Current Knowledge and Implementation of Therapeutic Strategies in Cardio-Oncology: A National Physician-Based Survey.

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.