Cardio-Oncology: Protecting Your Heart During Cancer Treatment
"A comprehensive guide to understanding and mitigating cardiotoxicity, ensuring heart health during cancer therapy."
Cancer treatments have advanced significantly, improving outcomes for many patients. These treatments often combine established therapies like anthracyclines and radiation with newer, molecularly-targeted therapies such as tyrosine kinase inhibitors and immune modulators.
Comprehensive care for cancer patients now includes considering the potential impact of these treatments on various organ systems, particularly the cardiovascular system. This awareness has led to the development of cardio-oncology, a field focused on identifying, monitoring, treating, and preventing cardiovascular issues that may arise during cancer therapy.
This article provides a detailed overview of the cardiovascular effects of various cancer therapies, offering insights into selecting appropriate imaging modalities and strategies to protect and manage heart health throughout cancer treatment.
Guidance and Treatment Decisions
In 2020, the French Working Group of Cardio-Oncology convened cardiologists, oncologists, hematologists, and pharmacologists to develop practical roadmaps and algorithms for treatment-related cardiovascular toxicity. A 2024 expert-panel approach describes cardio-oncology care during potentially cardiotoxic cancer therapy, including cardioprotection strategies intended to minimize cardiovascular toxicity. The 2022 concept of permissive cardiotoxicity emphasizes that toxicity does not automatically require stopping cancer treatment: a cardio-oncology specialist can coordinate cardiovascular management with the cancer team to support the best achievable cardiovascular prognosis while enabling treatment.
The Field Takes Shape
The International Cardio-Oncology Society’s account traces the field’s origins to the 1970s, when oncologists observed cardiac dysfunction and heart failure in patients treated for cancer, particularly after anthracyclines. The field has since developed alongside an expanding range of cancer therapies associated with distinct cardiovascular and cardiometabolic syndromes. In 2019, cardio-oncologists proposed a blueprint for National Institutes of Health-funded studies addressing cardiovascular toxicities of contemporary cancer treatment.
Understanding Anthracycline Cardiotoxicity and Protective Measures
Anthracyclines, a class of drugs widely used in cancer treatment, are known for their potential to cause cardiotoxicity, making it a significant concern for patients. While patients receiving anthracyclines may experience a small change in left ventricular ejection fraction (LVEF), anthracycline cardiotoxicity is defined by more substantial decreases in LVEF, indicating impaired heart function.
- Risk Factors: Older age (over 65), being female, pre-existing cardiovascular disease, hypertension, previous exposure to cardiotoxic therapies, and high individual doses of anthracyclines.
- Oxidant Stress: Anthracyclines can cause oxidant stress in heart cells, leading to the formation of harmful free radicals. This process can damage cardiomyocytes and impair mitochondrial function.
- Monitoring: Regular monitoring of LVEF is essential during anthracycline therapy. Newer non-invasive methods are being developed to detect subclinical left ventricular dysfunction. Serum biomarkers like troponin I may also help identify cardiotoxicity earlier than changes in LVEF.
Imaging and Prevention Research
An imaging review reports that early decreases in cardiac deformation measures during or after cancer therapy can help predict later declines in left ventricular ejection fraction (LVEF). The ASE/EACVI Expert Consensus supports global longitudinal strain (GLS) during follow-up and identifies a relative decrease of more than 15% from baseline as clinically significant. However, the trial discussed in “Straining for More Evidence” found no difference between its two arms in LVEF at one year or in the rate of LVEF below 55% at that point.
Limits in the Evidence Base
A systematic review and meta-analysis of randomized trials of anthracyclines identified shortcomings in how cardiotoxicity was assessed and reported. Common limitations included insufficient detail to judge randomization, lack of blinded outcome assessors, and cardiotoxicity outcomes reported for only subsets rather than the full randomized samples. The review also noted inadequate assessment and reporting, especially when cardiotoxicity was not a primary endpoint.
Integrating Cardio-Oncology for Better Patient Outcomes
As cancer therapies continue to evolve, the importance of integrating cardio-oncology into patient care becomes increasingly clear. Understanding the potential cardiovascular toxicities associated with various treatments allows cardiologists to select the most appropriate monitoring strategies and preventive measures. By working collaboratively, oncologists and cardiologists can optimize patient outcomes, ensuring both effective cancer treatment and long-term heart health.
Balancing Evidence and Judgment
A 2023 review examines how evidence and expert opinion should be balanced when developing cardio-oncology clinical practice guidelines. It focuses on the 2022 European Society of Cardiology (ESC) Cardio-Oncology guidelines and argues that expert opinion is important but should be used judiciously alongside available evidence. The review also considers factors shaping the weight given to expert opinion and the potential effects of guideline recommendations on health care systems.
From Consensus Toward Science
A July 2026 article describes cardio-oncology as having grown from a niche focus on the cardiac toxic effects of cancer therapies into a broad, increasingly central discipline. It places the field at the intersection of cancer and cardiovascular disease, which it identifies as the world’s two leading causes of death. Its title frames the next phase as a move “from consensus to science.”