Ludovic Jovenaux1, Jennifer Cautela1, Noemie Resseguier2, Michele Pibarot3, Myriam Taouqi3, Morgane Orabona1, Johan Pinto1, Michael Peyrol4, Jeremie Barraud4, Marc Laine4, Laurent Bonello4, Franck Paganelli1, Fabrice Barlesi5, Franck Thuny6. 1. Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France; Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Oncosaftey Network of the Early Phases Cancer Trials Center (CLIP(2)), France. 2. Aix-Marseille University, Department of Public Health, Research Unit EA 3279, France. 3. Assistance Publique - Hôpitaux de Marseille (AP-HM), ONCO-PACA-CORSE Oncology Regional Network, France. 4. Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France. 5. Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Oncosaftey Network of the Early Phases Cancer Trials Center (CLIP(2)), France; Aix-Marseille University, Multidisciplinary Oncology & Therapeutic Innovations Department, Assistance Publique - Hôpitaux de Marseille (AP-HM), Hôpital Nord, France. 6. Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Mediterranean University Cardio-Oncology Center (MEDI-CO Center), Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, Hôpital Nord, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), France; Groupe Méditerranéen de Cardio-Oncologie (gMEDICO), France; Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (AP-HM), Oncosaftey Network of the Early Phases Cancer Trials Center (CLIP(2)), France. Electronic address: franck.thuny@gmail.com.
Abstract
BACKGROUND: Cardiovascular toxicity has become a challenging issue during cancer therapy. Nonetheless, there is a lack of consensual guidelines for their management. We aimed to determine the current practices of oncologists regarding cardiovascular toxicity related to anthracyclines, trastuzumab and angiogenic inhibitors and to gather their opinions on the development of cardio-oncology programs. METHODS: A cross-sectional declarative study was submitted to French oncologists in the form of an individual, structured questionnaire. RESULTS: A total of 303 oncologists responded to the survey. Ninety-nine percent of oncologists prescribed cardiotoxic therapies, including anthracyclines (83%), trastuzumab (51%) and other angiogenic inhibitors (64%). The method adopted for managing cardiovascular toxicity was based on guidelines from expert oncology societies for only 35% of oncologists. None was aware of recommendations from expert cardiology societies. Prescription of pre-, peri- and post-therapy cardiovascular assessment was inconsistent and significantly less frequent for all classes of angiogenic inhibitors than for anthracyclines and trastuzumab (P<0.0001). Relative to pre-therapy assessment, post-therapy assessment was prescribed significantly less often for all cancer therapies (P<0.0001). Attitudes regarding the onset of left ventricular dysfunction were much more inconsistent when angiogenic inhibitors were involved. Additionally, the management of hypertension and QT prolongation was also inconsistent. Finally, 88% of oncologists supported projects of cardio-oncology programs development. CONCLUSIONS: Practices of oncologists are disparate in the field of cardiovascular toxicity. This finding underlines the complexity of managing many different situations and the need for distribution of formal guidelines from oncology and cardiology expert societies. The development of personalized cardio-oncology programs seems essential.
BACKGROUND:Cardiovascular toxicity has become a challenging issue during cancer therapy. Nonetheless, there is a lack of consensual guidelines for their management. We aimed to determine the current practices of oncologists regarding cardiovascular toxicity related to anthracyclines, trastuzumab and angiogenic inhibitors and to gather their opinions on the development of cardio-oncology programs. METHODS: A cross-sectional declarative study was submitted to French oncologists in the form of an individual, structured questionnaire. RESULTS: A total of 303 oncologists responded to the survey. Ninety-nine percent of oncologists prescribed cardiotoxic therapies, including anthracyclines (83%), trastuzumab (51%) and other angiogenic inhibitors (64%). The method adopted for managing cardiovascular toxicity was based on guidelines from expert oncology societies for only 35% of oncologists. None was aware of recommendations from expert cardiology societies. Prescription of pre-, peri- and post-therapy cardiovascular assessment was inconsistent and significantly less frequent for all classes of angiogenic inhibitors than for anthracyclines and trastuzumab (P<0.0001). Relative to pre-therapy assessment, post-therapy assessment was prescribed significantly less often for all cancer therapies (P<0.0001). Attitudes regarding the onset of left ventricular dysfunction were much more inconsistent when angiogenic inhibitors were involved. Additionally, the management of hypertension and QT prolongation was also inconsistent. Finally, 88% of oncologists supported projects of cardio-oncology programs development. CONCLUSIONS: Practices of oncologists are disparate in the field of cardiovascular toxicity. This finding underlines the complexity of managing many different situations and the need for distribution of formal guidelines from oncology and cardiology expert societies. The development of personalized cardio-oncology programs seems essential.
Authors: Jose A Alvarez-Cardona; Jordan Ray; Joseph Carver; Vlad Zaha; Richard Cheng; Eric Yang; Joshua D Mitchell; Keith Stockerl-Goldstein; Lavanya Kondapalli; Susan Dent; Anita Arnold; Sherry Ann Brown; Monica Leja; Ana Barac; Daniel J Lenihan; Joerg Herrmann Journal: J Am Coll Cardiol Date: 2020-11-10 Impact factor: 24.094
Authors: Giuseppe Curigliano; Evandro de Azambuja; Daniel Lenihan; Maria Grazia Calabrò; Daniela Cardinale; Carlo Maria Cipolla Journal: Oncologist Date: 2019-05-07
Authors: Somaira Nowsheen; Paul V Viscuse; Ciara C O'Sullivan; Nicole P Sandhu; Tufia C Haddad; Anne Blaes; Jennifer Klemp; Lara Nhola; Joerg Herrmann; Kathryn J Ruddy Journal: Curr Breast Cancer Rep Date: 2017-07-14