travel. In addition, Stanton Health's new facility will coordinate prevention and post-procedure care and, by virtue of its physical design, encourage physician collaboration to treat comorbidities. Progressive organizations may want to consider a similar investment to ensure they are designing facilities that meets future needs, promotes a multidisciplinary approach, and differentiates their program from competition.

The benefits of a multidisciplinary approach

As cardiovascular and oncology leaders consider how best to collaborate, the benefits remain clear: A multidisciplinary approach can help organizations reduce costs and provide better care. Beyond these advantages, a deeper connection between CV and oncology physicians creates the potential to improve patient access, convenience, and satisfaction. It also demonstrates a commitment to patient-centered care, while future-proofing your program to meet growing need. Whether your program is planning to create a new care model or a new facility for these patients, a collaboration between cardiologists and oncologists will provide better care for cardiotoxicity.

The financial toxicity of cancer is harming patients. How can your program help?

The financial distress of cancer treatment has a negative impact on the physical and mental health of patients. Read our recent blog post to learn how to tackle these burdens.

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