The clinical activity of the first nurse-led cardio-oncology clinic in the United Kingdom

Abstract Background Patients with cancer are now living longer because of the advancement in cancer treatments. The development of increasingly potent cancer treatments has helped to improve cancer survival, but at the potential cost of cardiovascular toxicity. These cardiovascular complications can occur during or after cancer treatment, in short, medium or long term. This study aims to provide an overview of the clinical activity of the first nurse-led cardio-oncology clinic in the United Kingdom. Methods This is a single centre, retrospective, observational cohort study reviewing our cardio-oncology clinic activity from 2023 to 2024. Patients receiving cancer treatment were included if they were referred to the nurse-led clinic for treatment and management of their cardiovascular condition before, during or after treatment. Results 534 patients were seen in the nurse-led Cardio-Oncology clinic, 102 of these patients were new referrals who were then followed up throughout the year from 2023-2024. The mean age of the patients was 65+14 years old and 46 (45%) were male. Amongst the new referrals, haematological and breast malignancies were most common (27.4% and 30.3% respectively), followed by lung and sarcoma malignancies (both 7.8%). Eighteen (17.6%) were treated with human epidermal growth factor receptor 2 (HER2) targeted therapies, 23.5% of patient received anthracycline-based chemotherapy. Seven (6.8%) received immunotherapy, 10 (9.8%) received radiotherapy, 8 patients received tyrosine kinase inhibitors, 3 (2.9%) received taxane, 5 (5.8%) were treated with 5FU and 1 (0.9%) CDKi inhibitor. Six (5.8%) patients had surgery and two (1.9%) underwent stem cell transplants. Six (5.8%) patients had combination therapy and 8 (7.8%) had other disease-specific treatments. Heart failure (HF) with reduced ejection fraction (EF) was most common cardiovascular complication in 33 (32.3%) of patients referred, then 14 cases of (13.7%) HF with preserved EF, arrhythmia in 12 (11.7%), 10 (9.8%) presented with chest pain, 15 (14.7%) treated for hypertension and 9 (8.8%) referred prior to chemotherapy. More than half of the HF referrals (30.3%) resulted from cancer treatment-related heart dysfunction. Sixty-two (60.7%) patients referred were only having nurse-led follow-up in the Cardio-Oncology clinic and were no longer being seen in the doctor’s clinic. Forty-two (41.1%) continued cardiotoxic cancer treatment with monitoring in nurse-led clinic and 12 (11.7%) patients died due to cancer disease progression. Conclusion The Cardio-Oncology nurse-led clinic encompasses holistic patient care and permits rapid up-titration of medications to optimal target dosages, resulting in treatment of cardiovascular conditions thus significant improvements in cardiac function, education, and support of side effect management. This allows uninterrupted continuation of cancer treatment, with the potential to translate into better long-term cancer and cardiovascular outcomes. Figure 1table continued