Related Experiment Video
Updated: Aug 18, 2025
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Preferences and Attitudes of Cardiologists in Management of Patients with Cancer
Ibrahim Azar1,2, Stephani Wang3, Vikram Dhillon1
1Division of Hematology-Oncology, Department of Medicine, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA.
Insights
Cardiologists recommend fewer invasive treatments for metastatic cancer patients, potentially due to comorbidities or stigma. Improved communication between cardiology and oncology is crucial for personalized cancer and cardiovascular disease care.
Area of Science:
- Cardiology
- Oncology
- Medical Decision Making
Background:
- Increasing cancer patient survival necessitates better management of cardiovascular disease (CVD) in this population.
- Current U.S. data are lacking on how cancer's presence and extent affect cardiologists' decisions for common CVDs.
Purpose of the Study:
- To investigate how the extent of cancer influences cardiologists' treatment recommendations for common cardiovascular conditions.
- To identify potential disparities in care for cancer patients with CVD.
Main Methods:
- An anonymous online vignette-based survey was distributed to cardiologists at five U.S. institutions.
- The survey assessed treatment recommendations for atrial fibrillation, aortic stenosis, unstable angina, and coronary artery disease based on cancer stage (localized vs. metastatic).
Main Results:
- Cardiologists were significantly less likely to recommend procedural interventions for patients with metastatic cancer compared to localized cancer.
- For localized cancer, recommendations included left atrial appendage occlusion (20% vs. 8%), aortic valve repair (83% vs. 11%), left heart catheterization (70% vs. 27%), and percutaneous coronary intervention (81% vs. 38%).
- In metastatic cancer cases, cardiologists frequently sought oncology (82%) or palliative care (69%) consultations, yet undertreatment in localized and overtreatment in end-of-life disease were observed.
Conclusions:
- Cardiologists are less inclined to recommend invasive cardiovascular therapies for patients with metastatic cancer, possibly influenced by comorbidities, quality of life, or cancer stigma.
- Enhanced communication between cardiologists and oncologists is essential for delivering personalized care that optimizes benefits and minimizes morbidity for cancer patients with CVD.
Background:
With recent improvements in survival of cancer patients and common use of high-value care at end of life, the management of cardiovascular disease (CVD) in patients with cancer is increasingly important. To our knowledge, there are no current U.S. data examining how the presence and extent of cancer influence cardiologists' decision making for common cardiovascular conditions.
Methods:
An anonymous online vignette-based survey of cardiologists was conducted at five U.S. institutions investigating how the extent of gastrointestinal and thoracic malignancies (prior/localized, metastatic) would influence treatment recommendations for atrial fibrillation (AF), aortic stenosis, unstable angina (UA), and obstructive coronary artery disease (CAD).
Results:
Thirty-three percent (86/259) of cardiologists completed the survey between September and November 2019. Participants were 67% male, 51% below age 40, and 58% had five or more years of clinical experience. Majority of cardiologists practiced at teaching hospitals (72%) and were noninterventional (63%). Cardiologists were more likely to recommend procedural interventions for patients with localized cancer than for those with metastatic disease: AF (left atrial appendage occlusion: 20% vs. 8%), atrial stenosis (aortic valve repair: 83% vs. 11%), UA (left heart catheter: 70% vs. 27%), and obstructive CAD (percutaneous coronary intervention: 81% vs. 38%). In patients with metastatic cancer, most cardiologists sought an oncology (82%) or a palliative care (69%) consultation. However, a persistent trend of undertreatment in patients with localized cancers and overtreatment in patients with end-of-life disease was apparent.
Conclusions:
Cardiologists were less likely to recommend invasive cardiovascular therapies to patients with metastatic cancer. This preference pattern likely reflects the influence of comorbidities and quality of life expectation on cardiologists' treatment recommendations but may also be related to the stigma of advanced cancer. Better communication between cardiologists and oncologists is necessary to provide a personalized care of patients with cancer and CVD that would maximize treatment benefit with least morbidity.
More Related Videos
14:24Percutaneous Contrast Echocardiography-guided Intramyocardial Injection and Cell Delivery in a Large Preclinical Model
Published on: January 21, 2018
12:24A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Related Concept Videos
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:29Cardiomyopathy V: Interprofessional Care
01:27Nursing Ethical Principles II
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...
01:26Angina IV: Management
01:20Angina V: Nursing Management
01:27Coronary Artery Disease V: Interprofessional Care