American journal of therapeutics · 2025
Current Knowledge and Implementation of Therapeutic Strategies in Cardio-Oncology: A National Physician-Based Survey.
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Ivanescu Andreea Cristina, Nitipir Cornelia, Bumbea Horia, Badila Elisabeta, Dan Gheorghe-Andrei
Аннотация
BACKGROUND: Cardio-oncology has developed as an intersection science and practice, balancing the risks and benefits of chemotherapy treatment. Implementing a cardio-oncology program in practice is currently one of the most challenging areas of clinical medicine. In Romania, there are scarce cardio-oncology centers and no dedicated training programs. Thus, the care of these patients is highly heterogeneous and empirical, often without following guideline recommendations.
STUDY QUESTION: This study evaluates the awareness and knowledge of cardio-oncology diagnosis and treatment strategies among Romanian physicians.
STUDY DESIGN: A cross-sectional validated online survey was sent to clinicians treating oncological patients with cardiovascular (CV) risk or associated CV pathology.
MEASURES AND OUTCOME: The survey covered formal training, knowledge of basic cardio-oncology concepts, and therapy.
RESULTS: One hundred ninety professionals responded to our questionnaire, most being cardiologists (73.2%), 20.5% oncologists/hematologists, and the remaining had other specialties. Only 21 respondents mentioned the availability of dedicated cardio-oncology teams. Eighty percent would not prescribe prophylactic medication before starting a potentially cardiotoxic oncological treatment in patients with a normal left ventricular ejection fraction and low CV risk. Even in patients with high CV risk, 34.7% would still not prescribe medication for primary prevention of cardiotoxicity. However, most respondents (63.2%) did not consider chemotherapy in patients at high risk of CV events. Most respondents (90.5%) recommend direct oral anticoagulants for CV pathology if indicated. For acute coronary syndromes under fluoropyrimidine treatment, the responses are heterogeneous for all specialties, with a tendency to stop chemotherapy for cardiologists. Sixty-four respondents considered long QT secondary to oncologic treatment a reason to interrupt treatment, with cardiologists more likely to consider it.
CONCLUSIONS: This survey highlights the heterogeneity in understanding, preventing, and treating CV toxicity. It emphasizes the lack of clear, well-implemented clinical practice algorithms in the population studied. Our survey underlines the gap between guidelines and clinical practice.
STUDY QUESTION: This study evaluates the awareness and knowledge of cardio-oncology diagnosis and treatment strategies among Romanian physicians.
STUDY DESIGN: A cross-sectional validated online survey was sent to clinicians treating oncological patients with cardiovascular (CV) risk or associated CV pathology.
MEASURES AND OUTCOME: The survey covered formal training, knowledge of basic cardio-oncology concepts, and therapy.
RESULTS: One hundred ninety professionals responded to our questionnaire, most being cardiologists (73.2%), 20.5% oncologists/hematologists, and the remaining had other specialties. Only 21 respondents mentioned the availability of dedicated cardio-oncology teams. Eighty percent would not prescribe prophylactic medication before starting a potentially cardiotoxic oncological treatment in patients with a normal left ventricular ejection fraction and low CV risk. Even in patients with high CV risk, 34.7% would still not prescribe medication for primary prevention of cardiotoxicity. However, most respondents (63.2%) did not consider chemotherapy in patients at high risk of CV events. Most respondents (90.5%) recommend direct oral anticoagulants for CV pathology if indicated. For acute coronary syndromes under fluoropyrimidine treatment, the responses are heterogeneous for all specialties, with a tendency to stop chemotherapy for cardiologists. Sixty-four respondents considered long QT secondary to oncologic treatment a reason to interrupt treatment, with cardiologists more likely to consider it.
CONCLUSIONS: This survey highlights the heterogeneity in understanding, preventing, and treating CV toxicity. It emphasizes the lack of clear, well-implemented clinical practice algorithms in the population studied. Our survey underlines the gap between guidelines and clinical practice.