Cardio-oncology: Helping Patients Navigate Complex Health Issues; Health Equity

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): I'd like to welcome our listeners to this episode of Heart to Heart Nurses, where we're going to learn how to help our patients with CVD and cancer navigate their complex health issues.

First, I'd like to have our guests introduce themselves. We are so honored to have Janet Celli and Kerry Skurka with us today. Janet, could you introduce yourself first, and then we'll ask Kerry to do the same?

Janet Celli (guest): Yes. Thank you, Geralyn, for having us today. I am a cardiology oncology nurse at Advent Health in Orlando. I have been blessed to do this job since 2019. My career from 1986 to now, I had spent the first couple of years in oncology and the [00:01:00] subsequent years in cardiology. So, this blends both of those specialties in adult medicine together and has helped us to be proactive with our patients instead of reactive with trying to help patients with cardiovascular disease.

Kerry Skurka (guest): Hi, my name is Kerry Skurka and I am a cardio-oncology nurse. My story is pretty much like Janet’s, in that I was a cardiac nurse for many, many years in lots of different fields of cardiology. And then, went to the field of oncology. And in 2016, I became a cardio-oncology nurse navigator. And I'm so excited about being able to blend these two fields and help patients down the road, through this, this trying time.

Geralyn Warfield (host): Thank you both so very much. For listeners who listen to our previous episode—and if you haven't yet, it's a great place to start—we discuss the field of cardio-oncology and the [00:02:00] links between cardiovascular disease and oncology.

So, in this episode, I'm hoping we can learn a little bit more about how to help our patients face these incredibly challenging and incredibly complex health issues. Janet, can you please start us off?

Janet Celli (guest): Yes. So, hopefully, if you haven't had an opportunity to listen to the first podcast, you, you'll find some time to do that, but as you may already know, anthracyclines have been around since the 1960s, Adriamycin being a key one that is utilized in the treatment of leukemias and some of the GI cancers and breast cancers.

And anthracyclines have been quite successful with actually helping as a cancer treatment. In the late 1980s and the early 1990s, we started to see some cancer survivors that had actually gone into remission, have cardiology symptomology. So, cardiologists were scratching their head at that time, trying to say, why, why is this person coming into my [00:03:00] clinic with congestive heart failure or needing, perhaps, an ICD or something like that in their early forties when they had breast cancer earlier on?

And that's when we actually started to develop the actual subspecialty of cardio-oncology. Some of the chemotherapy agents, we now know, such as Adriamycin®, can put people at a higher risk or a moderate risk for cardiovascular disease. Especially if it's, if they're utilized in higher doses, such as 450 mg/m2—that’s considered a higher range of that Adriamycin®.

We also know that, when combined with HER2 therapies such as Herceptin and Perjeta®, these anthracyclines actually utilized with their Herceptin, Perjeta®, have a synergistic effect and can put people in a higher risk category for cardiovascular disease just by utilizing those two methodologies for their, for their cancer treatment.

So our goal is to review, really to look at the [00:04:00] patient's comorbidities as we start them in their oncology journey, you know, for treating the actual cancers. And we want to make sure that we're reviewing all of their history and comorbidities, and then making sure that we do preventatively monitor them so that they don't have cardiovascular disease as a result of successfully completing their cancer treatments.

And Kerry, if I may, would you like to review some of the actual comorbidities that patients might have that we would look at?

Kerry Skurka (guest): Thanks, Janet. That's, that is one of the things that we've found out as we've gone further into cardio-oncology is that the comorbidities for both cancer and cardiovascular disease overlap significantly.

And so, just to mention some of them, I would say that diabetes is one that could lend you to both, as [00:05:00] well as hypertension, hyperlipidemia. Smoking, of course, can cause cancer and also cardiovascular disease. I think we've talked about that a lot and, in our lifetimes, trying to get people to quit smoking, and, and that includes vaping. So, there's new research that shows that vaping can, is not as helpful as we initially had hoped that maybe it could be.

One of the interesting things is that obesity is an independent predictor comorbidity of both cancer and cardiovascular disease, as well as a sedentary lifestyle.

And I think, you know, as we look at these comorbidities, trying to help people, mitigate those comorbidities by managing them, is something that [00:06:00] the cardio, cardio-oncology team helps with. The best thing that can happen for a patient is that they are presented to a cardio-oncologist and his or her team, whoever it may be, to help look at where are they, if they have any of these comorbidities, and make sure we are addressing those comorbidities on the front side, before they start their treatment so that we can help them have a more successful treatment course.

As well as, a lot of times, as Janet mentioned, what we will do is surveillance testing. We'll look at. cardiovascular screening tools such as echos, or EKGs, or biomarkers, or looking at their lipids, their blood sugars. All of those things are very helpful and help the cardio- [00:07:00] oncologist get the patient so that they're in the best condition to move forward in their cardiovascular disease treatment as they go through their cancer journey.

