Background: Given the relevance and the growing complexity of the management of cardio-oncology (CO) outpatients, a common care pathway has been recently proposed by ANMCO and AIOM Tuscany.
Materials and methods: The proposal: 1) defined 3 categories of patients to be entered into the pathway (A: known cardiac disease needing active oncology treatment; B: undergoing cancer treatments with potential cardiac toxicity; C: experiencing cardiac toxicity and/or worsening of cardiovascular risk profile); 2) proposed two standard request forms for oncology (ONCO) and hematology (HEM); 3) set the minimum requirements for a cardio-oncology path; 4) indicated follow-up strategies during and after oncological treatments. Given the short observation interval we focused on points 1 and 2. Medical records of all cancer patients for whom a CO examination was required were analized to check if proposed forms have been used and if cases fulfilled into appropriate categories. Observation period was retrospectively set to 1 year starting from October 2022. Minimum appropriateness threshold for each process index was set to 80%.
Results: A total of 480 requests for a CO visit were retrospectively identified, 322 out of 480 (67%) from medical oncology and 158 out of 480 (33%) from hematology units. Appropriate request form was used in 95% of cases (456 out of 480) with no difference between ONCO and HEM units. All patients but 20 (460 out of 480, 95.8%) fulfilled (at least) one of the 3 pre-defined categories with no difference between ONCO and HEM units. Categories distribution was: A group 25%, B group 60%, and C group 15%. Patients from medical oncology were more likely to belong to A and B groups while cases from hematology to B and C groups.
Conclusions: Our data indicate that minimum thresholds were met for both index 1 and 2 (with values that are approaching to 100%) so supporting the use of the proposed clinical CO pathway.