10 MARCH 2019 • HEALTHCARE INNOVATIONS
Specialist clinics
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DR LYON’S UNDERSTANDING OF MY DISEASE, ITS CAUSES AND EFFECTS HAVE ENABLED ME TO SLOWLY BUT SURELY GET MY LIFE BACK ON TRACK. WE’VE WORKED TOGETHER ON MY TREATMENT PLAN AND, THANKS TO HIM, I HAVE A BEATING HEART AND A HEAD FULL OF DREAMS FOR THE FUTURE. I’M DEEPLY GRATEFUL FOR ALL HIS SUPPORT — Kreena Dhiman
DR LYON AND KREENA DHIMAN
when early signs of heart strain are detected and before they develop more serious heart problems.” Dr Lyon continues: “We offer a
personalised approach to risk status and management. It’s certainly not the case of ‘one size fits all’, where everybody should automatically receive
cardioprotective medica-
tion. We know that problems only occur in a minority of individuals receiving any particular cancer treat- ment. Terefore, rather than exposing everybody to heart medication, where for some this is unnecessary, we have a bespoke approach to tailor the treat- ment plan to each individual.” Te Royal Brompton Hospital
Cardio-Oncology team has looked after more than 1,000 cancer patients — and the specialists have observed different patterns emerging. Initially, patients referred to the service tended to be people who were developing problems after receiving treatment. More recently, a greater proportion of higher risk patients have been referred by their oncologist or surgeon before cancer treatment has started. “Tis is ideal as it allows the cardio-oncology team to monitor the patient’s heart health and support them through their treatment safely.”
I WAS REFERRED TO DR ALEXANDER LYON — SOMEONE WHO HAS A WEALTH OF KNOWLEDGE IN WHAT’S A GROWING AREA: PEOPLE LIVING WITH THE LATENT EFFECTS OF BEING TREATED WITH CHEMOTHERAPY AND RADIOTHERAPY IN THE 1980S AND 1990S — Rachel Wellbelove
EXAMPLES OF DIFFERENT CANCER PATIENT GROUPS: BREAST CANCER PATIENTS Te cardio-oncology service looks after people with abnormalities of heart function picked up on a standard screening for some common treatments. For example, trastu- zumab — also known as Herceptin — for HER2+ breast cancers, where three four-monthly ultrasound scans of the heart are standard. Unfortunately, many patients
across the world receiving Herceptin have their treatment stopped when their heart function falls below a certain threshold. Te Royal Brompton Hospital Cardio-Oncology team has learned that many women can tolerate a minor reduction in heart function while continuing treatment without long-term problems. Tis is good news since interrupting this critical cancer treatment can have a negative impact on cancer outcomes, with a higher risk of cancer returning
if the 12-month course of Herceptin is interrupted. Trough close moni- toring, signals of cardiac strain can be picked up earlier — ensuring breast cancer patients are able to continue taking their Herceptin safely.
PROSTATE CANCER PATIENTS Over the past 20 years, advances in prostate cancer treatment have allowed patients to live for many years with their prostate cancer controlled. Tis is particularly the case with an effective treatment strategy called androgen deprivation therapy (ADT). Unfortunately, the main ADT medi- cations — three monthly injections — can accelerate coronary disease and other vascular disease by increasing the development of diabetes and raising cholesterol.
CHILDHOOD AND YOUNG ADULT CANCER SURVIVORS Te Royal Brompton Hospital Cardio-Oncology team also provides care to adults who had cancer in earlier life — either as children or young adults in their 20s and 30s. Many of these individuals required chemotherapy which is toxic to the heart and/or high doses of radio- therapy to their chest, which results in their heart receiving the radiation.
CARDIO-ONCOLOGY FOR THE FUTURE Dr
Lyon and his team recently
published a report on their initial five-year experience setting up and running their cardio-oncology service at the Royal Brompton Hospital. “We’ve shared our experience with
medical colleagues who are planning to start or are currently delivering their own cardio-oncology services. We hope the specialist model we’ve developed can be rolled out widely across the UK and even beyond,” explained Dr Lyon. “We’ve shared details of the
range of cardiovascular diseases now encountered in patients during or after their cancer treatment. We’ve also designed a new classi- fication structure to help doctors make decisions regarding cancer treatment and treatments to protect their patients’ hearts when
implementing surveillance
strategies for people during their cancer treatments.” Since
starting the service, Te
Royal Brompton Hospital has been collecting feedback from patients at the end of their initial visit, and this has been very positive. Patients rated their experience of it with an average score of 9.3 out of 10 from over 270 patients who provided feedback, and 99% of patients would recommend the Royal Brompton Hospital Cardio-On- cology service to friends and family. Dr Lyon says: “We’re very pleased
with the response and feedback we’ve received so far. We continue to strive to maintain these very high standards and improve each and every patient’s experience further.”
PATIENT TESTIMONIALS “I was referred to Dr Alexander Lyon — someone who has a wealth of knowl- edge in what’s a growing area: people living with the latent effects of being treated with chemotherapy and radio- therapy in the 1980s and 1990s. He was able to explore other factors impacting on my heart and overall health, under- take extensive tests, make changes
to my medication and take proactive steps to treat me as a ‘whole person’. I’m confident that the steps I’m taking now — and the knowledge of the whole team at Royal Brompton & Harefield Hospi- tals Specialist Care — gives me the very best chances of living a long and healthy life,” said patient Rachel Wellbelove.
“I was diagnosed with acute heart
failure back in 2016 while I was on holiday in the Canadian city of Vancouver. My hospital consultant at the time spoke to me about Dr Alexander Lyon and his work in the cardio-oncology field. As soon as I returned to England I was referred to him. I've felt safe since being in his care. He’s taken me from an ejec- tion fraction of below 20% to one in line with a normal heart. His under- standing of my disease, its causes and effects have enabled me to slowly but surely get my life back on track. We’ve worked together on my treat- ment plan and, thanks to him, I have a beating heart and a head full of dreams for the future. I’m deeply and sincerely grateful for all his support,” said patient Kreena Dhiman.
MEET THE EXPERT
Dr Alexander Lyon is a consultant cardiologist at the Royal Brompton Hospital in London. He’s currently President of the British Cardio-Oncology Society, Chair of the Cardio-Oncology study group of the Heart Failure Association of the European Society of Cardiology, as well as being the Cardiology Adviser to Macmillan Cancer Support. Dr Lyon leads the NHS Cardio- Oncology service at the Royal Brompton Hospital and sees private patients at the Royal Brompton Hospital and The Physicians’ Clinic.
NHS patients: referrals can be sent from NHS GPs to E:
rbh-tr.BHOPNewRF@
nhs.net Private patients call 020 7118 4141 or E:
pa@drlyon.co.uk rbhh-specialistcare.co.uk
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