Cardio-oncology: Effective Strategies for Team-Based Care

Welcome to Heart to Heart Nurses, brought to you by the Preventive Cardiovascular Nurses Association. PCNA's mission is to promote nurses as leaders in cardiovascular disease prevention and management.  

Geralyn Warfield (host): Thank you so much to our listeners for joining us for this episode of Heart to Heart Nurses, where we're going to learn how to team up for success with colleagues, in oncology and cardiology both, to help our patients. 

We're so grateful to our guests who have brought with them a breadth of experience in this field and are very passionate about sharing it with others so that we can all work collectively together to improve patient outcomes. Kerry Skurka and Janet Celli could you please introduce yourself to our listeners? Kerry, why don't you go first?  

Kerry Skurka (guest): Hi. My name is Kerry Skurka and I, my background is, I was in cardiac nursing, just about any field you can think of, for many, many years. And then, through my own personal [00:01:00] experience, moved over to oncology. And in 2016, I became a cardio-oncology nurse, where I could marry both specialties in my past. That gave me the opportunity to move forward in this brand-new field that helps cancer patients every day.  

Janet Celli (guest): And my name is Janet Celli. I am from Boston, Massachusetts, and currently in Orlando, Florida. But I started my nursing career in 1986 in oncology and surgical oncology. And did that for a couple of years and then moved into cardiology. 

And then, in 2019, I was very fortunate to be offered the role of a cardio-oncology nurse navigator at Advent Health in Orlando. And we have been blessed to be able to be proactive in helping people prevent cardiovascular disease, or word off long, long-term effects of cardiovascular disease. [00:02:00]  

Geralyn Warfield (host): Thank you both so very much. For those listeners that have just joined us for the first time, I will let you know that this is the third of three episodes on cardio-oncology. Today's focus is on team-based care, which is much more than a buzzphrase. But is, instead, a critical component to ensuring effective care for all of our patients. 

So, while team-based care is not isolated to cardio-oncology, Janet, could you start us off talking about how it can be applied in the cardiology and oncology settings?  

Janet Celli (guest): Yes, absolutely. Thank you, Geralyn. This is a, a passionate subject for me, because as, as is mentioned many times in many forums, it takes a village to get care accomplished. 

And in my mind, it’s vital to appreciate that the patient is really at the hub of the entire plan. And if you're looking at, at tire, we've got different stakeholders that represent different spokes on the wheel. And it's important to realize that the [00:03:00] oncologists, cardiologists, our schedulers, and our boots on the ground—folks like nurses and sonographers—really make things happen for our patients every single day.  

And it's also important to really, when we get patients into the program, meet patients where they actually are in the process. This is a very overwhelming process for someone who has just been hit with a cancer diagnosis, and to appreciate their story and where they're at and what they have for a support system is really vital. So, whenever I have folks come into our program, I will always give them my phone number and make sure that they know they can utilize me as a phone-a-friend. And if, if I can have Kerry add, I know Kerry has been an amazing cardio-oncology nurse, but she also has a personal story to share. If, if you wouldn't mind sharing and opening up to us, Kerry, regarding that.  

Kerry Skurka (guest): Thanks a lot, Janet. I, I, I just want to say, you know, sharing a story [00:04:00] is really, really important because it, it helps people remember things. And that's one of the things, as Janet was talking about, the team that I learned was so helpful as I tried to get patients navigated through a very complex system.  

So, my story is that in 2008, I was diagnosed with non-Hodgkin’s lymphoma. And I, also in 2013 and 2017, my late husband also was diagnosed with cancer. And when the first, after the first diagnosis, I decided that I wanted to go to oncology and give back to this field because they had given so much to the both of us. 

And when I started in an infusion, as an infusion nurse—those nurses are amazing!—I kept seeing cardiovascular [00:05:00] symptoms in front of me. And, I think if you remember from our previous podcast, or if you didn't, I will just state again, that a lot of the comorbidities of both of these diseases replicate each other. 

