Jean-Bernard Durand, MD
Implantable cardiac devices are providing a more nuanced understanding of how technology can extend care to the patient’s front door, according to Jean-Bernard Durand, MD.
According to data from The University of Texas MD Anderson Cancer Center, survivors of cancer are more likely to die of heart disease than their cancer, and should be carefully monitored for heart problems both during and after cancer treatment. Approximately 3% to 50% of patients have heart failure during chemotherapy, depending on the systemic drug used.
“When caring for cancer survivors, it’s important to recognize their vulnerability to atrial fibrillation and heart failure caused by previous chemotherapy, and to be vigilant for these heart problems,” said Durand, associate professor in the department of cardiology at MD Anderson. Chemotherapy and radiation therapy can increase the risk for cardiovascular problems such as severe hypertension, cardiomyopathy, ischemia, atrial fibrillation, and congestive heart failure, he added.
Though the symptoms of systemic drugs vary, cytotoxic chemotherapeutic drugs weaken the heart muscle. Taxanes can cause abnormal heart rhythms during treatment in some patients, and angiogenesis inhibitors can cause increases in blood pressure, risk for blood clots, and heart failure.
With implantable cardiac devices like the CardioMEMS and Reveal LINQ systems, Durand hopes to eliminate the need to discontinue cancer treatment in order to prevent heart failure. In an interview with OncLive
, he discussed the new medium and how patients may be able to continue their treatment regimen.
OncLive: What are the specifics of this technology?
There is a relatively common problem we all have in our practice, and that is when we have patients who see us from all over the city, all over the state, and all over the country, how do we communicate with these patients and monitor them? Historically, we have always managed this by patients coming to our clinic and having a face-to-face encounter with them. Then we make our decisions about therapies, diagnostics, and diagnosis.
Now, with all these new technologies that have come along, we have some new tools that we can use, specifically using web-based technology where we can not only monitor patients remotely but also diagnosis. What is happening in parallel to these new technologies is that governmental agencies are now recognizing the importance of being able to communicate through web-based technology with patients who cannot get to our offices.
Think about the patient who lives very far away and then has to get into the city to see our doctors. How do we communicate with those individuals? We now have this web-based technology. Web-based technology is the ability to monitor and track patients with different diagnoses, in particular for cardiovascular disease. We now can use noninvasive, FDA-approved technology that we can implant within the patient’s body, and we can monitor them anywhere they are around the world and anywhere the provider is around the world.
That information is transmitted through cellular technologies, so as long as there is a cell tower around them, they can transmit information either to our computer or our smartphone anywhere in the world. The importance of how that relates to oncology is, we already know there are many oncology drugs that have side effects, in particular that affect the heart. Typically, we require these patients to come into our clinic.
Now with the implantation of this technology, we can monitor these patients remotely. We can look on our smartphone at a dashboard, for example, at their blood pressure or their heart rate, and whether their heart rate is fast or slow and what type of rhythm it is. Based on what we see on our smartphone or computer, we can call the patients and either adjust their medicines or start new medications without them ever coming into our offices provided they’re stable.
Patients who are sick need to have a face-to-face encounter, but now we have the ability to monitor these patients and make decisions in real time, anywhere around the world, so that they don't have to get into a cab, onto a train, find transportation to get here, and wait many hours to be seen. It is cutting down on our time to make real-time decisions.