Knowledge gaps and educational needs for common cancer therapy-related cardiovascular toxicities and related drug interactions.

Abstract

e13672 Background: Unprecedented growth in novel oncolytic agents has led to an increase in the complexity of cancer management, including cancer therapy-related cardiovascular toxicities (CTR-CVTs) and related pharmacodynamic (PD) and pharmacokinetic (PK) drug-drug interactions (DDIs). The intent of this survey is to assess the landscape of CTR-CVTs including health care provider (HCP) educational needs. Methods: A 20-question survey was distributed to HCPs primarily specializing in cardiology, oncology, hematology and cardio-oncology. The survey was distributed on email listservs of targeted organizations, including the International Cardio-Oncology Society. In addition to demographics, the survey assessed CTR-CVTs and related DDIs encountered. Perceived knowledge gaps were also assessed. Data was analyzed and summarized utilizing descriptive statistics. Results: Of 220 survey respondents, 46% were pharmacists and 54% were other HCPs ( > 80% physicians). Respondents predominately practiced in North America (59%) or Europe (20%), with the majority at academic medical centers (65% academic, 35% community) and primarily specializing in cardiology (71%, cardiology, 26% oncology, 14% hematology). Types of malignancies managed were primarily solid tumors (74%), however hematological malignancy management was also common ( > 60%). All HCPs reported encountering the following CTR-CVTs most commonly: cancer therapy-related cardiac dysfunction (CTRCD) (88%), hypertension (HTN) (79%) and thromboembolic disease (71%). Overall, pharmacists reported managing CTR-CVTs less frequently than other HCPs, especially regarding atrial fibrillation/flutter, coronary artery disease/vasospasm and bradycardia/AV block. The most common cardio-oncology-related PD DDIs encountered were CTRCD and QT prolongation/Torsades de Pointes (QTP/TdP). The most frequently managed cardio-oncology-related PK DDIs included antiarrhythmic agents, direct-acting oral anticoagulants and antiplatelet agents. All HCPs reported greatest comfort managing anthracycline/HER2 targeted therapy-associated CTRCD and least comfort managing arsenic-associated QTP. Immune checkpoint inhibitor-associated myocarditis (74%), immune modulator-associated thrombosis/thrombotic events (64%), Bruton tyrosine kinase inhibitor associated bleeding (58%) and atrial fibrillation (55%) were ranked of highest educational need. Overall, responses for PD/PK DDIs and educational recommendations were similar between pharmacists and other HCPs. Conclusions: This survey provides insight on the most commonly encountered CTR-CVTs and related DDIs as well as knowledge gaps of HCPs managing CTR-CVTs. These specific areas should be targeted for future educational initiatives to optimize the cardiovascular care of patients with cancer.