Cardio-Oncology Education and Training: JACC Council Perspectives

Abstract

The innovative development of cancer therapies has led to an unprecedented improvement in survival outcomes and a wide array of treatment-related toxicities, including those that are cardiovascular in nature. Aging of the population further adds to the number of patients being treated for cancer, especially those with comorbidities. Such pre-existing and developing cardiovascular diseases pose some of the greatest risks of morbidity and mortality in patients with cancer. Addressing the complex cardiovascular needs of these patients has become increasingly important, resulting in an imperative for an intersecting discipline: cardio-oncology. Over the past decade, there has been a remarkable rise of cardio-oncology clinics and service lines. This development, however, has occurred in a vacuum of standard practice and training guidelines, although these are being actively pursued. In this council perspective document, the authors delineate the scope of practice in cardio-oncology and the proposed training requirements, as well as the necessary core competencies. This document also serves as a roadmap toward confirming cardio-oncology as a subspecialty in medicine.

Keywords: cancer; cardio-oncology; cardiotoxicity; training.

FIGURE 1. Cardio-Oncology as the Integration of Cardiology and Oncology/Hematology

The specialty of cardio-oncology can be considered as the blend of both cardiology and oncology/hematology, with the large diversity in disease entities and subspecialty aspects, as illustrated.

FIGURE 2. Road to Cardio-Oncology Based on Prior Training Track

Both cardiology and hematology/oncology fellows are eligible for training in cardio-oncology. Their training needs, however, differ, emphasizing the learning of the knowledge of their counterpart discipline. CT = computed tomography; CV = cardiovascular; ECG = electrocardiography; MRI = magnetic resonance imaging.

CENTRAL ILLUSTRATION. Central Elements of Cardio-Oncology Training

Cardiology and hematology/oncology trainees or specialists can aspire to different levels of cardio-oncology training and acquire core knowledge elements and core competencies as outlined in an environment that provides the appropriate learning environment.