Study calls for better collaboration between cardiologists, oncologists

A study published in the February issue of the Journal of the National Comprehensive Cancer Network found cancer patients who are dually diagnosed with heart disease face a disproportionately high financial burden—something that might improve with a more streamlined and collaborative approach to cardio-oncology.

The cardiotoxic properties of some chemotherapy agents—namely anthracyclines like daunorubicin and mitoxantrone—can exacerbate heart problems in patients already fighting a cancer diagnosis. But Ishveen Chopra, PhD, MBA, and colleagues revealed the issue isn’t purely physical.

“Treatment regimens used for colorectal cancer may increase cardiotoxicity and therefore increase coronary artery disease (CAD) management cost to patients,” Chopra said in a press release. “In addition, non-adherence to CAD medications during cancer treatment may also contribute to higher CAD complications and total overall costs.”

Chopra, of West Virginia University, et al. compared medical costs for 12,095 CAD patients diagnosed with breast, colorectal or prostate cancer to costs of 34,237 CAD patients with no cancer. Subjects were recruited from the SEER-Medicare registry and a 5 percent non-cancer random sample of Medicare beneficiaries.

All patients were enrolled in traditional, fee-for-service Medicare plans, Chopra said, and were 68 or older. There were no deaths during the 48-month study period.

The researchers measured patients’ healthcare expenses every 120 days during two periods: one year pre-cancer diagnosis and one year post-diagnosis. After considering the Consumer Price Index for medical services, Chopra and colleagues reported CAD expenses post-cancer diagnosis increased around three times over pre-cancer costs for patients with colorectal cancer. Post-cancer diagnosis expenses were twice as high for women with breast cancer and one and a half times higher for men with prostate cancer.

CAD costs in the non-cancer cohort remained steady, the authors said.

“Heart problems that needed to be treated with in-patient hospitalization accounted for the highest added expenditures, representing two-thirds of the total costs,” Chopra said. “There is a need for more coordinated and patient-centered care among older adults with multiple chronic conditions. An interdisciplinary and integrated approach to cardiovascular management in the elderly diagnosed with incident cancer would improve cardiovascular outcomes.”

Chopra et al. said they assumed some of the cost increases are the direct result of pricey cancer treatments that might induce or elevate cardiotoxicity. They suggested providers could reduce costs by preventing inpatient encounters as best they can.

“In the recent publication by Dr. Chopra et al., the authors show that healthcare spending for CAD-related services in elderly Medicare beneficiaries is higher for those with cancer than those without,” John Fanikos, MBA, said in the release. Fanikos is the executive director of pharmacy at Brigham Health.

“It highlights the importance of maintaining collaborative relationships between cardiovascular and oncology practitioners for patients that require prevention, early detection or optimal management when these two conditions intersect.”