Seeing these symptoms in front of me all the time, I kept going to my oncology friends and I'd say, “You know, guys, I think this is a, a cardiac thing.” And they go, “Kerry, you're in oncology now.” And, and I go, “Okay. Okay.” And I did that a few times till one day, they just really, in unison, said, “Kerry, you're in oncology!” And I think that's important to remember because I think that what a lot of people don't realize is that they do mimic each other. And so, the field of cardio-oncology is so special because you have trained people who are capable of looking at both [00:06:00] sides of the fence and seeing it.  

It wasn't a week later, I was blessed with having the director come to me and say, “Hey, Kerry, do you know anything about cardio-oncology?” And I said, “I know nothing, but I'm going to learn everything I can.” And I can just tell you, as a cancer patient, you know, it's really hard because it's a death diagnosis. And so, you want to do everything you can to hopefully not meet that. 

And so, when you are told about a new treatment strategy that they're planning for you, you know, you, great guns, you go after it. Because you want to beat this cancer and you know that, despite everything that everyone does, you're going to have symptoms. And that's something that I think you need to remember, and it's really important for [00:07:00] healthcare professionals to help patients recognize.  

And especially in cardio-oncology. It's bad enough to be told that you have a cancer, then to be told, “Well, there's also this cardiac thing going on,” is just so overwhelming. And they need to understand that there is so many things that we can do to help with symptoms. And that it doesn't mean that we're going to stop their treatment. I think that is so important.  

And you need to also remember that at that patient side is a caregiver, and that caregiver is doing everything in their power to support that patient in all kinds of avenues. And they need to be recognized. They need to be talked to, and they need to understand this just as much as the patient does. And they will be so helpful in moving this patient forward, to make [00:08:00] sure that their cardio-oncology symptoms are managed, and that they have successful movement through their treatment.  

Janet, you were just talking, and if you don't mind sharing your personal story, because I think as you shared with us, it, it shares very well. What it can look like.  

Janet Celli (guest): Yes. And just, as you mentioned, as, as a cardiac nurse for most of my career, we, I have been blessed and saddened by my mother-in-law has glioblastoma. And when we have been caring for her, hospice has been great. The whole team here has been great, but her heart rate has been in the one fifties and one sixties, which is very alarming to a cardiac nurse, and not so much to the oncology nurses. But with cardiology as a background, you're, you're obviously thinking, you know, like, “Why is her heart rate so fast? Is she in pain? Does she [00:09:00] have, is she dehydrated?” And, and it, it's really just kind of a mix of both of those fields, cardio-oncology is in it on a personal level. 

It has been more concerning for, for me as a cardiac nurse, to be able to try and get her heart rate down just a little bit so that she gets good perfusion, and good pump, but her blood pressure's good. So, it’s just a blessing to be able to care for her in that respect. And like, as I, if I can just supplement what Kerry has said already, we just want to, just really educate our patients and make them realize that the anthracyclines and the chemotherapy treatments, when they ring the bell, and they have successfully completed their treatment: some of the cardiovascular side effects can last for many, many years.  

And I always share with people when we exit them from our program, that you know your own body better than anybody. And if you are short of breath, or you're having chest pain, or you're having fatigue that has not been there before, [00:10:00] even though it's been three or five years post your chemo, that is something that you need to make your PCP or oncologist if you're following up with them, or your cardiologist, make them aware of that. Because we want to make sure that that patients realize that some of the long-term effects of the chemo can be very real. And, and we just want to make sure that patients are on top of making their providers aware. 

Geralyn Warfield (host): We've been discussing how cardio-oncology is actually a team sport with the patient at the center, and healthcare providers, families, and caregivers all surrounding that patient in decision-making and support. We will be right back.  

Geralyn Warfield (host): We're back with Kerry Skurka and Janet Celli, discussing cardio-oncology. And we're going to shift gears just a little bit and talk about how the recent COVID pandemic has sparked a change in healthcare, and not just in a single way, but in a multitude of ways as those of us in healthcare are abundantly aware. I'd like to know [00:11:00] how the two of you have seen improvements of cardio-oncology care as a result. Janet, why don't we start with you. 

