Ted Rogers Cardiotoxicity Prevention Program

Location: University Health Network (UHN)

This program is a key component of the Centre’s Integrated Program for Excellence in Heart Function. Its aim is to reduce the burden of cardiovascular disease in patients with such diseases as cancer, diabetes, arthritis and inflammatory bowel disease. A unique and diverse team of specialists are performing state-of-the-art clinical care, impactful research, and unparalleled education of patients, medical professionals and future health care leaders.

It is the world’s first program that focuses on managing cardiotoxicity from any systemic therapies, uniquely situated to leverage the cardiovascular expertise, databases, imaging and patient groups available at University Health Network.

The issue

Diseases such as cancer, arthritis, inflammatory bowel disease, and diabetes are common causes of morbidity and mortality. While improved treatments mean that patients are living longer, some drugs can cause direct toxicity to the cardiovascular system, either during treatment or years down the road. This can lead to circumstances even more serious than the initial diseases posed.

Cardiotoxicity is an ideal model to study heart disease and cardiomyopathy, as there is usually a clear starting point – the beginning of therapy. It is a huge opportunity to study risk factors, prevention strategies, surveillance methods and consequences of cardiotoxicity – with a range of experts working to achieve prolonged survival of patients with systemic disease by reducing cardiovascular morbidity and mortality.

Clinical care

Ambulatory patients are referred to this program to assess and manage their cardiovascular risk, existing cardiac disease during cancer treatment, and cardiac events that occur in the context of other diseases – as well as treat and manage acute or chronic cardiotoxicity. One key aspect is using advanced echocardiographic imaging, which can detect early signs of heart failure, and which will uncover new biomarkers in patient groups with conditions like diabetes.

The program’s ultimate goal is to integrate clinical care with cardiologists and other specialists in oncology, endocrinology, rheumatology, and gastroenterology. The Ted Rogers Centre care team extends to an advanced care nurse practitioner and an exercise physiologist for additional patient support. In all this, educating patients will be paramount in preventing and managing cardiotoxicity.

Research

Our cardiotoxicity research program is focused on (1) development of a large cardiotoxicity database, (2) performance of prospective and retrospective clinical studies, and (3) collaboration with basic scientists to embark on mechanistic work.

Many important answers require work with large databases, and this program is uniquely positioned to generate them through existing infrastructure at UHN and the University of Toronto’s Cardiovascular Data Management Centre.

The Centre will engage first in retrospective studies using data from our local program, in collaboration with subspecialties like oncology and rheumatology, whose results will be used to plan prospective studies focused on detection, prevention and treatment. Finally, multicenter, randomized controlled studies will be a key to answering important clinical questions about cardiotoxicity. Along the way, biological samples from patients will be used to establish a biobank to inform future studies on novel biomarkers and genetic predisposition.

Education

The field of cardiovascular toxicity is emerging. Significant experience and training is needed to understand where cardiotoxicity is originating and how to manage these patients over the long term. This program will include focused training for the next generation of specialists and physicians.

To that end, the Centre has established a world-class fellowship training program in heart failure with a focus on cardiotoxicity. For cardiology residents, this program provides exposure to focused cardiac issues related to cardiotoxicity of systemic therapy for the first time ever. It will also offer education and training to oncology and other specialty residents, internal medicine residents and cardiologists/internists (through CME).