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Nursing knowledge in cardio-oncology: results of an international learning needs-assessment survey

Cardio-Oncology volume 11, Article number: 4 (2025) Cite this article

Abstract

Background

With early detection and improvements in systemic and local therapies, millions of people are surviving cancer, but for some at a high cost. In some cancer types, cardiovascular disease now competes with recurrent cancer as the cause of death. Traditional care models, in which the cardiologist or oncologist assess patients individually, do not address complex cancer and cardiovascular needs. Nursing disciplines should be an integral part of holistic assessment in cardio-oncology care. To learn what educational needs nurses perceive important for provision of competent cardio-oncology nursing care, we undertook an international survey, aiming to understand their learning needs and preferred learning modalities.

Methods

A cross-sectional survey was developed by members of the International Cardio-Oncology Society (IC-OS) Nursing Research group. The survey was in English and consisted of 23 questions which include demographic information, clinical specialty (oncology, cardiology, or cardio-oncology), multiple-choice questions related to clinical topics that nurses might be interested in learning, and preferred methods of instruction.

Results

Three hundred and twenty-nine responses were received. The majority expressed interest in learning more about cardio-oncology related topics, primarily via pre-recorded webinars (n = 206, 67%) and live virtual meetings (n = 192, 63%). Formal programs leading to certification were highly endorsed (n = 247, 80%). In relation to specific cardio-oncology topics, there was a strong interest in learning more about specific cardiovascular toxicities, and their monitoring and management (n = 205, 66%).

Conclusion

Cardio-oncology is a new field of expertise requiring competent nurses with current knowledge incorporating both specialties. The survey we conducted described the sample’s characteristics, identified cardio-oncology learning needs and preferred methods of delivery. A cardio-oncology core curriculum based on the survey responses can offer convenient, accessible and learner-directed education for nurses worldwide. Ultimately, development of cardio-oncology nursing expertise will benefit cancer patients and survivors worldwide.

Background

Worldwide, cancer and cardiovascular diseases are leading causes of morbidity and mortality in middle and upper-income countries. With early detection, improvement in systemic and local therapies [1, 2], millions of people are surviving cancer, but for some at a high cost. In some cancer types, cardiovascular disease now competes with recurrent cancer as the cause of death [3, 4]. Moreover, cardiovascular disease represents multiple possible events inclusive of cardiovascular mortality, myocardial infarction, stroke, heart failure, and pulmonary embolism [5]. These events are highly prevalent regardless of cancer site with risk persisting 10 years beyond diagnosis [5].

Traditional care models, in which the cardiologist or oncologist assess patients individually, do not address intersecting cancer and cardiovascular needs [6]. This practice results in fragmented care, variability in assessment and management, and suboptimal outcomes for patients [6]. Figure 1 describes potential decision making and subsequent clinical outcomes of cancer patients at risk or presenting with cardiotoxicity [6]. Dual-specialty clinics or health professionals with dual-specialty training are essential to ensure optimal outcomes from both oncologic and cardiovascular perspectives [7].

Fig. 1
figure 1

Potential decision making and clinical outcomes of cancer patients at risk for cardiovascular disease depending on assessing discipline

Legend: Cardiovascular disease (CVD); Hematopoietic stem cell transplant (HSCT)

Full size image

In the last 15 years, the term ‘cardio-oncology’ was coined to describe multidisciplinary clinics aiming to manage complex cardiovascular problems experienced by cancer patients [8]. In oncology literature, multidisciplinary cancer conferences have a positive impact on patient outcomes with improvements in diagnosis and treatment planning, patient survival, as well as patient and clinician satisfaction [9,10,11,12]. Patient needs are often unmet by a physician-only approach as many patients require holistic care addressing education, lifestyle modification, polypharmacy review, social support, pain control and end of life care [10,11,12,13,14]. The American Heart Association endorses a similar multimodal cardiac rehabilitation-based approach to improve cardiovascular outcomes in cancer survivors [15]. This care model typically involves a comprehensive medical evaluation, exercise prescription, pharmaceutical and behavioral cardiovascular risk factor management, and education/counseling support [16].

The specific roles of nursing within cardio-oncology clinics are yet to be fully elucidated [17]. We previously conducted an integrative review of cardio-oncology clinics aiming to describe nursing roles [18]. The consensus amongst all studies was that cardio-oncology clinics should be composed of a multidisciplinary team [18]. While the majority of papers focused on physician disciplines, nursing was broadly considered an essential resource, but no specific roles nor responsibilities were discussed in any papers [18]. Nursing should be a part of the initial and ongoing assessment in cardio-oncology care [19,20,21]. However, cardio-oncology is a relatively new field of study and the nursing knowledge standard to provide holistic care has not been established. Moreover, nurses commonly have knowledge based in either cardiology or oncology but rarely both. For competent cardio-oncology nursing care to be fostered, accessible and acceptable educational opportunities must be readily available. Accordingly, we undertook an online survey to assess the learning needs of nurses in the competent care of cardiovascular issues in patients with cancer, aiming to understand their learning needs and preferred learning modalities.

