Presenter: Kristen T. Peterson, PharmD, BCOP, Duke University Medical Center
Co-Authors: Heather Moore, PharmD, BCOP, CPP, Duke University Medical Center, Durham, NC; Craig Beavers, PharmD, FACC, FAHA, FCCP, BCCP, BCPS, CACP, Baptist Health Systems–Kentucky and Indiana, Louisville, KY; Sarah Hayes, PharmD, BCOP, University of Minnesota Health Systems, Robbinsdale, MN; Israa Yaseen, BPharm, BCCP, BCPS, Bagdad Heart Center–Medical City, Bagdad, Iraq; Preston Skersick, PharmD, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC; Kelsey Truitt, PharmD, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC; Sarah Kaspari, PharmD, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC; Stephen Casselli, PhD, International Cardio-Oncology Society, Tampa, FL; Jo E. Rodgers, PharmD, BCPS, BCCP, FCCP, FHFSA, FAHA, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
BACKGROUND: An unprecedented rise in the number of novel oncolytic agents has recently led to a substantial increase in the complexity of cancer management. The real-world use of these therapies has increased the awareness of cancer therapy–related cardiovascular toxicities (CTR-CVTs) and related drug–drug interactions (DDIs), warranting healthcare provider education.
OBJECTIVE: To obtain further insight into knowledge gaps and educational needs based on the frequency of observed CTR-CVTs and related DDIs and the perceived ease of their management.
METHOD: A 20-question survey was distributed to pharmacists and other healthcare providers using e-mail listservs of targeted professional organizations, including the International Cardio-Oncology Society and the Hematology/Oncology Pharmacy Association. The survey assessed background (eg, training, practice setting), CTR-CVTs, and the related DDIs encountered. In addition, the preferences for future educational topics were assessed.
RESULTS: Of 220 survey respondents (102 pharmacists and 118 other healthcare providers, >80% physicians), the majority reported being at academic medical centers (>60% academic, >30% community). Although pharmacists were predominately from North America (96%) and represented cardiology (49%) and oncology/hematology specialties (44%/28%), other healthcare providers were from more diverse regions (Europe, 36%; North America, 28%; South America/other, 25%) and primarily specialized in cardiology (86%). The cancer types varied greatly across all of the healthcare providers. Of 102 pharmacists, 89% were PharmD-trained, and 56% and 33% completed residency and board certification in cardiology or oncology, respectively. In all, 49% of the pharmacists specialized in cardiology and 44% specialized in oncology. The most common CTR-CVTs reported by pharmacists were cancer therapy–related cardiac dysfunction (77%), thromboembolic disease (71%), and hypertension (64%). The most common pharmacodynamic DDIs that were encountered were QT prolongation/torsades de pointes, thromboembolic disease, bleeding, and hypertension, whereas the pharmacokinetic DDIs were with oral anticoagulants, antiarrhythmic agents, and numerous oncolytic agents. The pharmacists reported the least comfort with managing ibrutinib- or other drug–associated bleeding and arsenic-associated QT prolongation, and the greatest comfort with managing anthracycline- or HER2-targeted therapy–associated cardiac dysfunction. Regarding the recommendations for future education, immune checkpoint inhibitor–associated myocarditis (70%), ibrutinib- or other drug–associated bleeding (61%), and atrial fibrillation (61%) were ranked of highest need. Similar survey results were observed with other healthcare providers.
CONCLUSION: This survey indicates that knowledge gaps exist for pharmacists and other healthcare providers for several CTR-CVTs and related DDIs. Future educational initiatives should target these specific areas.