Thanks to current advances in chemotherapy, immunotherapy, targeted therapies, and radiation techniques, five-year survival rates for a range of malignancies have improved dramatically—from 50% in the late 1980s to 72% in 2017–2021 (Australian Institute of Health and Welfare, 2025). In Australia, there are now over one million people living with cancer. This success, however, comes with an important caveat: many cancer treatments can cause collateral damage to the heart that is sometimes only apparent years or even decades down the track. Additionally, the full extent of potential cardiotoxicity from novel cancer therapies, such as immune checkpoint inhibitors, bispecific antibodies, and CAR-T cell therapies is uncertain. Thus, as survival from cancer has improved over time, long-term cardiovascular consequences of cancer therapy have become more frequently diagnosed. Ensuring patient quality of life after cancer treatment has become just as important as achieving remission.
What is Cardio-Oncology?
Cardio-oncology is a subspecialty of cardiology dedicated to preventing, detecting, and managing cardiovascular complications that may arise before, during, and after cancer therapy.
Baseline cardiovascular assessment allows risk stratification based on the planned cancer treatment, helping identify patients who may benefit from cardioprotective strategies and closer monitoring. The primary goal is to optimise cardiac health so patients can safely receive the most effective therapy for their malignancy, though occasionally cardiac considerations may require treatment modifications. The cardio-oncologist’s role is to protect the heart so that patients can complete their course of cancer treatment.
How Can Cancer Therapy Affect the Heart?
Different cancer treatments are associated with different cardiac risks:
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Anthracyclines (e.g. doxorubicin) and HER2-targeted therapies (e.g. trastuzumab) can cause cardiomyopathy and heart failure. Early detection and treatment can often prevent permanent damage.
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Immune checkpoint inhibitors, which have transformed treatment for melanoma and lung cancer, carry a small but significant risk of myocarditis—inflammation of the heart muscle requiring urgent management.
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VEGF inhibitors (e.g. bevacizumab, sunitinib) commonly cause hypertension requiring proactive management.
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Various targeted therapies can cause QT prolongation, arrhythmias, and blood clots.
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Chest irradiation for breast cancer, lymphoma, or lung cancer is associated with accelerated coronary artery disease and/or valvular heart disease that may not appear until 10–20 years later.
Cardio-Oncology in Practice
The following scenarios illustrate the breadth of cardio-oncology care:
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A lymphoma patient with borderline heart function requires cardiac optimisation and enhanced monitoring before starting anthracycline-based chemotherapy
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A renal cell carcinoma patient with pre-existing hypertension needs blood pressure optimisation before and during bevacizumab treatment
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A melanoma patient on immunotherapy presents with fatigue and elevated troponin, prompting urgent evaluation for myocarditis
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A lung cancer patient with incidental severe aortic stenosis requires coordinated planning for valve intervention alongside cancer care
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A cancer survivor presents years later with breathlessness from coronary artery disease, valvular heart disease or constrictive pericarditis following prior chest irradiation
Who Should Be Referred?
Referral to a Cardio-oncologist is appropriate for:
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Baseline assessment before cardiotoxic cancer therapy, particularly for patients with pre-existing heart disease or risk factors (hypertension, diabetes, dyslipidaemia, obesity)
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New cardiac symptoms during or after cancer treatment—chest pain, breathlessness, palpitations, reduced exercise tolerance, leg swelling, or fainting
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Abnormal cardiac tests during treatment, such as a reduction in heart function on serial echocardiography or elevated cardiac biomarkers
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Long-term follow-up of survivors treated with anthracyclines, trastuzumab, immune checkpoint inhibitors, or chest irradiation
A Collaborative Approach
Cardio-oncology relies on close collaboration between cardiologists, oncologists, haematologists, GPs, and allied health. The aim is to integrate cardiac care into the cancer pre-treatment planning process without compromising cancer outcomes. For patients, this means being managed by a multi-disciplinary team of experts that considers the whole person—not just the cancer.
Seeking a Cardio-Oncology Opinion?
For referring doctors, detailed information is available on our Referrals page.
Patients wishing to discuss whether a cardio-oncology assessment may be appropriate for them are welcome to speak with their GP or cancer specialist about their suitability for Cardio-oncology input.
