Adressing interdisciplinary gaps in cardiotoxicity management among chemotherapy patients: insights from a multispecialty survey in germany

Abstract Background Cardiotoxicity is a critical issue in chemotherapy patients, requiring a collaborative, multidisciplinary approach. This study explores variations in the management of cardiotoxicity across outpatient settings and medical specialties, highlighting potential disparities in patient care. Methods A comprehensive survey was designed to evaluate the practices and perspectives of cardiologists, oncologists, and gynecologists in managing cardiotoxicity among outpatient chemotherapy patients in Germany. The study involved 1,329 medical professionals via an online platform, achieving a response rate of 9.9%, with 132 participants. Results The participants reported collectively managing 1,905 chemotherapy patients monthly, with individual workloads ranging from 1 to 200 patients. Tumor types treated varied by specialty. Gynecologists primarily managed breast cancer, ovarian and adnexal tumors, and uterine body cancers, while oncologists predominantly treated bowel cancer, hematological malignancies, and lung cancer. Only 37% of oncologist-treated and 48% of gynecologist-treated patients underwent routine cardiological exams. Key reasons for the lack of cardiac care included no indication for follow-up (32.1% vs. 53.8%), limited cardiologist capacity (35.7% vs. 18.5%), and minimal perceived impact on therapy (14.3% vs. 12.3%). Less common reasons were insufficient cardiologist contact (10.7% vs. 6.2%) and other factors (7.1% vs. 9.2%). Only 42,9% of the cardiologist, 32,9% of the gynecologist and 70,6% of the oncologist reported conducting CV toxicity risk assessments. Commonly identified risk factors included prior heart disease, high-dose anthracyclines, HER2 or proteasome inhibitor therapy, obesity, age, and radiotherapy. Notably, elevated cardiac biomarkers were considered by just 20% of cardiologists and 37.5% of gynecologists. A significant portion of participants (56%) highlighted the need for simplified cardio-oncology guidelines. Among the respondents, 64,3% of cardiologists, 64,7% of oncologists, and 39,5% of gynecologists expressed interest in tools to aid cardiovascular toxicity risk assessment and the implementation of appropriate therapeutic measures for chemotherapy patients: 67,9%, 58,8% and 38,2% respectively. Conclusions This study highlights notable gaps in interdisciplinary care for cardiotoxicity, potentially leading to a higher risk of undiagnosed cardiovascular complications in chemotherapy patients. The variability in management practices across medical specialties underscores the importance of raising awareness and fostering collaboration. Developing comprehensive clinical pathways and establishing a dedicated cardio-oncology network could help address these issues, especially by providing support to primary care physicians.