Current Diagnostic Practices and Management Strategies for Cancer Therapy-related Cardiac Dysfunction: An Exploratory Multicentre Survey in Indonesia
Abstract
Background: Cancer therapy-related cardiac dysfunction (CTRCD) has emerged as a major complication of modern cancer therapy, particularly as cancer survival continues to improve. Although international guidelines provide standardised recommendations for CTRCD surveillance and management, real-world implementation remains highly variable, especially in low- and middle-income settings. Key diagnostic modalities include left ventricular ejection fraction and global longitudinal strain, ideally integrated within a multidisciplinary cardio-oncology framework. Aim: To characterise real-world practice patterns and inter-centre variation in CTRCD screening, monitoring and management across participating centres in Indonesia. Methods: A cross-sectional electronic survey was conducted between July and August 2025 among cardiologists involved in CTRCD care. Participants were recruited using cluster-based sampling from 65 medical centres across Indonesia. Results: A total of 65 responses were analysed. Although most respondents (94%) reported referring to European Society of Cardiology guidelines, substantial variation in clinical practice was observed. Echocardiography follow-up schedules were frequently determined at the oncologist’s discretion (50.8%) rather than by standardised protocols. Usage of global longitudinal strain and cardiac biomarkers remained limited, with 53.8 and 64.6% of respondents reporting no routine use, respectively. Comprehensive guideline-based heart failure therapy, ‘four pillars’, was implemented by 47.7% of respondents. Post-treatment surveillance strategies also differed considerably across institutions. Conclusion: Despite high guideline awareness, CTRCD diagnosis and management in Indonesia remain heterogeneous, with limited adoption of advanced surveillance strategies. These findings highlight the urgent need for standardised national monitoring pathways, strengthened multidisciplinary collaboration, and targeted capacity-building programmes to improve early detection and long-term cardiovascular outcomes among cancer survivors.