Anthracyclines, trastuzumab, and radiation exposure to the chest affect multiple disease sites and, thus, multiple oncology specialties, notes Michael Fisch, MD, chair of the department of general oncology at the University of Texas MD Anderson Cancer Center in Houston, Texas.

His work in general oncology and quality-of-life issues led to his involvement with the International Cardioncology Society and his work as principal investigator of the Effectiveness of Using Biomarkers to Detect and Identify Cardiotoxicity and Describe Treatment (PREDICT). The goal of this multicenter study in patients receiving anthracycline- based chemotherapy is to assess the effectiveness of using biomarkers to detect and identify cardiotoxicity and describe treatment of these patients.

In the study, participants' blood will be tested for 2 biomarkers, B-type natriuretic peptide (BNP) and Troponin 1. If these biomarkers are above a certain level in patients, they will be considered high risk for cardiotoxicity. The trial is not testing a treatment intervention; rather, it will describe what happens to these patients and whether point of- care testing is valuable.

Oncologists may choose to involve a cardiologist in their high-risk patients' care, or they may opt just to carefully monitor them and conduct risk assessments for cardiac problems.

“It may be a wake-up call for oncologists to look for things they already should be doing—like assessing whether the patient smokes or exercises or needs to control his weight,” Dr. Fisch says.

He, Dr. Lenihan, and colleagues plan to enroll about 830 patients from multiple research centers to ensure they will have enough cardiac events (ie, changes in heart function such as heart failure, arrhythmias, or acute coronary syndrome) to determine the intervention's effectiveness. Participants likely will be followed for about a year, with study completion expected to take about 3 years.

Promptingoncologiststopaymoreattentiontocardiacissuesisachallengebecause of the host of variables they have to consider in addition to treating their patient's cancer, Dr. Fisch notes. “Oncologists are a bit overwhelmed,” he says. “The overall scope of what they should be knowledgeable about is very large.”

They are expected to address multiple issues related to improving quality care, ranging from depression, to post-treatment planning, end-of-life care, survivorship, fertility issues, pain control, and more. Dr. Fisch notes that each area requires a certain skill set, and oncologists are trying to implement all of these skills at “game speed.”

To accomplish the goal of addressing cardiac issues, oncologists will need to partnerwithmoreinternistsandcardiologistsaswellasmoremidleveloncologyproviders— the latter of whom will need to be educated on these issues. At the same time, however, the more people who are involved in a patient's care, the more fragmented, expensive, and time consuming it can become, he adds.

Further, the sheer number of drugs that patients are likely to be on, and the cost and complexity of monitoring them as well as problems of patient adherence to their drug regimens, all add further layers of complexity.

Still, the International Cardioncology Society should be able to help address some of these problems by getting all the parties—from cardiologists to oncologists to basic scientists—together to discuss them, Dr. Fisch notes. “There are a lot of opportunities to improve care, but it won't be simple to get there.”