Cardio-Oncologist

What is a cardio-oncologist?

Cardio-oncologists are cardiologists or oncologists who provide care to people diagnosed with cancer. Cardiologists are heart doctors; oncologists are cancer doctors. Cardio-oncologists gain more training outside of their primary specialty to manage heart disease in people who have cancer.

Cancer treatments (like chemotherapy and radiation therapy) can help people live longer. But unfortunately, these treatments have many possible side effects. These include new or worsening heart disease. The type of damage to your heart and the risk of causing a problem vary widely depending on the therapy. Such heart damage is called cardiotoxicity or radiation heart disease.

This problem led to the growth of cardio-oncology as a subspecialty of medicine. Cardio-oncology focuses on identifying, monitoring and treating cardiovascular diseases caused by cancer therapies. The goal is to reduce the side effects of cancer treatment on your cardiovascular system.

Cardio-oncologists help you receive the most effective cancer treatment with minimal heart damage. They collaborate with other healthcare providers to tailor treatment to your needs.

What training do cardio-oncologists receive?

Cardio-oncologists are medical doctors who are specialists in their fields (cardiology or oncology). Beyond their specialist training, they receive additional training to learn:

• Side effects of cancer therapies that affect your cardiovascular system.
• How cancer affects the entire body, including your cardiovascular system.
• How to check cardiovascular risk before, during and after cancer treatment.
• How to diagnose and manage cardiovascular disease in people who have cancer.
• How to decide which chemotherapies are safe for your heart and which pose too much risk.
• How to monitor your heart muscle and heart valves for side effects of cancer treatment during and after your treatment.

This training often takes place during an intensive one-year fellowship that includes:

• Direct instruction through lectures.
• Participation in conferences.
• Hands-on experience with patients in cardio-oncology clinics.
• Research experience.

Some cardio-oncologists also become board certified by the International Cardio-Oncology Society.

Why are cardio-oncologists important?

Cardio-oncologists are becoming more and more important as cancer treatments continue to improve. That’s because the number of people who survive cancer is steadily going up. In 2016, over 15 million people in the U.S. were cancer survivors. Researchers estimate that by 2040, this number will reach 26 million. As the number of cancer survivors increases, so does the number of people who experience side effects from treatment.

About 7 in 10 people who survive cancer are at least 65 years old. As cancer survivors get older, they may face heart risks from their cancer treatment. Plus, they face increased risks from aging, lifestyle factors and associated medical conditions. So, it’s essential they receive care that takes into account all these factors.

Cardio-oncologists have the training and experience to support this growing population.

What does a cardio-oncologist do?

Cardio-oncologists diagnose and treat cardiovascular problems in people who have cancer. They first must identify the underlying cause of the problem. For example, it’s not always clear if cancer treatment is the cause of an issue like heart failure. Often, people who have cancer have other heart disease risk factors. So, cardio-oncologists need to untangle the many possible causes of heart problems.

They must also balance two goals that sometimes compete with each other:

• The need to treat your cancer.
• The need to protect your heart.

That’s where multidisciplinary collaboration is vital. Cardio-oncologists work with other specialists to decide the best plan for each individual.

Here are some of the many tasks a cardio-oncologist performs as part of their job:

• Performs a detailed assessment of your cardiovascular risk before beginning cancer treatment.
• Conducts state-of-the-art imaging and diagnostic tests to find any heart or blood vessel problems.
• Creates a treatment plan that targets your cancer with the least possible harm to your heart.
• Monitors you throughout your cancer treatment to detect heart problems early.
• Provides follow-up care after your cancer treatment has ended.
• Recommends surgeries and therapies for heart disease caused by cancer treatment.

Cardio-oncologists help manage many different heart problems, including:

• Arrhythmias, like atrial fibrillation and Torsade de Pointes.
• Coronary artery disease.
• Heart failure.
• Heart valve disease.
• High blood pressure (hypertension).
• Restrictive cardiomyopathy.

Who do cardio-oncologists treat?

Cardio-oncologists provide care to people who have cancer along with heart disease or heart disease risk factors. They also treat people who develop heart disease after completing cancer treatment. Some cardiotoxicities show up right away. Others don’t appear for several years (even 10 or more) after a person’s cancer treatment has ended.

Cardio-oncologists help people who:

• Need to start cancer treatment and have one or more heart disease risk factors. These include obesity, diabetes and high blood pressure.
• Need to start cancer treatment and have heart disease.
• Are undergoing chemotherapy or radiation and develop heart disease symptoms. These include edema, fatigue, chest pain and arrhythmia.
• Received cancer treatment in the past and now have new heart problems.
• Developed heart problems from cancer therapies and need heart surgery or other treatments.
• Have a heart tumor.

Do I need to see a cardio-oncologist?

Your primary care provider or oncologist is the best person to ask about the care you need. You need a referral from one of your doctors to see a cardio-oncologist.

You may need to see one if you fall into any of these groups:

• You have heart disease and were recently diagnosed with cancer.
• You received cancer treatment in the past, including during childhood.
• You’re currently receiving cancer treatment.

When should I see a cardio-oncologist?

The timing of when to see a cardio-oncologist varies widely. You may begin receiving care before your cancer treatment and then have follow-ups for years afterward. Follow your care team’s guidance on how often you need to come in.

Cardiovascular imaging tests (like echocardiograms) are a key part of your cardio-oncology care. This is true even after your cancer treatment has ended. These tests can show early signs of heart problems. So, it’s important to keep all of your appointments.

A note from Cleveland Clinic

Getting through cancer treatment is a huge milestone. So, learning you have heart issues that need treatment can feel overwhelming and exhausting. It’s like you’ve just run a marathon and now need to run another one right after. But be assured that you’re not alone in this process. Cardio-oncologists are specialists with the knowledge to help you manage heart disease, whether you’re at risk or have a diagnosis. Talk with your primary care provider or oncologist to learn more about how a cardio-oncologist can help you.