Development of a cardiac device service at the largest single site oncology hospital in Europe

Increasing numbers of patients with Cardiac Electronic Implantable Devices (CIED) are requiring imaging and treatment for cancer. Access to specialist services for these cancer pathways for CIED patients is inconsistent and can result in delays or impaired outcomes.

Prior to 2023 at this specialist oncology hospital, patients with CIEDs could not have radiotherapy, proton beam therapy or Magnetic Resonance Imaging (MRI) scans on site and needed these tests or treatments at other centres. This was because there were no scientific healthcare staff with specialised CIED expertise on site for management of the CIED pre/intra/post procedure. In collaboration with the local tertiary cardiac service, a new Cardiac Physiologist device service was developed, enabling patients to have all their tests and treatments in one centre.

Cardiac Device Specialist Physiologists provide daily cover for device patients undergoing surgery, MRI scans and radiotherapy. The cardiac physiology team triage referrals for patients with CIEDs according to device type, pacing dependency and type of procedure, in line with national and local guidelines and Standard Operating Procedures. The necessary pre- and post-procedure device checks were performed as well as Electrocardiogram (ECG) monitoring throughout treatment, as required. Teaching sessions were held for staff involved in the patient journey to raise awareness and understanding of the new service. Activity data for the first 12 months of the new CIED-oncology service was collected.

One hundred and eighty patient referrals were triaged. Of these, 124 patients required intervention from the cardiac device team. 40 patients underwent radiotherapy (each undergoing up to 30 treatments), 57 had MRI scans, 21 had surgery, 1 underwent proton beam therapy and 5 required in-patient CIED checks, including permanent Implantable Cardioverter Defibrillator (ICD) deactivation. In total, 557 CIED device checks were performed. In a UK first, a patient with a pacemaker was able to safely undergo proton beam therapy for Chordoma (located at the base of the skull).

Interdisciplinary working between CIED specialists and the oncology team has improved access to important diagnostic tests and treatment pathways in CIED recipients who have cancer. A new onsite cardiac device service at Europe’s largest single site oncology hospital now means patients have all their oncology procedures and tests at one hospital. We suggest that all moderate-large oncology services should have clear treatment pathways that ensure that CIED recipients have timely and efficient access to cancer diagnostics and treatments.