Reasons for referral to a cardio-oncology clinic during a 6-year period: have the patterns changed?
R B Tepper, M Lago, F N Currao, M Amor, H A Mosto, G J Souto, P I Barral, J N Stagnaro, M Salame, J Carbajales, E A FeigelsonAbstract
Background
Proactive, specialised cardiovascular care for cancer patients is essential to prevent cancer treatment-related cardiovascular toxicity (CTR-CVT). Despite the recommendations of international and local guidelines, a survey of cardio-oncology centres found that only 35.3% of respondents always refer patients to cardio-oncology before starting potentially cardiotoxic therapies. This suggests that most oncologists and onco-haematologists do not routinely refer patients before initiating treatment.
Purpose
In 2019, a cardio-oncology clinic was established at a public hospital. The objective of this study was to analyse changes in referral patterns to cardio-oncology over a 6-year period.
Methods
This observational, retrospective study used data from a prospective database of cancer patients referred to the cardio-oncology clinic between January 1, 2019, and December 31, 2024. Demographic data, comorbidities, reasons for referral and types of cancer were analysed. Quantitative variables were reported as mean and standard deviation or median and interquartile range, while qualitative variables were presented as numbers and percentages. A multinomial regression model was used to evaluate the association between the number of visits, reasons for referral and cancer diagnoses. The relationship between pretreatment referrals and year was assessed with logistic regression, expressed as odds ratios (OR) and 95% confidence intervals (CI). All analyses were performed using R.
Results
A total of 498 patients were included, with an average of 83 first visits per year. Median age was 57 years (IQR: 35-79), and 58% were women. Common comorbidities included obesity (45%), smoking habits (39%), and hypertension (35%). The most common cancer types were chronic myeloid leukaemia (CML, 28%), breast cancer (18%), and non-Hodgkin lymphoma (NHL, 14%). Since 2021, breast cancer referrals increased significantly: 20% of first visits in 2022, 24% in 2023, and 36% in 2024 (OR: 1.93; 95% CI: 1.50-2.5), while CML referrals decreased (OR: 0.44; 95% CI: 0.33-0.57). Pre-treatment assessment was the most common reason for referral (33%). After a decline in 2021, first pre-treatment visits rose significantly from 23% in 2021 to 33% in 2022, 38% in 2023, and 44% in 2024 (OR: 1.4; 95% CI: 1.15-1.71). Among patients referred for pre-treatment assessment, NHL (32%), breast cancer (26%), and leukaemia other than CML (12%) were most common. Pre-treatment visits for breast cancer increased significantly, from 11% in 2021 to 31% in 2022, 37% in 2023, and 47% in 2024 (OR: 1.83; 95% CI: 1.25-2.79).
Conclusions
Referral patterns to cardio-oncology have shifted over the evaluated period, with more first visits for pre-treatment assessment, especially among breast cancer patients. This likely reflects growing awareness among oncologists of the importance of pre-treatment assessment in preventing CTR-CVT, indicating improvement in multidisciplinary care over time.