Method

A cross-sectional survey was developed by members of the International Cardio-Oncology Society (IC-OS) Nursing Research group, with invitations distributed through IC-OS as well as national and international nursing societies and associations. The survey was in English and consisted of 23 questions which include demographic information, clinical specialty (oncology, cardiology, or cardio-oncology), multiple-choice questions related to clinical topics that nurses might be interested in learning, and preferred methods of instruction. No identifying information was requested thus participants remained anonymous. The survey qualified for exempt status by institutional board review and completion was considered implied consent of participation. The survey was conducted online via the IC-OS website with submissions accepted between the dates of December 1, 2023, to February 29, 2024. The secure Research Electronic Data Capture (REDCap) program was utilized to administer the survey which took approximately five minutes to complete [22]. Survey questions were purposefully developed to describe potential cardio-oncology events across the treatment and survivorship continuum. Depending on the format of the question, respondents could choose as many areas of interest as desired. Aiming for the broadest perspectives and representation of different health care systems, participants were recruited by convenience sampling in multiple countries and were currently working in cardiology, oncology or cardio-oncology programs.

Results

Three hundred and twenty-nine responses were received during the study time frame. The majority of respondents reported as residing in the United States (n = 206), Canada (n = 45), United Kingdom (n = 14) China (n = 12), Qatar (n = 5), Australia (n = 1), Ireland (n = 2), Poland (n = 2), Turkey (n = 1) and Italy (n = 1). The majority were female (n = 290, 93%) with 49% educated to Bachelor´s level (n = 151, 49%) and working in oncology (n = 218, 70%) in direct patient care roles (n = 260, 85%) (Table 1). A total of 201 (65%) nurses stated they had cardio-oncology experience.

Table 1 Demographic and clinical characteristics of respondents (n = 329)
Full size table

In terms of previous education and training in cardio-oncology, the majority stated that they had no formal education (n = 268, 88%) and approximately one-third have formal cardio-oncology programs in their workplace (n = 110, 36%) (Table 2). The majority of respondents expressed an interest in learning more about cardio-oncology related topics, primarily via pre-recorded webinars (n = 206, 67%) and live virtual meetings (n = 192, 63%). Formal programs leading to certification were highly endorsed (n = 247, 80%).

Table 2 Cardio-oncology education and training
Full size table

Respondents were asked about training topics categorised into cardio-oncology, oncology and cardiology (Table 3). In relation to specific cardio-oncology topics, there was a strong interest in learning more about cardiovascular toxicities and their management (n = 205, 66%) along with interest in cardio-oncology programs and cancer therapeutics.

Table 3 Respondents interest in specific cardiology and oncology topics
Full size table

Discussion

Cardio-oncology is a new sub-specialty requiring competent health care providers with knowledge that incorporates both specialties. To learn what educational needs nurses perceive important for provision of competent cardio-oncology nursing care, we undertook an international survey. We report the sample’s demographic and educational characteristics, clinical practice settings, cardio-oncology learning content and preferred methods of delivery. To our knowledge, this is the first survey of its kind.

Only 22% of respondents reported any formal education or training in cardio-oncology in their practice setting. Multiple choices for topics of interest were allowed with desire for education being high across all subtopics. These results highlight the complexities and potential knowledge gaps faced by nurses when assessing cancer patients with cardiology issues. 36% reported a formal cardio-oncology program in their workplace, suggesting there are few formal resources available to nurses and other multidisciplinary team members for referral and collaboration. This finding is similar to a survey of healthcare professionals exploring facilitators and barriers to injectable cardiovascular therapies where professional education was highlighted by respondents [23].

In terms of their current learning approaches, respondents modestly endorsed continuing education programs, journals, conferences or webinars. The majority expressed considerable interest in learning about cardio-oncology topics, primarily via pre-recorded webinars and live virtual meetings. A previous survey reported preferences for face-to-face training (44%) whereas online learning was less favored (26%). The COVID-19 pandemic restrictions necessitated online learning for health professionals, which has since been embraced with higher attendance of courses and greater flexibility of delivery [23, 24]. Formal programs leading to certification were highly endorsed. In many countries, specialty certification is desirable as a means of validation with formal examination of nurses’ knowledge, skills, and abilities specific to their specialty beyond entry-level education and licensing [25]. The anticipated results of such certifications are improved safety, quality of care, and health outcomes for care recipients [25]. Undoubtedly having an informed and educated nursing workforce who practice using an approved curriculum will improve patient care [26]. A key part of the nursing role is patient assessment and education regarding their treatment and how to self-manage. A previous survey of cardiovascular patients highlighted their need for ongoing education from healthcare professionals and this is usually undertaken by nurses [27].

