Getting to the Heart of Cardio-Oncology With Jessica Coviello, DNP, RN, ANP-BC

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, we're here at ONS Congress and I'm joined by Dr. Jessica Coviello. Thank you so much for joining me today.

Jessica Coviello, DNP, RN, ANP-BC: Thank you. Pleasure to be here.

Oncology Data Advisor: Would you like to introduce yourself and share what your work focuses on?

Dr. Coviello: Yes. I am Jessica Shank Coviello, and I have been in practice for a very long time. The last probably 12 to 13 years, I have been in cardio-oncology. Most of my work throughout my nursing career has been in cardiology, either in the critical care unit (CCU) or I started a cardiac rehab program at Yale, probably 30 years ago now, and it's still in existence. I like to innovate and get programs started and move them forward. And in 2011, in the context of my DNP, we wrote a needs assessment and started a cardio-oncology clinic at Yale New Haven Hospital in New Haven.

Oncology Data Advisor: Oh, that's great. You just presented a session on cardio-oncology and cancer care. Why is there a need for cardio-oncology services at a specialized area?

Dr. Coviello: The incidence of pretty awesome cardiac side effects can occur with certain types of cancer chemotherapies. The original work that was done looking at cancer and cardiovascular side effects was done with childhood bone marrow transplant patients as well as breast cancer patients, because those particular populations used a drug called anthracycline. In breast cancer, they also used a drug called trastuzumab, also known as Herceptin®. And we saw that those particular drugs had a cardiovascular side effect that in some cases was, again, pretty awesome. Patients would develop left ventricular dysfunction, some of whom would recover from that, others whom would not. It became important to have cardiology on board to help manage those patients.

As chemotherapeutic agents have continued to evolve, and may have become more and more cardiac therapies, we've seen more cardiac side effects that have arisen either in the form of high blood pressure or arrhythmias or more heart failure or pericarditis. There's a whole series of cardiovascular complications that can occur, so that's why we're in the game.

Oncology Data Advisor: Yes. What is the importance of cancer patients having a comprehensive baseline cardiovascular assessment?

Dr. Coviello: Well, what we know is that from our studies looking at population health, we know that particularly for women, their sense of being at risk for cardiovascular disease is a lot less than for being at risk for breast cancer. The data shows that even for women who have continued to have good primary care or have continued to see primary care, two things happen. First of all, if cardiovascular risks are discussed with them, they don't remember. They don't know what the cardiovascular risks are. They don't know what the results of their cholesterol level is or their blood pressure, and they don't see themselves at risk—again, more at risk for breast cancer than cardiovascular disease.

In addition to that, with very busy primary care practices, the Women's Health Initiative demonstrated that about 39% of primary care physicians are able to really discuss cardiovascular risk with their patients. So that's a fairly low amount. And we see that women are entering cancer chemotherapy and never really having been assessed, although the Heart Association says that at the age of 20, we should all be assessed. We should all know our blood pressure and we should all know our cholesterol, but that has not been the case. So, people enter cancer chemotherapy without ever really having comprehensive cardiovascular assessment, and that's where the problem lies.

Oncology Data Advisor: Right. And on the flip side, for survivors, how often should survivors be monitored for cardiovascular risk?

Dr. Coviello: It's really a great question, and it depends upon the chemotherapeutic agent that was used and what their cardiac side effects were in the course of their chemotherapy. I think the other thing to be considered is who should be doing that type of continuing ongoing care. I was just talking to someone a few minutes ago who was asking the question, "Who should we be teaching about cardiovascular risks and how to manage those and how to assess for those?" And it really is primary care providers, because our patients in long-term survivorship go back to their primary care person and they really need to be the ones who are most on top of those things. And it's not that hard. There's a recipe now; we talked today about the new cardio-oncology guidelines that came out. So, that recipe is pretty clear as to what it is that needs to be done. The question is, do primary care physicians have the time to do that?

Oncology Data Advisor: Right. So, where do you anticipate the future of cardio-oncology going?

Dr. Coviello: Well, I think where we're going is first of all, the discipline is going to change in that it's going to become much more collaborative. We talked today in the presentation about trainings that are going to take place for us together, rounds for us to do together between cardiology and oncology. I think that is going to be a place I would like to see us be a lot more diverse. And I think that from a scientific standpoint, I need to continue to work on creating clinical trials that will give us better information up and direction on how to treat some of these problems that we've seen in the context of chemotherapy and radiation. And I think other than that, I think we need to work on overall cardiovascular and cancer risk reduction. We talked about the social determinants of health and how they can affect both cardiac and cancer outcomes. So, I'm hoping that we will also be able to move in that direction.

About Dr. Coviello

Jessica Coviello, DNP, APRN, ANP-BC, is Associate Dean of Faculty Development at Cizik School of Nursing at the University of Texas. She has multiple presentations and articles in the area of cardio-oncology.

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Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.