Reducing the impact of cardiovascular disease in older people with cancer: a qualitative study of health care providers

Purpose: : Cancer survivors are at greater risk of cardiovascular disease (CVD) than cancer-free controls. Despite evidence-based guidelines recommending CVD risk factor assessment, surveillance and risk-reduction, many people with cancer do not receive adequate CVD care. To address potential barriers and enablers of care, we examined health care professionals’ (HCP) perceptions and experiences of CVD risk assessment and management in people with cancer. Methods: : We conducted one focus group and 12 individual interviews to examine HCPs’ perceptions and experiences of CVD care in care. We used reflexive thematic analysis to collect and analyse the qualitative data to construct and understand themes. Results: : 21 HCPs participated (8 oncologists, 5 nurses, 3 general practitioners, 2 dietitians, 1 cardiologist, 1 haematologist and 1 physiotherapist). Majority HCPs were aware of CVD risk in cancer, but were concerned they could not deliver CVD care alone due to system-level barriers including lack of time and training. HCPs also perceived patient-level barriers including socioeconomic disadvantage and fatalistic outlook. Despite barriers, HCPs suggested diverse solutions for improving CVD care in cancer including new models-of-care, clinical pathways, risk assessment/management tools and education. Conclusions: : The diversity of perceived barriers and suggested solutions identified by HCPs suggests the need for a multilevel approach tailored to context. Future research involving people with cancer is needed to co-design acceptable interventions. Implications for cancer survivors : Improved understanding of HCP’s perceptions can inform the development of new interventions to deliver CVD care to people with cancer to reduce morbidity and mortality.