Guided by the survey results, the IC-OS Nursing Research and Education committees are currently in the process of developing a Cardio-Oncology Nursing Education program core curriculum. The modules will be evidenced-based reflecting the latest research and will also incorporate the relevant guidelines and consensus documents as appropriate [28]. The didactic component of the learning program will be composed of modules inclusive of the multiple cardio-oncology topics identified in the survey [29]. Access to the educational presentation is anticipated to be offered via on-demand, learner- directed modules which can be accessed by participants globally at their own convenience. A cardio-oncology nursing certificate of completion will be available upon successful completion of the modular learnings.

Strengths and limitations

A strength of this email survey is the participants were primarily working in clinical roles. The delivery method was efficient, convenient, and inexpensive and resulted in over 300 responses. The survey was distributed through national and international societies and associations therefore we are confident that the responses reflect nurses working in oncology and cardiology specialties. Given the brevity and focused nature of the survey, we do not believe response fatigue was a major issue. The survey was in English therefore did not capture non-English speaking nurses. Nurses are busy professionals with scant time for professional activities thus the sample size may be limited by those who were unable complete the survey within the deadline. A limitation of surveys with pre-formatted responses is lack of open-ended questions which likely would have illuminated the meaning of survey responses or demonstrated areas of unknown need. Similarly, 65% of nurses reported having cardio-oncology experience, but the type and depth of knowledge is unknown, hence the potential for overestimating knowledge. Nevertheless, we believe this study provides insight into the current educational needs of nurses caring for a patient population with highly complex problems and provides essential information for the purpose of curricular development.

Conclusion

Cardio-oncology is a new field of expertise requiring competent nurses with current knowledge incorporating both specialties. The survey we conducted described the sample’s demographic characteristics, identified cardio-oncology learning needs and preferred methods of delivery. A cardio-oncology core curriculum based on the survey responses can offer convenient, accessible and learner-directed modular education for nurses worldwide. Ultimately, development of cardio-oncology nursing expertise will benefit cancer patients and survivors worldwide.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

ICOS:

International Cardio–Oncology Society

REDCap:

Research Electronic Data Capture

COVID:

19–Coronavirus disease

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Authors and Affiliations

  1. Departments of Nursing and Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, FC2.2018, Unit 0456, 77030-4009, Houston, TX, USA

    Anecita Fadol

  2. Catherine McAuley School of Nursing & Midwifery, Brookfield Health Sciences Complex University College Cork, Cork, T12 AK54, Ireland

    Geraldine Lee

  3. Department of Nursing, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0456, 77030-1407, Houston, TX, USA

    Valerie Shelton

  4. Lehigh Valley Health Network, LVPG Cardiology Heart and Vascular Institute, 2649 Schoenersville Rd, 18017, Bethlehem, Pa, USA

    Kelly C. Schadler

  5. Cardio-Oncology, Hamad Medical Corporation, P.O.Box 3050, Doha, Qatar

    Asma Mohammed Younus

  6. AYA Program, IWK Health Centre, University Avenue, PO Box 9700, Halifax, NS, 5850/5980, B3K 6R8, Canada

    Mary Stuart

  7. Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA

    Lisa Nodzon

  8. Dept of Oncology Tier 2 Canada Research Chair, University of Alberta, Alberta, Canada

    Edith Pituskin

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  1. Anecita Fadol
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Contributions

A.F. made substantial contributions to the conception of the study, design the survey, led the manuscript writing, and provided critical manuscript revisions. V.S. made significant contributions in the acquisition of data, and collated survey responses. E.P., and G.L. made substantial contributions in survey dissemination, writing and revising the manuscript, and critical review for intellectual content. K.S, L.N., A.Y., and M.S. contributed to the writing of the manuscript. All authors engaged in the critical review, approved the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Anecita Fadol.

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Ethics approval and consent to participate

No identifying information was requested thus participants remained anonymous. The survey qualified for exempt status by institutional board review and completion was considered implied consent of participation.

Consent for publication

Consent for publication of Fig. 1 was approved by Elsevier.

Competing interests

The authors declare no competing interests.

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Fadol, A., Lee, G., Shelton, V. et al. Nursing knowledge in cardio-oncology: results of an international learning needs-assessment survey. Cardio-Oncology 11, 4 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40959-025-00304-x

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Keywords

Cardio-Oncology

ISSN: 2057-3804

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