Table 1 Questions in online survey. For each question, only one of the answers could be selected. As an alternative, there was the possibility to write free text instead of choosing one of the available options for every multiple-choice question. In the last column, the percentage response to the respective options is given. Additional file 1 includes the remarks that were given at in the open text field at the option ‘other’

Demographics

In what professional way are you affiliated to cardio-oncology?

a. Oncologist (medical/clinical/radiation therapy

b. Cardiologist

c. Pre-clinical researcher

d. Epidemiologist

e. Other, …

a. 26 (28.0%)

b. 48 (51.6%)

c. 8 (8.6%)

d. 2 (2.2%)

e. 9 (9.7%)

In what kind of institution is your main position?

a. University/teaching hospital

b. Community hospital

c. Private hospital

d. Research institute

e. Other, …

a. 83 (90.2%)

b. 3 (3.3%)

c. 2 (2.2%)

d. 2 (2.2%)

e. 2 (2.2%)

How long have you been practicing your profession?

a. > 20 years

b. 10–20 years

c. 5–10 years

d. < 5 years

e. In training

a. 38 (41.3%)

b. 28 (30.4%)

c. 15 (16.3%)

d. 7 (7.6%)

e. 4 (4.3%)

How long have you been involved in cardio-oncologic care/research?

a. > 20 years

b. 10–20 years

c. 5–10 years

d. < 5 years

e. In training

a. 9 (9.8%)

b. 23 (25.0%)

c. 28 (30.4%)

d. 29 (31.5%)

e. 2 (2.2%)

What is your gender

a. Female

b. Male

a. 34 (37.8%)

b. 56 (62.2%)

Organization of cardio-oncologic care

How is the care for patients with an oncological diagnosis and cardiovascular disease (CVD) organized at your institution?

a. Dedicated clinical team with scheduled multi-disciplinary conferences

b. Ad-hoc multi-disciplinary discussions and referrals

c. No possibilities for this

d. Other, …

e. Not applicable

a. 38 (41.3%)

b. 42 (45.7%)

c. 5 (5.4%)

d. 4 (4.3%)

e. 3 (3.3%)

Prevention

Do you prescribe preventive medication before start of a potentially cardiotoxic oncological treatment in patients with a normal left ventricular ejection fraction (LVEF) and without uncontrolled risk factors for cardiovascular disease (CVD)?

a. No

b. Yes, an ACE-inhibitor or angiotensin receptor antagonist

c. Yes, a beta-blocker

d. Yes, a statin

e. Yes, anticoagulants

f. Yes, a combination of the abovementioned

g. Only in case of estimated increased risk for cardiotoxicity based on published risk scores (e.g., Ezaz et al., J Am Heart Assoc 2014; Herrmann et al., Mayo Clin Proc 2014)

h. Other, …

i. Not applicable

a. 48 (52.7%)

b. 4 (4.4%)

c. 1 (1.1%)

d. 0

e. 0

f. 8 (8.8%)

g. 15 (16.5%)

h. 6 (6.6%)

i. 9 (9.9%)

Do you provide life-style advices to your patients (with and without CVD) before they commence an oncological treatment?

a. No, no time for this

b. No, not enough evidence to support such recommendations

c. Yes, physical exercise

d. Yes, weight loss

e. Yes, smoking cessation

f. Yes, a combination of the abovementioned

g. Other, …

h. Not applicable

a. 4 (4.4%)

b. 5 (5.5%)

c. 5 (5.5%)

d. 0

e. 0

f. 65 (71.4%)

g. 5 (5.5%)

h. 7 (7.7%)

What do you regard the best method for prevention of future development of CVD in patients treated for a malignancy?

a. Cardiovascular risk management according to general guidelines, with treatment initiation based on accepted thresholds (blood pressure, lipid profile, glucose)

b. Preventive medication such as ACE-inhibitors, ARBs, beta-blockade independent of risk factors

c. Preventive medication such as ACE-inhibitors, ARBs, beta-blockade in patients with rises in troponin/NT-proBNP

d. Life style management (e.g., physical exercise, weight loss)

e. Other, …

f. Not applicable

a. 48 (53.3%)

b. 6 (6.7%)

c. 16 (17.8%)

d. 8 (8.9%)

e. 5 (5.6%)

f. 7 (7.8%)

Follow-up

Is there a standardized follow-up schedule that you use for patients treated with potentially cardiotoxic cancer treatments?

a. Yes, according to the ASCO guideline (Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers, 2016)

b. Yes, according to childhood cancer survivorship guidelines

c. Yes, we have our own local/regional guideline

d. No, pragmatic and/or individualized schemes

e. Other, …

f. Not applicable

a. 28 (31.1%)

b. 4 (4.4%)

c. 24 (26.7%)

d. 20 (22.2%)

e. 2 (2.2%)

f. (13.3%)

