Most cancer clinicians want to have dedicated cardio-oncology services to manage cardiotoxicity in cancer patients but face barriers such as lack of funding and expertise, an Australian study has shown.
An online survey that drew responses from more than 100 specialists in oncology and cardiology found that nearly 90% agreed that cardio-oncology was an important subspeciality.
However only 30% of respondents said their institution currently had dedicated cardio-oncology services, mainly due to insufficient funding (48%), and lack of available expertise (30%).
The survey, which was targeted at members of professional bodies such as the Clinical Oncology Society of Australia (COSA) and cardiology Society of Australia and New Zealand (CSANZ), revealed that 70% of specialists believed their institutions would set up cardio-oncology services in the next two years, but again dependent on having funding and expertise.
Currently only about half the respondents said they had confidence in the identification of cardiotoxicity in cancer patients. In the absence of dedicated cardio-oncology services most said they would refer patients to general cardiology clinics to manage potential cardiotoxicity.
The oncology and haematology specialists who accounted for more than half of survey participants estimated that around 15% of their patients did not receive optimal cancer treatment because of cardiotoxicity or a history of cardiovascular disease.
Most oncologists and haematologists (62%) reported that they always screened patients for cardiovascular history and risk factors prior to cancer therapy. Screening for cardiotoxicity during cancer therapy with cardiac imaging was reported for 44% of patients regardless of symptoms and for 33% with symptoms.
There was overwhelming support for Australian cardio-oncology guidelines (97% of respondents) and for having cardio-oncology sessions at national society meetings (88% support)
The organisers of the survey led by Dr Christopher Yu of the Cardiology Department, Nepean Hospital, Sydney, said the responses provided the first snapshot of the status of cardio-oncology services in Australia.
They said cardio-oncology was growing in importance due to the success of cancer therapies improving long term survival, with cardiovascular mortality now the leading cause of death in many cancer patients.
The survey findings provide strong support for further cardio-oncology education, guidelines and services nationally, they concluded.
“A multi-disciplinary team funding model following existing templates in oncology may be a pathway forward,” they suggested.
The survey findings are published in Internal Medicine Journal.