There's a lot of things that you can do to help a patient with those comorbidities and, I think, managing your blood pressure is probably one that people can do a lot to help with that. And learning how to manage your blood pressure is a challenge because sometimes it's something you, you can have because of other comorbidities, or it can be inherited things. Sometimes it doesn't matter that you do the best, you just have bad genes and that is not anybody's fault. That's just that your, your parents gave that to you, right, Janet?

Janet Celli (guest): Yes, exactly right. And you can't do much about that, but if you have the [00:08:00] knowledge that you have hypertension or a genetic predisposition, you can definitely try to ward off extended visits to the hospital by just taking care of yourself, and, and being involved in wellness. For sure.

Geralyn Warfield (host): We've been talking with Kerry Skurka and Janet Celli about cardio-oncology factors that include lifestyle modification, things like exercise, and hypertension, and controllable risk factors, as well as the things that we have inherited from our parents for good or for bad. We will be right back.

Geralyn Warfield (host): And we're back discussing cardio-oncology. And we are happy to have with us, Kerry Skurka, and Janet Celli to give us some more detailed information about one of the things that worries many of us, keeps us up at night, perhaps, and that is the idea of health equity. It's one of the key considerations for healthcare providers. And [00:09:00] really impacts patients across the spectrum, including those with cardiology issues and those with oncology issues.

So, I'm hoping that our team might be able to describe how health equity can affect treatment for patients with cancer and with CVD. Janet, could you get us started?

Janet Celli (guest): Yes. Thank you, Geralyn. It, it is a struggle because as we, as we may know, academic programs and community programs can be extremely different. Academia, we are blessed for, because this is where we benchmark a lot of our care. But that, that actually accounts for, academic programs account for just a little over 6% of all cancer patients that we, we treat. Most cancer patients are going to be treated in a community setting. And although we're grateful for the research and the advancements in medicine that are derived from the academic centers, we have to really be aware that the majority of the patients are going to be treated in a community [00:10:00] center.

And many of our patients are underinsured or not insured at all. So, we've been thankful for the support, in my Advent Health setting, for patient financial services. We utilize case managers and our foundation quite a bit.

So, we've been blessed to try to assist patients that are either underinsured or self-pay. Because we really want to make sure that, we realize there's a, a lot, as involved in the Black, Hispanic, Asian populations in our society, have a higher difficulty with cardiovascular disease. And that's all research-based.

So, knowing that we want to be able to help everyone across the board and really focus on making sure that we give everybody the very best of care that we possibly can and not have the actual health be, be affected by the fact that [00:11:00] patients may not have insurance or, or be underinsured. So we, we do work quite a bit with patient financial services, case management, and a lot of, a lot of different supports.

And I, I do know Kerry, you had mentioned some other resources that can provide patient advocacy for financial assistance or nonprofits.

Kerry Skurka (guest): Yes, actually, there are a lot of different things and, you know, just like Janet mentioned, I mentioned before, you know, your parents, you know, who they are, you don't have control over your genes.

And of course, unfortunately, Hispanics, Blacks, and also Asians, tend to have, a higher incidence of cardiovascular disease. And so, you know, it is important, therefore, to focus on those things as they go through their cancer treatment. [00:12:00] And there are lots of resources out there that people can use.

There are, you can go to, actually, your own cancer center and talk with [them]. They have a patient advocacy in the financial counselors there. They're really great about finding avenues for support. One of the other ones is the foundations within your institution can also help you with support financially.

And then there is one that people don't think about is the pharmaceutical companies. They all have supports to get treatments to patients that don't have the financial needs. And that's really important to know.

And as Janet mentioned, you know, most of the care is being done in the community setting. And, but all the science is in the academic setting, and I say that as the most up-and-coming trials and [00:13:00] research are available there. But one thing that you can do is go to a second opinion clinic. A second opinion clinic is where you may be in a community center. All you have to do is make an appointment with an academic center at their second opinion clinic.

And they can, therefore, see you there, make recommendations for treatment, and then you can be treated with that in your community setting, which really takes a large burden off of the patients. because there is where all their other providers are, that's where their support systems are. And that tends to be a challenge for the patients.

A couple others that I can think of is the Little Red Door, and, as I mentioned once before, the Cancer Support Community. Those can also be avenues to help you with any, [00:14:00] resources that you might need to move through your cancer journey.

Geralyn Warfield (host): This has been such a rich conversation. We have covered some of the side effects of cardio-oncology and the cardiovascular impacts. We've talked about access to care and health equity issues. And we've been talking with Janet Celli and Kerry Skurka about how to help our patients access care and actually manage these complex diseases.

In our next episode, we'll be looking at the importance of, and the best strategies for success, in team-based care for patients with CVD and cancer. We are grateful to you for your time to be a listener of the Heart to Heart Nurses podcast. This is your host, Geralyn Warfield, and we will see you next time.

Thank you for listening to Heart to Heart Nurses. We invite you to visit pcna.net for clinical resources, continuing education, and much more. [00:15:00]