Janet Celli (guest): Yes. The pandemic has definitely brought about some positive advances in technology. We, at our hospital, it kind of pushed us into utilizing Microsoft teams to be able to communicate. 

And telehealth has really come into the forefront of being able to see patients and not have them have to get into the office environment and, and potentially risk being exposed to somebody. The internet-based references and the, Carrie had mentioned before, ACC CardioSmart, and ICOS, I've mentioned as well. 

Those are great forums that are on the internet for platforms to really be references, not only for our patients, but to collaborate with other healthcare providers. It's really been a, a blessing and a curse, [00:12:00] the pandemic, but I think just formats like this, for example, have been allowed because of the pandemic, we've been able to utilize technology and utilize it at its best. 

Kerry Skurka (guest): I'm going to add to that Janet, in that we were talking the other day about the second opinion clinic, and how most care gets taken care of, cancer care gets taken care of in the community setting. At our facility, we had six satellite offices, and telehealth was wonderful because you could have the patient, you know, miles and miles away, and they could still talk to a cardio-oncologist. 

We had referral-based, you know, they didn't have a cardio-oncologist…there aren't, you know, it's just a new field, and so, to find a cardio-oncologist is not always easy. But telehealth made it, made it easy, because we could always find, [00:13:00] some way to connect them. 

And we used all kinds of resources. Grandchildren aunts, uncles, anybody that had the techno skill, or the iPad, or whatever we needed so that we could help take care of that patient.  

Geralyn Warfield (host): Janet, I'm hoping you can add a little bit more information about ICOS and what an excellent resource it is for those of us in cardiology and oncology.  

Janet Celli (guest): Yes. Thank you so much for asking about that. ICOS is the International Cardio-Oncology Society, and if you have an opportunity, if you don't do anything else this afternoon, or, or this morning, what, whatever time you are looking at or listening to the podcast, please look up on its IC and then dash O S Dot org. [ic-os.org]  

And we actually have weekly ICOS meetings from 9:00 AM to 10:00 AM Eastern standard time on Thursdays. And we'd like to invite anybody that is interested [00:14:00] in learning more about cardio-oncology on an international level. Please look at joining ICOS because it has been a great forum of collaboration with other healthcare professionals who have a passion for cardio-oncology and have a passion for excellence in care.  

And the other thing I would like to mention is on October 5th, 2022, with the assistance of the Toronto Canada colleagues that are involved in the GCOS summit, we have been invited to do a pre-conference nursing summit, which will be from 1:00 PM to 6:00 PM on the day before the actual GCOS summit. And we will be speaking with nurses, specifically, on cardio-oncology topics, broadening, anything from how to build a cardio-oncology program, oral chemos that we need to be concerned about, and survivorship [00:15:00] programs. 

So, it's going to be a hybrid format. If you're wanting to join us in Toronto, we would love to have you there, but if you're not able to, you can certainly find more information on the IC-OS.org site about the actual summit. And we would love to see in person or virtually.  

Kerry Skurka (guest): I just want to leave with our listeners today that the goal of cardio-oncology is not to stop treatment. And I want you to hear that: not to stop treatment, but to prevent or mitigate side effects so that cancer patients may move through their treatment regimens successfully and have the best results so that their quality of life in survivorship is not succumb by cardiovascular disease. Thank you so much for this opportunity. 

Geralyn Warfield (host): It has been an extreme pleasure speaking with Kerry Skulka and Janet Celli for three episodes of the Heart to Heart Nurses [00:16:00] podcast series. I'm sure our audience is just as grateful as I am to have had the opportunity to learn from you both. And we look forward to taking this knowledge and putting it into practice. 

Thank you both. This is your host Geralyn Warfield, and we will see you next time.  

Janet Celli (guest): Thank you. 

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