Cardio-oncology 2020: The need for a closer collaboration between cardiologist and oncologist

Cardio-oncology 2020:
The need for a closer collaboration between cardiologist and oncologist
Ettore Antoncecchi; Enrico Orsini
Editors di Cardiologia Ambulatoriale


Cardiovascular diseases and cancer share the sad record of beeing the leading causes of death worldwide. However, important progresses have been done during the last decades in the care of both vascular and neoplastic diseases. In particular, an impressive improvement in surgical, chemotherapy and radiotherapy treatment has drastically reduced the mortality for cancer, allowing a substantial increase in the life expectancy of such patients.

Chemotherapy and radiotherapy, however, due to increasingly powerful drugs and aggressive treatment protocols, have a price to be paid. In particular,  all anticancer drugs are potentially cardiotoxic, exhibiting a wide range of cardiovascular side effects, peculiar to each class. Moreover, the increase in life expectancy for cancer exposes survivors to the delayed side effects of the treatment, not known until a few years ago.

Left ventricular systolic dysfuntion and heart failure are the traditional and most important cardiotoxicities, typically of anthracyclines. However, therapeutic apparatus has been progressively enriched with numerous anticancer drugs in last years, provided with new mechanisms of action and side effects: anti-HER2 drugs, fluoropyrimidines, angiogenesis inhibitors, tyrosine kinase inhibitors, immuno-checkpoint inhibitors. The oncologists have therefore known new cardiovascular forms of toxicity of anticancer therapy: chest pain/transient angina and myocardial ischemia, coronary artery disease, myocardial infarction, arterial thromboembolic disease, arterial hypertension, QT prolongation, cardiac arrhythmias, atrio-ventricular block, pericardial diseases, myocarditis, TakoTsubo syndrome. Besides, cancer patients are more prone to venous thromboembolism, both for the underlying disease and for surgery and chemotherapy.

Because of this complex picture, it is  obvious that the cardiologist must become a reference figure, closely supporting the historical specialists of cancer care, surgeons, oncologists and radiotherapists. And it is equally obvious that to do this, the cardiologist must acquire the specific skills of such a complex matter.

Cardio-oncology is a subspecialty born to give concrete answers to these needs. The general objectives of cardio-oncology could be summarized as follows:

  1. Provide the cardiologist with a good knowledge of anticancer drugs pharmacology, the indications and potential cardiotoxicity of each drug
  2. Provide the cardiologist with a good knowledge on the role and the risk ratio of radiotherapy.
  3. Define and improve the cardiovascular risk profile of the patients to be submitted to chemiotherapy or radiotherapy.
  4. Accordingly with the oncologist, define specific diagnostic protocols, on the basis of cardiovascular risk level of each patient.
  5. Identify early signs of cardiotoxicity by means of echocardiography, advanced imaging or biomarkers.
  6. Promptly begin an appropriate cardiovascular


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