Ivanescu Andreea Cristina, Nitipir Cornelia, Bumbea Horia, Badila Elisabeta, Dan Gheorghe-Andrei
Carol Davila University of Medicine, Bucharest, Romania.
Colentina University Hospital, Bucharest, Romania.
Am J Ther. 2025;32(3):e223-e233. doi: 10.1097/MJT.0000000000001970.
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.
This study evaluates the awareness and knowledge of cardio-oncology diagnosis and treatment strategies among Romanian physicians.
A cross-sectional validated online survey was sent to clinicians treating oncological patients with cardiovascular (CV) risk or associated CV pathology.
The survey covered formal training, knowledge of basic cardio-oncology concepts, and therapy.
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.
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.
心脏肿瘤学已发展成为一门交叉学科和实践领域，旨在平衡化疗治疗的风险与益处。在实践中实施心脏肿瘤学项目是当前临床医学中最具挑战性的领域之一。在罗马尼亚，心脏肿瘤学中心稀缺，且没有专门的培训项目。因此，这些患者的护理高度异质且缺乏规范，往往未遵循指南建议。
本研究评估罗马尼亚医生对心脏肿瘤学诊断和治疗策略的认知与了解。
向治疗有心血管（CV）风险或相关CV病变的肿瘤患者的临床医生发送了一份经过验证的横断面在线调查问卷。
该调查涵盖了正规培训、心脏肿瘤学基本概念的知识以及治疗方法。
190名专业人员回复了我们的问卷，其中大多数是心脏病专家（73.2%），20.5%是肿瘤学家/血液学家，其余人员具有其他专业背景。只有21名受访者提到有专门的心脏肿瘤学团队。80%的受访者表示在左心室射血分数正常且CV风险较低的患者开始可能具有心脏毒性的肿瘤治疗前，不会开具预防性药物。即使在CV风险较高的患者中，仍有34.7%的受访者不会开具预防心脏毒性的药物。然而，大多数受访者（63.2%）不会考虑对CV事件高风险患者进行化疗。大多数受访者（90.5%）建议在有指征时对CV病变使用直接口服抗凝剂。对于接受氟嘧啶治疗的急性冠状动脉综合征，所有专业的回答都不一致，心脏病专家倾向于停止化疗。64名受访者认为肿瘤治疗导致的长QT间期是中断治疗的原因，心脏病专家更倾向于这样认为。
本次调查突出了在理解、预防和治疗CV毒性方面的异质性。它强调在所研究人群中缺乏明确且实施良好的临床实践算法。我们的调查凸显了指南与临床实践之间的差距。
