Samantha’s Web: Integrated breast cancer and heart failure treatment – VCU Health

Report on Multidisciplinary Healthcare and its Alignment with Sustainable Development Goals

Case Study: VCU Health Cardio-Oncology Program

This report analyzes the multidisciplinary healthcare model implemented by VCU Health, using the case of a patient with concurrent postpartum heart failure and breast cancer. The analysis emphasizes the model’s direct contributions to achieving the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being).

Analysis of Integrated Care Model

Patient Profile and Clinical Challenge

The case involves a female patient who developed peripartum cardiomyopathy (postpartum heart failure) following childbirth complications. Subsequently, she was diagnosed with bilateral breast cancer. This dual diagnosis presented a significant clinical challenge, as standard cancer treatments, such as chemotherapy, are known to be cardiotoxic and could exacerbate her pre-existing heart condition. This situation directly pertains to SDG 3, Target 3.4, which aims to reduce premature mortality from non-communicable diseases (NCDs) like cancer and heart disease.

The Multidisciplinary Team Approach

VCU Health addressed this complex case through its cardio-oncology program, a specialized, integrated unit that exemplifies SDG 17 (Partnerships for the Goals). The core components of this approach include:

• Collaboration between cardiologists from the Pauley Heart Center and oncologists from the Massey Comprehensive Cancer Center.
• Development of a unified treatment plan that simultaneously managed heart failure and administered effective cancer therapy.
• Proactive cardiac monitoring throughout the cancer treatment process to mitigate risks and adjust therapies as needed.
• Involvement of surgical, plastic surgery, and radiation oncology teams within a single, coordinated system.

This model ensures that treatment for one NCD does not compromise the management of another, thereby improving patient safety and outcomes.

Contributions to Sustainable Development Goals (SDGs)

SDG 3: Good Health and Well-being

The VCU Health model makes significant contributions to ensuring healthy lives and promoting well-being for all ages.

1. Reducing Premature Mortality from NCDs (Target 3.4): By creating a framework to safely treat cancer in a patient with severe heart failure, the program directly prevents premature mortality. The patient successfully entered remission with improved cardiac function, a testament to the model’s efficacy.
2. Ensuring Access to Quality Essential Health-Care Services (Target 3.8): The cardio-oncology program represents a high-quality, essential health service. Its integrated nature moves beyond fragmented care to provide a comprehensive solution, which is a key component of achieving universal health coverage.
3. Strengthening Maternal and Women’s Health: The case originated with postpartum heart failure, a serious maternal health issue. The program’s ability to manage this condition alongside cancer underscores a commitment to women’s health, aligning with the broader goals of SDG 3 and SDG 5 (Gender Equality).

SDG 9: Industry, Innovation, and Infrastructure

The cardio-oncology program is an innovation in healthcare service delivery.

• It represents an enhancement of institutional infrastructure, fostering research and specialized care.
• This collaborative clinical model is a form of process innovation that upgrades the capability of the health sector to manage complex co-morbidities, aligning with Target 9.5 to enhance scientific research and upgrade technological capabilities.

SDG 17: Partnerships for the Goals

The success of the patient’s treatment is fundamentally rooted in partnership. The intra-institutional collaboration between distinct medical specialties (cardiology, oncology, surgery) serves as a powerful example of the partnership principle outlined in SDG 17. This framework demonstrates that complex global health challenges can be addressed effectively through coordinated, multi-stakeholder efforts.

Outcomes and Public Health Implications

Clinical Outcome

The patient’s treatment was successful. She is now in cancer remission, and her heart failure has been resolved, with cardiac function strengthened. This outcome validates the multidisciplinary approach as a superior model for complex patient care.

