Early Cardio-Oncology Intervention in Thoracic Radiotherapy: Results of the Cardiac Aggressive Risk Mitigation (CARMA) Pilot Study

Abstract Background While there is increasing recognition of the morbidity of cardiovascular disease (CVD) in cancer survivors, including accelerated atherosclerosis following thoracic radiotherapy (RT), patients are frequently under-optimized for CV risk. Methods In this prospective single-arm pilot study, patients were treated with high-dose thoracic RT and had early consultation with cardio-oncology. The primary endpoint was adherence to cardio-oncology consultation. Secondary endpoints were cardio-oncology CV medication intervention rate and patient-reported intervention perspectives. Results Twenty patients were enrolled. The median age was 71 years. Most were female (13/20), had primary lung/mediastinal carcinoma (12/20), and 7/20 had pre-existing atherosclerotic CVD. Cardio-oncology consultation was completed in 19/20 patients and resulted in CV medication optimization changes in 12/19, most commonly to initiate/increase statin therapy. 8/12 patients with a primary cardiologist prior to enrollment had medication changes recommended. Most (12/17) were glad to learn about their heart health during cancer treatment. Conclusions To our best knowledge, this is the first study reporting adherence and outcomes of early cardio-oncology intervention and patient reported perspectives. We observed in this high CV risk cohort that early cardio-oncology consultation was feasible, led to CV medication optimization in majority (> 60%) of participants, was viewed positively by patients, and worthy of further study.