The Continued Growth of Cardio-Oncology Efforts

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 - Freeman_Barac
Andrew Freeman, MD, FACC, and Ana Barac, MD, PhD, FACC

An increasing number of patients with cancer and cancer survivors live with cardiovascular disease. Pre-existing cardiac conditions or risk factors may limit available therapeutic options for cancer treatment, while cancer therapies, or cancer itself, may lead to development of cardiovascular complications. With widespread use of novel cancer therapies, there has been growing recognition of their cardiovascular adverse effects.

A number of dedicated cardio-oncology programs have emerged to meet clinical demand, often in collaboration with comprehensive cancer centers. Cardiologists at oncology-dedicated institutions have led the way over the years and have set groundwork in the field.

Areas of need & focus:

  1. Providing risk assessment and comprehensive cardiac care for patients who develop or may be at risk for cardiovascular complications while undergoing treatment for cancer. Patients with pre-existing cardiac conditions also fall into this category.
  2. Providing care for cancer survivors who have developed cardiac complications as a result of chemo- or radiation therapy.
  3. Development of new strategies for early recognition and treatment of known side effects of cancer therapies such as hypertension or asymptomatic left ventricular dysfunction. This includes development and implementation of latest technologies in cardiac imaging and 3D-imaging, as well as cardiovascular biomarkers into cancer treatment-specific cardiac protocols.
  4. Development and implementation of cardiac monitoring protocols in the setting of Phase I-III clinical trials with the goal of early recognition of potentially unexpected cardiac effects.

In the spring of 2013, the National Heart, Lung, and Blood Institute and National Cancer Institute organized a leadership meeting to discuss cancer treatment-related cardiotoxicity and the need for a joint effort of multiple disciplines within cardiology and oncology. This conference focused on scientific knowledge gaps and summarized research activities and priorities.

With the increased growth of clinical cardio-oncology programs there is a need for development of metrics and standardization of different components of the programs and development of curriculum content for cardiology trainees.

On a broader perspective, there is a need for a cross-disciplinary interaction, education and collaboration among cardiology and oncology societies and their members that would result in faster development of novel educational modules, as well as clinical and research activities. As a dynamic and growing field, cardio-oncology is of particular interest for early career professionals and fellows in training. Many areas within cardio-oncology overlap with established cardiology subspecialties such as cardiovascular imaging, heart failure and pediatric cardiology.

A recently formed Cardio-Oncology Working Group, currently within the Early Career Professionals Section, works diligently on identifying priorities and task-items in diverse areas of need. The goal of the group is to create a foundation that will allow for the development of a full and feature-rich set of cardio-oncology offerings within the ACC. The group recently conducted a survey assessing cardio-oncology programs in the U.S., and the results are expected to be published early next year.

Dr. Freeman is chair of the ACC’s Early Career Professional Section and Dr. Barac is chair of the ACC’s Cardio-Oncology Working Group. A version of this article also appeared on