A total of 1049 responses were received; however, 76 were rated as an invalid response because of the questionnaire with incomplete and/or inconsistent answers. 973 responses were finally solicited and included in the analysis. Of the 973 physicians responded, 444 (45.6%) were oncologists and 529 (54.4%) were cardiologists; 885 (91.0%) practiced in Tertiary grade A hospitals. The surveyed physicians were from 22 provinces, 4 autonomous regions, and 4 municipalities of mainland China; we only failed to reach the physicians in the Tibet autonomous region. 25.5% (N=248) of surveyed physicians worked in the middle region of mainland China, 33.2% (N=323), and 41.3% (N=402) of surveyed physicians practiced in the western and eastern of mainland China, respectively. The geographical characteristics of surveyed physicians were nicely correlated with the geographical profile of tertiary hospitals (Supplementary table-2) (14). The proportion of surveyed physicians appointed as a chief doctor, assistant chief doctor, doctor in charge, the junior doctor was 22.7% (N=221), 28.8% (N=280), 27.5% (N=268) and 12.1% (N=118), respectively. 86 (8.9%) medical students who worked in the hospital as trainees also took our survey.
1. The awareness of cardio-oncology
Of 973 respondents, only 3 were not aware of cardio-oncology at all, and 970 (99.7%) respondents were aware of cardio-oncology or related concepts. 343 (35.3%) respondents were fully aware of cardio-oncology in terms of patients, discipline, and special units. Full awareness of cardio-oncology was associated with the following characteristics of respondents: specialty (P-value < 0.0001), level of the hospital (P-value < 0.001), and level of the physician (P-value =0.01) (Table 1). The highest awareness of cardio-oncology was among the oncologists worked in a tertiary grade-A hospital as a chief doctor.
2.The attitude toward and barriers to building a cardio-oncology unit
Among the 973 respondents, the majority (N=929, 95.5%) of them were in favor of building a special unit of cardio-oncology (Supplementary Table-3). The oncologists who worked in a tertiary grade-A hospital were more supportive of the development of cardio-oncology unit compared to cardiologists.
And 960 (98.7%) respondents admitted that it would not be easy to establish a cardio-oncology unit since many barriers existed (Table 2). The most recognized barrier was a lack of awareness and knowledge in this multidisciplinary area, particularly among the respondents who worked in a tertiary grade-A hospital. In addition, about 22% of respondents believed that a lack of enough demand from cardio-oncology service was also a barrier to open a cardio-oncology unit in the hospital.
3.The knowledge level of cardio-oncology
The average/median score was 22.8/23 (out of 34 cardio-oncology questions) for all the respondents. Only 3 respondents were fully correct about the total of 34 questions. The scores for questions related to the CVD complications and cardioprotective drugs were marked a lower correctness rate (approximately 51% and 65% correct, respectively), scores are summarized in Supplementary Table-4. The correct rate was 78%, 75%, and 72% in questions related to the proper timing to run the CVD risk assessment, the recommended approaches to monitoring the heart function, and the types of cancer treatment that led to a higher risk for developing cardiac dysfunction, respectively.
There were 33.4% of respondents who could correctly answer all questions about the timing of CVD risk assessment. 26.1% of respondents were correct about the recommended approaches for monitoring heart function. 37.1% of respondents gained the full marks of questions related to the types of cancer treatments affected heart functions. The percentages of respondents who reached the full marks in questions of the CVD complications and cardioprotective drugs were 7.4% and 3.3% respectively, which were quite low (Table 3).
GLM regression analysis was used to examine the factors associated with a better knowledge level of cardio-oncology (Table 4). Our results demonstrated that knowledge level of cardio-oncology was better in respondents with a cardiology background (P-value =0.001), worked in the higher-level hospital (P-value =0.01), from the east or west region of mainland China (P-value <0.001), at a high position of doctor (Chief doctor, P-value =0.009), with full awareness of cardio-oncology (P-value <0.001) and favorable attitude toward cardio-oncology development (P-value <0.001).
4.The implementation of cardio-oncology knowledge
Of the 973 valid respondents, 863 respondents believed the CVD risk assessment for cancer patients should be run before the cancer therapy initiated. Among the 863 respondents who opt to run the CVD risk assessment before the treatment, 781 of them stated that they did perform the CVD risk assessment and 81 respondents who thought the pre-treatment CVD risk assessment was not essential also evaluated the CVD risks. Of the 966 respondents who were aware of cancer patients with cardiac complications, 908 of them always check the clinical history of cancer and cardiovascular disease of patients, and 6 respondents who have not seen a cancer patient with cardiovascular complications were willing to check the clinical history thoroughly. The chief doctors and oncologists implemented these good practices more often (Table 5).