Cardio-oncology lives at the juntion between two fast-moving fields. Cancer treatment keeps improving, patients live longer, and more of those patients carry cardiovascular risk that has to be managed alongside their oncology care. That much is not in dispute. The open question is whether cardio-oncology is simply a corner of general cardiology that any cardiologist already covers, or a distinct body of knowledge in its own right.
Last month gave us the first real data on it.
The survey
At ESC Cardio-Oncology 2026, the second annual conference of the European Society of Cardiology’s Council of Cardio-Oncology, researchers presented the first comprehensive international survey of cardio-oncology education. The work came from the Cardio-Oncologists Of tomorrow Leaders (COOL) group within the ESC Council, which exists to develop training strategies for the next generation working in the field.
The method was straightforward. An anonymised, web-based survey went to cardiologists, cardiology trainees, and other clinicians who look after patients with cancer. It drew 398 respondents from 63 countries, and 73% of them were board-certified cardiologists. This was not a small single-centre poll. It is a broad international snapshot, and the seniority of the sample is the part that matters.
The finding that matters most
Only 10% of respondents reported any exposure to cardio-oncology during medical school. Only 17% had exposure during residency. And 87% said their institution offered no structured cardio-oncology training programme at all.
Now hold those figures against the fact that nearly three quarters of the respondents were already board-certified cardiologists. What the survey captures, in effect, is a large group of qualified cardiologists reporting that cardio-oncology was not part of the training that qualified them. That is the cleanest evidence available that this knowledge does not arrive automatically with a general cardiology certificate. It has to be acquired deliberately, and most clinicians have not yet had the chance to acquire it in a structured way.
This is the heart of the case for treating cardio-oncology as its own discipline. The argument does not rest on any suggestion that general cardiologists fall short. It rests on cardiologists’ own account of what their training did and did not include. Cardio-oncology is new enough, and specific enough, that it sits outside the standard curriculum. The data says so plainly.
What “distinct” means at the bedside
The distinction is not abstract. It shows up in the specific decisions that fill a cardio-oncology clinic, where familiar findings can carry unfamiliar meaning.
Consider a patient on an immune checkpoint inhibitor who presents with a mildly raised troponin and some fatigue. On a quick read that can look like demand ischaemia or a non-specific troponin bump, particularly when the ECG is unremarkable and the echo shows preserved function. In the oncology context, the same picture raises the possibility of immune checkpoint inhibitor myocarditis, a rare but potentially fatal complication where the early investigations can be falsely reassuring. Knowing when to push further, when to hold the immunotherapy, and when to escalate treatment is a judgment built on having seen these presentations before.
Or take a cancer survivor referred years after treatment with new heart failure symptoms. A standard workup might reasonably chase ischaemic heart disease, hypertension, and valvular disease. But if that patient had anthracycline chemotherapy in their youth, or chest radiation two decades ago, the cause may be treatment-related cardiomyopathy or accelerated coronary disease with a different natural history. The clue is in the cancer treatment history, and you only find it if you know to ask.
A third: atrial fibrillation that appears while a patient is on a BTK inhibitor such as ibrutinib. On the surface it is new-onset AF. In context, the drug itself is often the driver, and the usual anticoagulation and rate-control decisions have to be weighed against bleeding risk, drug interactions, and the oncology plan.
None of these are exotic. They recur, and the right move in each depends on knowledge that, as the survey shows, most clinicians have not been formally trained in.
The priorities clinicians named
Asked what they most wanted to learn, respondents pointed to exactly this territory: diagnosing cancer therapy-related cardiovascular toxicity, and the strategies around it, namely risk stratification, prevention, and monitoring. Those priorities line up with the scenarios above. They are the decisions that sit between cardiology and oncology rather than squarely inside either one. That is what a distinct discipline looks like.
Asked how they would prefer to build that knowledge, respondents put cardio-oncology fellowships at the top of their list, ahead of webinars, master’s degrees, and society position statements.
The field is building the answer
It is not all gaps, though. The researchers were clear that the tools to close them are being built. The ESC has published dedicated cardio-oncology guidelines, released a core curriculum for the field, and laid the foundations for a formal ESC cardio-oncology certification. Respondents named the ESC and national cardiac societies as the bodies best placed to lead education here.
It also confirms a preference clinicians hold themselves. When people who do this work were asked how they would rather learn it, they chose immersive fellowship training over shorter formats. That squares with something I have written before: guidelines give you a framework, but the pattern recognition and clinical judgment come from sustained, hands-on time with a high volume of complex cases. I set that argument out in more detail in my earlier post on what a dedicated cardio-oncology fellowship year looks like in practice. The ESC survey now puts numbers behind it.
When cardio-oncology input helps most
For a GP or an oncologist, the practical question is not whether cardio-oncology is distinct in principle, but when to bring it in. Input tends to be most useful in a few clear situations:
- A patient is about to start, or is already on, a cancer therapy with known cardiovascular effects (anthracyclines, HER2-targeted agents, immune checkpoint inhibitors, some targeted therapies) and you want a baseline assessment or a monitoring plan.
- A cardiac problem emerges during cancer treatment, and the question is whether and how to keep the treatment going.
- A cancer survivor develops cardiac symptoms months or years after anthracyclines or chest radiation.
- A patient’s cardiac risk is high enough that the oncology team wants it factored into treatment planning from the outset.
The role in these cases is usually a focused one. Assess the patient, advise on monitoring through treatment, manage any complications, and then hand ongoing cardiac care back to the patient’s regular cardiologist. It is no different in shape from a referral to an electrophysiologist for an arrhythmia or a structural specialist for a complex valve. The patient gets the right input at the right time, and the referring cardiologist keeps the longitudinal relationship.
What it means locally
For patients and referring clinicians in Brisbane, the survey is useful context. It confirms, on international data, that formal cardio-oncology training is uncommon, and more so outside the large European centres, a group that includes Australia. Locally, the number of cardiologists who have completed a dedicated period of cardio-oncology fellowship training remains small. That will change over time, and it should. As immunotherapy and other newer cancer treatments become more common, the need for this input will only grow.
The framing I keep coming back to is partnership, not replacement. A patient going through cancer treatment is best served when their cardiac and oncology teams are talking to each other, and when focused cardio-oncology input is available at the moments it matters. That is what I aim to support.
Read the source
If you work in or near this field, the abstract is worth reading here. The ESC press release is here, and it links through to the underlying study detail.
If you are a patient, a GP, or an oncologist with a question about cardiovascular care during cancer treatment, I am always happy to talk through how I can help. Contact details are on the site.
Reference: European Society of Cardiology press release, “Survey reveals major gaps in cardio-oncology training”, presented at ESC Cardio-Oncology 2026 (COOL group, ESC Council of Cardio-Oncology), 20 June 2026.