Broader Implications

• The case demonstrates a scalable and effective framework for managing patients with multiple NCDs, a growing global health concern.
• It highlights the critical need for integrated care systems within healthcare institutions to achieve the targets set by the Sustainable Development Goals.
• The VCU Health cardio-oncology program serves as a best-practice model for other health systems aiming to improve outcomes for complex diseases while promoting health equity and well-being.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The entire article is centered on health, detailing a patient’s journey with complex medical conditions—postpartum heart failure and breast cancer. It highlights the provision of advanced, comprehensive healthcare services, successful treatment outcomes, and the promotion of patient well-being, which are the core principles of SDG 3. The narrative focuses on ensuring a healthy life for the patient, allowing her to recover and thrive.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.1: Reduce global maternal mortality
   • The article explains that the patient’s health issues began with severe complications after childbirth, including a bowel perforation, sepsis, and heart complications that led to postpartum heart failure (peripartum cardiomyopathy). The successful management of this life-threatening postpartum condition directly relates to efforts to reduce maternal mortality and morbidity. The FAQ section explicitly mentions VCU Health’s specialists in “cardio-obstetrics” who provide “early diagnosis and treatment to prevent long-term complications” from conditions like postpartum heart failure.
2. Target 3.4: Reduce by one third premature mortality from non-communicable diseases (NCDs) through prevention and treatment and promote mental health and well-being
   • The article focuses on the advanced treatment of two major NCDs: cancer and cardiovascular disease (heart failure). The VCU Health cardio-oncology program is presented as a model for effectively treating these co-occurring conditions to prevent a premature death. The article states, “Together, the teams at Massey Comprehensive Cancer Center and Pauley Heart Center put a plan in place to beat breast cancer, while protecting Sam’s heart.” Furthermore, the patient’s positive outlook and statement, “I feel more confident that the future does exist for me,” reflects the promotion of mental health and well-being following successful treatment.
3. Target 3.8: Achieve universal health coverage, including access to quality essential health-care services
   • The article showcases the provision of high-quality, essential, and specialized healthcare. The patient’s case required a “multidisciplinary team approach” involving cardiologists, oncologists, surgeons, and radiologists working in a coordinated system. The patient’s testimony, “It was just so nice to have just one system,” emphasizes the value of accessible and integrated quality care, which is a key component of universal health coverage. The program ensures that patients with complex needs receive comprehensive attention without sacrificing the effectiveness of treatment for any single condition.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicators for Target 3.1 (Maternal Health)
   • Availability of specialized postpartum care: The article implies this indicator by highlighting the existence of specialists in “cardio-obstetrics” and a “cardio-oncology program” capable of managing severe, life-threatening complications arising after childbirth, such as peripartum cardiomyopathy.
2. Indicators for Target 3.4 (NCDs)
   • Implementation of integrated care models for NCDs: The detailed description of the “VCU Health cardio-oncology program” serves as a direct indicator of an integrated approach. The article notes this model “bring[s] together cardiologists, oncologists, nurses, and researchers to create personalized treatment plans.”
   • Successful treatment outcomes for co-morbid NCDs: The patient’s outcome is a clear indicator of progress. The article states, “Treatment worked and today she is in remission and has a heart that is stronger than ever.”
   • Improved patient well-being post-treatment: The patient’s personal testimony serves as a qualitative indicator. Her statement, “Every sunset, every sunrise, everything is like the best that it’s ever been in my mind,” demonstrates a significant improvement in her well-being.
3. Indicators for Target 3.8 (Universal Health Coverage)
   • Access to multidisciplinary healthcare teams: The article repeatedly emphasizes this as a cornerstone of care at VCU Health. The patient’s experience of having her “cardiologist in communication with my oncologist in communication with my surgeon” within “one system” is a strong indicator of access to coordinated, quality services.
   • Availability of advanced medical technologies and procedures: The use of proactive heart monitoring during chemotherapy, as mentioned in the article, indicates the availability of advanced healthcare services designed to ensure patient safety and treatment efficacy.

4. Summary Table of SDGs, Targets, and Indicators

Source: vcuhealth.org