MORGANTOWN – WVU Medicine has gained international recognition for its pioneering program in a relatively new and little known field: cardio-oncology.
The Heart and Vascular Institute’s cardio-oncology program has been named a Gold Center of Excellence – the highest possible designation – by the International Cardio-Oncology Society, WVUM announced.
The society defines a Center of Excellence as “a program within a healthcare institution that is assembled to supply an exceptionally high concentration of expertise and related resources centered on a particular area of medicine, delivering associated care in a comprehensive, interdisciplinary fashion to afford the best patient outcomes possible.”
International awards are presented at three levels – bronze, silver, and gold. Cardio-oncology is a medical subspecialty focused on the management of heart diseases in patients with cancer.
Program leader Dr. Chris Bianco, a cardio-oncologist ; Dr. Midhun Malla, a hematologist-oncologogist; and Dr. Brijesh Patel, a cardio-oncologist said the field continues to grow.
Bianco started the program in 2017 at the HVI. It grew from a single provider to now a shared collaborative clinic with a presence in the Mary Babb Randolph Cancer Center. It became a multi-provider clinic in 2019 when Patel joined. And it is now expanding with clinic dates at WVUM campuses in Bridgeport, Keyser and Oakland, Md.
The cardio-oncology process is multifaceted, they explained. Many patients who develop cancer already have cardiovascular disease, Bianco said. But cancer patients without cardiovascular disease can develop cardiovascular complications from the cancer or cancer therapies.
“We seek to prevent those from happening, if at all possible,” Bianco said. But if they do identify cardiovascular issues early on, they can start risk mitigation strategies to reduce cardiovascular disease down the road.
“There used to be this focus on just surviving your cancer,” he said, “and that certainly still is the goal of going through cancer therapies. But it’s then surviving as well as possible into a long life after cancer therapies, hopefully void of cardiovascular disease or at least well—treated cardiovascular disease.”
Patel likewise said certain chemotherapies can expedite that process of developing cardiovascular disease. Through the program’s research, “the goal is to find the high-risk patients and focus on prevention of cardiovascular disease itself. Then we keep a closer eye on those patients,” with more frequent monitoring, to identify issues early and treat them, so the patients can complete their cancer therapy without interruptions.
Malla works with the team both in the clinical and research fields. West Virginia ranks No. 1 for obesity-related and cardiovascular mortality, and cancer is up there with them.
“My aim or vision always is, they’re not a single disease. They’re a group of diseases mixed together. … I consider that the management of oncology is not a one-man show. I really need significant help from the team and we collaborate very well.”
Oncology treatment has grown significantly in the past couple decades, he said, and they are beyond just chemotherapy, with novel therapies coming out. And the side effects of chemotherapy are completely different form immunotherapy or targeted therapy, but heart-related side effects remain up there and need to be addressed too.
They didn’t have exact numbers, but this cardio-oncology program, they said, is the only one in the state, and one of the few in the region, and the world. There are similar programs in Pittsburgh and Columbus, but perhaps only 12 to 15 in the world – definitely less than 20. This program is part of the inaugural group receiving international recognition from the society.
And the demand for their special care is growing. Patel started at half a day in clinic and is now up to a day and a half while Bianco offers two full days.
The society bases its recognition on scoring in six categories: volume of new/established patients; research/publications; education; quality improvement; Cardio-Oncology Committee involvement; and program building.
The doctors talked about a few of those elements, starting with program building.
“To deliver that good clinical care takes building resources in terms of all the different types of studs we do for these patients, scheduling, administrative support,” Bianco said. Collaboration is needed to provide the highest level of care. They’ve brought specialized imaging services to the center.
Also, the development of building a patient registry and following patient outcomes and outcome of specifically designed trials for cardio-oncology is in its infancy as a specialty, Bianco said.
While Patel and Malla credited Bianco for doing the heavy lifting to get the program off the ground, Bianco credited his two colleagues for doing much in the academic and research areas to further the young field.
Other cardio-oncology program members are HVI cardiologist George Sokos and nurse specialists Kim Helmick and Stephanie Stoffa.
Each of the three doctors offered a few closing comments.
Bianco expressed his appreciation for his patients, his collaborators and WVUM and HVI leadership for seeing the vision with them and letting the program come to fruition so they can continue to improve cardiovascular care for cancer patients.
Malla said, “Research forms a key element in the pillar in the management of patients. Cardio-oncology in my opinion has been an orphan child for so long,” and its time has come to be recognized as a separate entity.
Research, he said, looks at outcomes of patients treated, which can lead to clinical trials. Through the international recognition, “Hopefully we can get prioritization for clinical trials as well. That’s where we can get novel landscape-changing treatments to our patient population.”
Patel said there are a lot of people behind the scenes. The doctors and nurses are the tip of the iceberg. “I don’t get tired seeing these patients. They need help and we can help to some extent.” That attitude is shared among the whole team. Doing the work and collecting the data helps them understand who the patients are, how their disease processes work together, and how they can help them better.
Dr. Vijay Rao, chair of the society’s Center of Excellence Committee, wrote a letter informing the team of gold-level designation. In it, he said, “Your program has demonstrated outstanding contributions to our field, and we thank you for your commitment to excellence.”
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