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Published on: December 5, 2020
Community-Based Cardio-Oncology Model for Hypertension Management in Gynecologic Oncology Patients on VEGF Inhibitors
Pragnya Tatikonda1, Lalitha C Medepalli2, Christopher N Cooper1
1Northside Hospital Gwinnett Internal Medicine Residency Program, Lawrenceville, Georgia, USA.
Background:
Vascular endothelial growth factor inhibitors (VEGFi) play an integral role in the treatment of gynecologic malignancies. However, a common limitation to treatment is hypertension, a known adverse effect of VEGFi. Patients requiring prolonged treatment with VEGFi carry a higher cardiovascular risk.
Project Rationale:
There is no standardized, prospective pathway to manage VEGFi-associated hypertension and keep cancer therapy on schedule, particularly in gynecologic oncology patients with prolonged therapy and comorbidities.
Project Summary:
We implemented a prospective, nonrandomized, and protocol-driven pilot quality improvement study enrolling 22 patients with gynecologic malignancies who were initiating or receiving VEGFi therapy. Management included mechanism-based antihypertensive therapy, grant-funded home blood pressure monitoring, structured education, and multidisciplinary follow-up. No patient had hypertension-related interruptions to VEGFi therapy, and most achieved control with 1 to 2 agents.
Take-Home Message:
A multidisciplinary cardio-oncology pathway successfully prevented hypertension-related VEGFi treatment interruptions while emphasizing the importance of addressing broader cardiovascular comorbidities beyond hypertension alone.
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