1Klinikum Chemnitz gGmbH Innere Medizin I - Kardiologie Chemnitz, Deutschland; 2Zweigstelle am Medizincampus Chemnitz der TU Dresden Zentrum für evidenzbasierte Gesundheitsversorgung Chemnitz, Deutschland
Background: Cardiotoxicity is a major concern in patients undergoing chemotherapy, requiring an interdisciplinary management. However, the extent to which cardiotoxicity is managed in the outpatient setting may vary among these specialists, potentially leading to gaps in patient care.
Methods: This questionnaire study assessed the current practices and perceptions of cardiologists, oncologists, and gynecologists regarding the management of cardiotoxicity in patients undergoing outpatient chemotherapy in Germany. A total of 1,716 medical professionals were contacted via an online questionnaire, and 132 (7.7%) were included in the in the survey. It ought to be noted that this rate mirrors the particular selection criteria, as exclusively those participants treating chemotherapy patients were included in this study.
Results: The participants in our survey reported treating a total of 1,905 chemotherapy patients per month (range 1 to 200). Of these patients, only 37% of those treated by oncologists (n=13) and 48% of those treated by gynecologists (n=53) received cardiological baseline and follow-up examinations. The results showed that 37% (49/132) of the healthcare professionals surveyed said they performed cardiovascular toxicity risk assessment of chemotherapy in their clinical practice. More than half of the participants (56%, 39/70) expressed a need for simplified cardio-oncology guidelines. The majority of participants (84% (59/70) and 83% (58/70), respectively) requested tools to assist in cardiovascular toxicity risk assessment and the implementation of appropriate therapeutic measures for patients undergoing chemotherapy.
Cardiological Baseline and Follow-up Examination
Only 37% and 48% of patients treated by oncologists (n=13) and gynecologists (n=48), respectively, receive cardiological baseline and follow-up examinations. Reasons for no cardiac care in cancer patients are summarized in Table 1.
Figure 1.
Regular Tests Performed on Patients
Medical history, ECG, and echocardiography were the most frequent examinations. Notably, 91.3% did not include cardiac biomarker measurements in their follow-up procedures (Figure 2) .
Figure 2.
Use of Cardio-Protective Medications (Figure 3).
Figure 3.
Cardiovascular Toxicity Risk Assessment
The results showed that 37.1 % (49/132) of the surveyed medical professionals reported performing CV toxicity risk assessment in their clinical practice. However, it should be noted that only 47.8% (63/132) of respondents answered the question.
Assessing Cardiotoxicity
When asked about cardiotoxicity, 65.5% of respondents agreed that any decrease in ejection fraction was a relevant marker for cardiotoxicity. Detailed information are shown in table 3. It is to note that only 50% (66/132) of those surveyed responded to this question.
On average, 13% of patients receiving chemotherapy underwent cardiac marker testing under medical supervision according to the respondents (n=70) in our survey. Table 4 provides a comprehensive analysis of the timing of biomarker testing across these specialties.
Conclusions: Our study underscores potential interdisciplinary care gaps, possibly increasing the risk of undetected cardiotoxicity. Variations in cardiotoxicity management among specialties highlight the need for increased awareness and improved collaboration. Interdisciplinary clinical pathways could address these issues, as could a dedicated cardio-oncology network for primary care physicians' support.