Table 2 Answers on questions covering specific oncological and cardiological treatment decisions, subdivided by responders’ profession and compared to the other respondents (i.e., all non-oncologists and non-cardiologists)

Oncologists (N = 26)

Other respondents (N = 67)

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. 10 (38.5%)

b. 12 (46.2%)

c. 0

d. 0

e. 4 (15.4%)

a. 25 (39.1%)

b. 12 (18.8%)

c. 0

d. 7 (10.9%)

e. 20 (31.3%)

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. 1 (3.8%)

b. 4 (15.4%)

c. 16 (61.5%)

d. 0

e. 0

f. 4 (15.4%)

a. 4 (6.3%)

b. 29 (45.3%)

c. 14 (21.9%)

d. 0

e. 4 (6.3%)

f. 13 (20.3%)

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. 11 (42.3%)

b. 5 (19.2%)

c. 8 (30.8%)

d. 0

e. 2 (7.7%)

a. 11 (17.5%)

b. 28 (44.4%)

c. 6 (9.5%)

d. 4 (6.3%)

e. 14 (22.2%)

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. 11 (42.3%)

b. 1 (3.8%)

c. 7 (26.9%)

d. 2 (7.7%)

e. 5 (19.2%)

a. 17 (27.0%)

b. 9 (14.3%)

c. 13 (20.6%)

d. 8 (12.7%)

e. 17 (27.0%)

Cardiologists (N = 48)

Other respondents (N = 45)

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. 2 (4.2%)

b. 41 (85.4%)

c. 4 (8.3%)

d. 0

e. 0

f. 4 (4.2%)

a. 4 (9.3%)

b. 18 (41.9%)

c. 2 (4.7%)

d. 1 (2.3%)

e. 0

f. 18 (41.9%)

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. 2 (4.2%)

b. 9 (18.8%)

c. 0

d. 0

e. 28 (58.3%)

f. 6 (12.5%)

g. 3 (6.3%)

a. 4 (9.3%)

b. 4 (9.3%)

c. 2 (4.7%)

d. 2 (4.7%)

e. 13 (30.2%)

f. 3 (7.0%)

g. 15 (34.9%)

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. 9 (18.8%)

b. 13 (27.1%)

c. 10 (20.8%)

d. 0

e. 1 (2.1%)

f. 0

g. 14 (29.2%) – all combo’s

h. 1 (2.1%)

a. 15 (34.9%)

b. 10 (23.3%)

c. 6 (14.0%)

d. 2 (4.7%)

e. 0

f. 0

g. 9 (20.9%)

h. 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. 36 (75%)

b. 3 (6.3%)

c. 8 (16.7%)

d. 1 (2.1%)

a. 17 (39.5%)

b. 5 (11.6%)

c. 17 (39.5%)

d. 4 (9.3%)