Cardio-Oncology: Why Heart Health Matters in Cancer Care

As cancer treatments have improved, more people are living longer during and after cancer, shifting the focus beyond treating disease alone to supporting long-term health and quality of life. One area gaining increasing attention is heart health. Cardio-oncology, a growing medical specialty at the intersection of cancer care and cardiovascular medicine, focuses on preventing, monitoring, and managing heart-related effects of cancer therapies. We spoke with Jayant K. Raikhelkar, MD, a cardio-oncologist at Columbia University Irving Medical Center, about what this multidisciplinary field aims to do and what it can offer patients in treatment and beyond.  

What is cardio-oncology? Is it a new field? 

Over the past 10 to 15 years, cancer treatment has advanced dramatically. In addition to traditional surgery, chemotherapy, and radiation, newer approaches such as immunotherapy and targeted therapies have helped patients live longer and often with a better quality of life. 

As these treatments have evolved, we have also learned that some cancer therapies can affect the heart. We know now that patients receiving certain treatments may need to be monitored differently to protect both their cancer outcomes and their long-term heart health. 

Out of this understanding, the field of cardio-oncology emerged. Cardio-oncology focuses on heart health before, during, and after cancer treatment to evaluate cardiac risk, monitor and manage side effects, and treat heart conditions so patients can safely receive the most effective cancer therapy possible. 

Today, cardiologists with specific training in cardio-oncology care for patients alongside their oncologists throughout their cancer journey with the shared goal of achieving the best possible outcomes for both the heart and the cancer. 

Why is heart health so important in cancer care? 

We think about a patient’s cardio-oncology needs across three phases of their cancer journey: before treatment, during treatment, and after treatment. 

Before cancer therapy begins, some patients already have underlying heart conditions such as high blood pressure, coronary artery disease, or even heart failure. These patients may be at higher risk for cardiac complications once treatment starts. The goal at this stage is not to delay or stop cancer therapy, but to identify risks early and put the best management plan in place to support patients through treatment. 

During cancer therapy, heart-related issues can sometimes arise. Patients may develop cardiac symptoms or side effects from their treatments. Our goal is protect the heart while allowing cancer treatment to continue whenever possible. 

The third phase is cancer survivorship, or after treatment. Some heart problems can emerge years after treatment has ended. We’ve seen patients develop conditions like heart failure eight to ten years after their initial cancer therapy. Ongoing monitoring allows us to identify these issues early and intervene before they become severe. 

How can cancer treatments affect the heart? 

Cancer therapies can affect the heart in a number of ways. One of the most common issues is damage to the heart muscle, which can weaken its pumping function. Certain chemotherapy drugs known as anthracyclines have long been associated with this risk. Some targeted therapies, such as anti-HER2 treatments used in breast cancer, can also affect heart function. 

With the rise of immunotherapy, clinicians have identified rarer but serious complications, such as inflammation of the heart muscle, known as myocarditis. Increased awareness over the past several years has helped providers detect and treat this condition earlier. 

Cancer treatments can also affect the heart’s electrical system, leading to rhythm abnormalities. Radiation therapy, particularly older forms used decades ago, may increase the risk of conduction problems or coronary artery disease later in life. Some chemotherapies, such as 5-fluorouracil used in colon cancer, can lead to  spasm of the coronary arteries  

Taken together, cancer therapies can impact nearly every aspect of cardiovascular health. Cardio-oncology exists to recognize these risks early and manage them effectively. 

Learn More- Columbia Cardio-Oncology Program 

How do you balance heart risks with the need for cancer treatment? 

A new cancer diagnosis is one of the most stressful experiences a patient can face. Being told there may also be risks to the heart can feel overwhelming. 

Our role as cardio-oncologists is not to stop cancer treatment. Our goal is to identify risks and treat heart conditions so patients can receive the best comprehensive cancer therapy available today. Using the most up-to-date tools and knowledge, we work proactively to reduce complications and help patients complete treatment safely. 

By managing cardiac risks alongside cancer care, we aim to improve outcomes for both conditions. Patients should feel reassured that this approach strengthens, not limits, their cancer treatment plan. 

What is your role in cancer survivorship? 

While some cardiac side effects occur during treatment, others may appear years later. Cancer survivors can be at increased risk for conditions such as heart failure, heart rhythm abnormalities, or coronary artery disease long after therapy has ended. 

In my practice, which includes advanced heart failure care, I’ve seen patients develop severe heart disease many years after cancer treatment. In rare cases, this can progress to advanced heart failure requiring therapies such as mechanical assist devices or even heart transplantation. 

At Columbia, we are able to draw on the full strength of our cardiology program to care for cancer survivors with complex heart conditions. Our experience with advanced therapies in cancer survivors—including heart transplantation and ventricular assist devices—is among the largest in the country. 

Cardio-oncology also works in the reverse direction. Patients who undergo heart transplantation are at higher risk for developing cancer later, making close collaboration between cardiology and oncology essential throughout survivorship. 

In a recent study published in the Journal of the American Heart Association, we evaluated outcomes in more than 100 cancer survivors who underwent heart transplantation at Columbia. Encouragingly, their survival outcomes were similar to those of patients without a history of cancer. We did observe a higher rate of secondary cancers in cancer survivors, most notably cancer survivors were four times more likely to have secondary cancer unrelated to their primary cancer, rather than a cancer recurrence. This has prompted ongoing work to improve early detection and risk reduction strategies in this unique population. 

Who should consider seeing a cardio-oncologist? 

Patients newly diagnosed with cancer should share their cardiac history and risk factors, such as high blood pressure or prior heart disease, with their oncologist. This information helps oncologists identify who may benefit from early cardio-oncology involvement. 

Cancer survivors should also be aware of the treatments they received. Certain chemotherapies, targeted therapies, and radiation, especially older radiation techniques, can increase the risk of late cardiac effects. People who received these treatments may benefit from evaluation by a cardio-oncologist or discussion with their primary care provider. 

What does a typical cardio-oncology visit involve? 

Cardio-oncology care is highly collaborative. Our team includes a cardio-oncologist, a specialized nurse practitioner, and at Columbia, we have one of the few cardio-oncology pharmacists in the country. 

During a visit, we review cardiac risk factors, symptoms, prior heart testing, and overall functional status. Equally important, we take a detailed oncology history to understand exactly which treatments a patient received or will receive. This combined perspective allows us to tailor care to each patient’s unique risk profile. 

Communication with the oncology team is central to this process. We work closely with oncologists to develop a coordinated plan that supports both heart health and cancer treatment. Cardio-oncology is truly a team effort. 

What else should patients know about cardio-oncology? 

It’s important for patients to understand that the goal of a cardio-oncology clinic is to help them receive the best possible cancer treatment—while protecting their heart along the way. 

Being referred to another specialist can feel stressful, but this care is proactive and protective. By addressing heart health early, we improve a patient’s ability to complete cancer therapy safely and support long-term well-being. 

Heart disease and cancer are closely linked, in cancer treatment and beyond. Cardio-oncology exists to address this intersection—ensuring that patients are supported from every angle throughout their cancer journey.