First phase implementation of cardio-oncology program in the middle-income country of Costa Rica at Hospital Metropolitano healthcare system.

Abstract

e24091 Background: Developing a cardio-oncology program in a middle-income country like Costa Rica can present unique opportunities and challenges. Hospital Metropolitano is a health care system in Costa Rica with a network of two hospitals, 36 clinics, and over 150,000 patients enrolled in its health plan, Medismart. Here we summarize our program, and the initial results of the implementation phase, hoping that institutions with similar resources in low-and-middle-income countries will use this as guidance to develop their own cardio-oncology program. Methods: A cardio-oncology committee was established in May 2019 and includes medical providers, clinical coordinators, administrative workers, and nursing and laboratory staff. A 4-month pre-launch period was established to create an institutional protocol after we reviewed guidelines and literature from similar programs in the United States and Europe. The protocol targets both active cancer patients undergoing treatment and cancer survivors. The program was launched in September 2019 and is currently in the first phase of implementation. Results: During the first phase of implementation, the program was limited to the outpatient setting and patients were referred exclusively by the medical oncology providers from our health care system. In this period, 28 patients met criteria for referral and all enrolled according to our protocol. The median age of our patients was 49 (range 16-77). 25 patients (89%) were female and 20 (71%) had a diagnosis of breast cancer. At the time of enrollment, 21 (75%) were receiving active cancer treatment and 7 (25%) were identified as cancer survivors. All patients are being followed prospectively. A committee review at the end of the first phase of implementation revealed that the most important challenges that the program needs to address for the second phase of implementation include the following: 1) patient education and outreach, 2) cost of care associated with the interventions recommended by the protocol, and 3) data tracking/registry given the lack of an electronic medical record. Conclusions: Our program represents a real-life experience of the challenges and opportunities that institutions in middle-income countries need to consider when launching such initiatives. To our knowledge, this is the first cardio-oncology program formally established in Central America and we are committed to continue to measure our outcomes prospectively and share these with the global oncology community.