Table 6.

Advocacy issues/concerns and potential proposed solutions/strategies

Stakeholder	Issues/concerns	Proposed solutions/strategies
Legislators	Healthcare policy and legislation come from specific committees in the US House and Senate. Advocates provide insight into the specialty and advocate for specific bills or policy issues such as limiting preauthorization and onerous documentation	Building relationships and articulating patient needs are critical and take an ongoing effort. Meeting legislators in DC as well as in district is critical to building these relationships. Local, state, and federal representatives should be engaged to educate them on the challenges of practitioners and patients alike
Researchers	Oncologic drug development needs specific measurements of cardiovascular toxicity included in adverse events protocols	FDA has accepted this need and has held meetings with cardio-oncology stakeholders to address the scope of cardiotoxicity
Physicians in training	Increased graduate medical education positions and help with education costs for the looming shortage of cardio-oncologists	While universal across all specialty programs, cardio-oncology is a new field that needs to be championed. In the USA, delineation of these fellowship programs is ongoing
Practitioners	Relieving administrative burden, preauthorization requirements, appropriate reimbursement, and prescription drug costs have been a concern with cancer and heart disease consuming a great deal of the healthcare resources	Partnering with other specialty groups is important to speak with a unified voice. Constant changes in federal and state regulations, patient privacy rights, and practitioner burnout all impact delivery of care
Survivorship groups	Ongoing efforts to address unique patient issues with need for awareness on late presentation/long-term cardiovascular effects of certain cancer treatments	Cancer and cardiovascular professional associations have developed programs for patients to learn the delayed effects of cancer treatment, particularly in survivors of cancer experienced during childhood
Payors	New technologies require specific codes and values for reimbursement. Work with the American Medical Association RUC Committee and the Centers for Medicare and Medicaid services (CMS) aims to ensure cardio-oncology representation with education for payors about what cardio-oncology is and how it impacts patients care	Taxonomy codes specific for cardio-oncology and reimbursement for consultative services and procedures such as MRI or strain echocardiography have been successful. The cost of prescription drugs and drug shortages are advocacy issues that need constant reminders for payors to be properly addressed

US, United States; DC, District of Columbia; FDA, Food and Drug Administration; RUC, Relative Value Scale Update Committee; MRI, magnetic resonance imaging