Cardio-oncology, from Guidelines to Practice: Filling the Gap - an Eastern European Viewpoint

Significant gaps persist in the real-world implementation of cardio-oncology guidelines, particularly in resource-limited settings. This viewpoint explores the application of evidence-based cardiovascular prevention, surveillance and management strategies amongst Romanian physicians treating cancer patients, enabling comparison with international data. A national, anonymous, online survey (September to November 2024) targeted cardiologists, oncologists, haematologists and internists. The 21-item questionnaire assessed institutional context, clinical practices, and adherence to international recommendations. A total of 190 responses were analysed. Centres with dedicated cardio-oncology teams and university affiliation more frequently apply structured risk stratification, monitor subclinical toxicity, and prescribe prophylactic pharmacotherapy. Centres without such teams demonstrate less consistent implementation of cardioprotective strategies and long-term follow-up. Cardiologists were more likely than oncologists to modify cancer therapy or initiate cardioprotective treatment in cases of early dysfunction. Long-term follow-up was inconsistently implemented and dependent on the institutional cardio-oncology organisation. Cardio-oncology practice in Romania remains heterogeneous, influenced by specialty, institutional resources and experience, highlighting the need for structured national programmes and interdisciplinary training.