Abstract Background There is still heterogeneity in the awareness, prevention, surveillance, and treatment of cardiotoxicity, especially in the centers where socioeconomic and health policy factors delay alignment with guidelines recommendations. Purpose To gain insight into current practices, aiming to improve multidisciplinary collaboration and patient outcomes. Methods An anonymized online survey was distributed to Romanian physicians involved in cancer care. We present a comparative analysis of cardiologists and oncologists responses. Results This analysis included the answers of 139 cardiologists and 39 oncologists. Only 10.1% reported the availability of cardio-oncology teams, with oncologists having more access (25.6%) to these centers than cardiologists (5.7%). 38 of 39 oncologists do not prescribe prophylactic medication before potentially cardiotoxic treatments for patients with normal LVEF and low cardiovascular risk, while 25.1% of cardiologists do. For high CV-risk patients, 76.9% of oncologists and 21.5% of cardiologists do not prescribe prophylactic medication. Among prescribers, oncologists use mostly anticoagulants, whereas cardiologists mostly ACEIs and beta-blockers. Cardiologists almost exclusively referred to lifestyle changes. Only 46.15% of oncologists and 59% of cardiologists prescribe prophylactic therapy for patients with positive CV markers. Oncologists predominantly use biomarkers (71.7%) to evaluate subclinical CV toxicity, while cardiologists favor a wider range of methods. Most respondents accepted DOACs for CV pathology if indicated. Among the 8 who do not, 7 are oncologists. Cardiologists consider it beneficial to discontinue trastuzumab therapy if it determines an asymptomatic mild decrease of LVEF. In patients with acute coronary syndrome on fluoropyrimidines, no oncologists would continue treatment, while 7.1% of cardiologists would do it. Long QT induced by oncological treatment led 66% of oncologists and 25% of cardiologists to interrupt treatment, while 31.6% of cardiologists and 15% of oncologists would continue treatment with monitoring. For cancer survivors, 38 out of 39 oncologists, felt cardiologists should monitor CV toxicity surveillance. Only 25 oncologists thought they should also be involved in cancer survivors’ surveillance. Still, most respondents agreed on the importance of outpatient clinics with a cardio-oncology department (51.2% of oncologists and 66.9% of cardiologists). Conclusions There is still a low degree of awareness regarding CV protection of oncologic patients. Discrepancies mainly involve prophylactic strategies. Oncologists prescribe fewer prophylactic medications and rely on biomarkers for subclinical CV toxicity, while cardiologists use a wider range of diagnostic methods. Cardiologists act more promptly in the presence of evidence of myocardial toxicity. However, dedicated multidisciplinary teams are insufficient, with oncologists having more access to them than cardiologists.
Ivănescu et al. (Fri,) studied this question.
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