Who do you deem responsible for CVD risk management in cancer survivors

a. Cardio-oncology outpatient clinic

b. Cardiologist

c. Oncologist

d. General practitioner

e. The patient self

f. Other, …

g. Not applicable

a. 44 (48.9%)

b. 12 (13.3%)

c. 6 (6.7%)

d. 15 (16.7%)

e. 1 (1.1%)

f. 7 (7.8%)

g. 5 (5.6%)

Management – oncological treatment decisions

What is your approach regarding choice of (neo-)adjuvant systemic breast cancer treatment in a patient with an indication for chemotherapy and a previous cardiovascular event, presuming the symptomatology is controlled and the patient has a normal LVEF?

a. Anthracycline- and taxane-based chemotherapy

b. Non-anthracycline containing chemotherapy

c. No chemotherapy because of co-morbidity

d. Other, …

e. Not applicable

a. 35 (38.9%)

b. 24 (26.7%)

c. 0

d. 7 (7.8%)

e. 24 (26.7%)

Do you continue treatment with trastuzumab (in curative and/or palliative setting) in case of an asymptomatic left ventricular ejection fraction (LVEF) drop to < 50% but ≥45%?

a. Never

b. Yes, often

c. Occasionally, after consultation with cardiologist when adequate anti-congestive treatment is initiated

d. I do not routinely check LVEF during trastuzumab treatment if patients do not have any clinical signs of heart failure

e. Other, …

f. Not applicable

a. 5 (5.6%)

b. 33 (36.7%)

c. 30 (33.3%)

d. 0

e. 5 (5.6%)

f. 17 (18.9%)

How do you respond when a patient develops a prolonged QTc under systemic oncological treatment?

a. Interrupt anti-cancer treatment, follow-up QTc and re-initiate only after QTc has normalized

b. Continue treatment with continued monitoring of QTc

c. I do not routinely check QTc under anti-cancer treatment

d. Other, …

e. Not applicable

a. 22 (24.7%)

b. 33 (37.1%)

c. 14 (15.7%)

d. 4 (4.5%)

e. 16 (18.0%)

Do you continue treatment with fluoropyrimidines (5-FU, capecitabin) if a patient has developed an acute coronary syndrome?

a. No

b. Yes, after initiation of a calcium-antagonist

c. Yes, only if there was no enzymatic myocardial infarction and if anti-angina treatment is started

d. Other, …

e. Not applicable

a. 28 (31.1%)

b. 10 (11.1%)

c. 20 (22.2%)

d. 10 (11.1%)

e. 22 (24.4%)

Management – cardiovascular treatment decisions

What systolic blood pressure do you aim for under treatment with anti-Vascular Endothelial Growth Factor therapy (bevacizumab, tyrosine kinase inhibitors)?

a. < 160 mmHg

b. < 140 mmHg

c. < 120 mmHg

d. Only if there are clinical symptoms of hypertension and/or proteinuria

e. Other, …

f. Not applicable

a. 6. 6.7%)

b. 56 (62.2%)

c. 6 (6.7%)

d. 1 (1.1%)

e. 0

f. 21 (23.3%)

Do you prescribe novel oral anticoagulants to patients with an oncological treatment?

a. No, because of bleeding risk

b. No, because of possible interactions with oncological treatment

c. Yes, for atrial fibrillation

d. Yes, for venous thrombo-embolism

e. Yes, both for atrial fibrillation and venous thrombo-embolism

f. Other, …

g. Not applicable

a. 4 (4.4%)

b. 6 (6.7%)

c. 11 (12.2%)

d. 2 (2.2%)

e. 41 (45.6%)

f. 9 (10.0%)

g 17 (18.9%)

Do you, apart from LVEF, use a biomarker for subclinical cardiovascular toxicity for clinical decision making?

a. No

b. Yes, circulating biomarkers (NT-proBNP, troponins)

c. Yes, global strain on echocardiography

d. Yes, diastolic function on echocardiography (E/A-ratio, tissue velocities)

e. Yes, cardiac MRI

f. Yes, coronary artery calcification scores on computed tomography

g. Other, …

h. Not applicable

a. 24 (26.7%)

b. 23 (25.6%)

c. 16 (17.8%)

d. 2 (2.2%)

e. 2 (1.1%)

f. 0

g. 15 (16.7%)

h. 9 (10.0%)

Do you consider placement of an implantable cardioverter-defibrillator (ICD) and/or cardiac resynchronization therapy (CRT) for a patient with cancer treatment-induced heart failure?

a. Yes

b. No

c. Other, …

d. Not applicable

a. 53 (58.9%)

b. 8 (8.9%)

c. 11 (12.2%)

d. 18 (20.0%)