Cardio-oncology research prioritisation in the United Kingdom: national surveys of health care professionals, patients and carers

Abstract

BACKGROUND: The relevance of cardiovascular disease in people with a history of cancer has increased in parallel with dramatic improvements in cancer-specific outcomes. There is an urgent need to improve the evidence underpinning cardio-oncology practice. Research prioritisation is essential and needs to account for multidisciplinary healthcare professional (HCP) perspectives, as well as patients and carers. METHODS: The NIHR-BHF Cardiovascular Partnership Theme in Cardio-Oncology conducted two UK-wide online surveys to identify research priorities. The first was distributed to HCPs with cardiology, oncology and haemato-oncology backgrounds. The second was distributed to patients and carers (PCs) with experience of cancer and/or cardiovascular disease. Surveys were co-designed by clinicians and patients. RESULTS: HCP Survey: 127 responded; 53% prioritised research 'during cancer treatment'. Immune checkpoint inhibitors and targeted therapies were identified as the highest-priority drug classes. Cardiac dysfunction/heart failure (53%) and myocarditis (22%) were priority cardiovascular toxicities of interest. The development of a cardio-oncology registry was marginally favoured over randomised trials. Prospective randomised open-label blinded endpoints (PROBE) designs were considered of similar priority to double-blinded placebo controlled trials. PC Survey: 267 responded. 54% were concerned about the impact of cancer treatment upon cardiovascular health. PC research priorities were: prevention of cardiac side effects (58%), long-term cardiac monitoring, and early detection of side effects. Willingness to participate in research was high. CONCLUSION: HCPs and PCs from the UK prioritised prevention and detection of cardiac dysfunction during and immediately following cancer therapy, particularly with agents such as immune checkpoint inhibitors and targeted therapies. These findings provide important strategy-setting insights for large-scale collaborative cardio-oncology studies.