Snapshot of cardio-oncology practice in Italy

Abstract Background Several types of patients should be referred to cardio-oncology services, but some may prevail in clinical practice. Moreover, with the global aging of the population of industrialized countries, the patterns of cardio-oncology care of elderly individuals should be object of particular attention. Purpose and methods We retrospectively collected the data of patients evaluated during the first 2 weeks of December 2024 at 9 centres, directed by members of the Cardio-Oncology Study Group of the Italian Society of Cardiology. Results 365 patients were seen during the study period, of whom 238 (65.2%) had solid tumours and 127 (34.8%) haematological tumours. The mean age was 66 (14-93) years and 159 (43.6%) were male. The most common cancers were breast cancer (BC; N=106, 29.0%), non-Hodgkin lymphoma (NHL; N=39, 10.7%) and acute myeloid leukaemia (N=21, 5.8%). The most frequent cancer treatment was immune checkpoint inhibitor (N=76, 20.8%). Consistent with the predominance of BC, chemotherapy agents, HER2-targeting drugs, and endocrine therapy were well represented (Fig. 1A). Sixty-four (17.5%) patients were not scheduled for, nor were receiving cancer treatment at the time of evaluation. The cardio-oncology visit was most often performed for monitoring of cardiovascular (CV) toxicity of ongoing cancer treatment (N=164, 44.9%), or for baseline risk assessment (N=100, 27.4%). The remaining patients were seen because of abnormal cardiac biomarkers, abnormal cardiac imaging, CV symptoms/signs, CV events, or overt CV disease (Fig. 1B). After the cardio-oncological evaluation, follow-up without any intervention was suggested for the majority of subjects (N=240, 65.8%). Another 105 (28.8%) were initiated on CV medications. Cancer treatment was stopped in 9 patients (2.5%), 4 (1.1%) were admitted, and 7 (1.9%) were not further followed (Fig. 1B). Patients with ≥70 years (N=140) were more often male (54.3% vs 36.9%, p=0.001) and had less often BC (17.9% vs 36%, P 0.001) than those younger than 70 years. There were non-significant trends for higher use of tyrosine kinase inhibitor (14.3% vs 8.4%, p=0.08) and lower use of HER2-targeting therapies (6.4% vs 11%, p=0.06) and hematopoietic stem cell transplantation (1.4% vs 5.3%, p=0.06) in older than younger patients. The reasons and outputs of the cardio-oncology assessment were similarly distributed in the 2 groups. Conclusions This cross-sectional study indicates that cardio-oncology practice in Italy largely consists of baseline evaluation and follow-up of patients with cancer, especially BC, with or without optimization of CV therapy, in agreement with the core tasks outlined by the ESC Guidelines on Cardio-Oncology. We did not detect substantial differences in the management of younger vs older patients.Figure 1