Targeting Barriers of Systems of Care in a Growing Multi-disciplinary Field

  • Tolulope A. Agunbiade
  • Yvonne Ottaviano
  • Debolina Goswami
  • George Ruiz
  • Ana BaracEmail author
Cardio-oncology (EH Yang, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cardio-oncology


Purpose of Review

Cardio-oncology is a growing multi-disciplinary field that focuses on treating and preventing cardiovascular complications in cancer survivors and patients. This review summarizes the current clinical needs and system-based approaches to target barriers of care.

Recent Findings

The field of cardio-oncology has experienced significant growth in recent years, and an increasing number of programs have been developed across the nation to provide improved and multi-disciplinary care to this patient population. Despite this burgeoning growth, practitioners in the field continue to face important challenges which include lack of administrative and departmental support, funding limitations, and gaps in the areas of mentoring, education, and research.


Despite continued growth, cardio-oncology providers continue to face a multitude of challenges. Early inclusion of multi-disciplinary stakeholders, oncologists, cardiovascular team members, and administrative leadership provides an opportunity to collaborate and achieve unique patient care and health system benefits, such as prevention of adverse cardiovascular outcomes, and facilitates the delivery of optimal oncologic treatment.


Cardio-oncology Cardiovascular disease Oncology Chemotherapy Radiation therapy Targeted therapy 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Bovelli D, Plataniotis G, Roila F. Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease: ESMO clinical practice guidelines. Ann Oncol : official journal of the European Society for Medical Oncology. 2010;21(Suppl 5):v277–82.CrossRefGoogle Scholar
  2. 2.
    Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am Coll Cardiol. 2009;53(24):2231–47.CrossRefGoogle Scholar
  3. 3.
    • Fradley MG, Brown AC, Shields B, Viganego F, Damrongwatanasuk R, Patel AA, et al. Developing a comprehensive cardio-oncology program at a cancer institute: the Moffitt Cancer Center Experience. Oncol Rev. 2017;11(2):340 This article details the experience of developing a cardio-oncology program and provides an overview of the challenges faced and practical solution suggestions. CrossRefGoogle Scholar
  4. 4.
    American Cancer Society. Cancer Treatment & Survivorship Facts & Figures 2016–2017. Atlanta: American Cancer Society; 2016.Google Scholar
  5. 5.
    • Lancellotti P, Suter TM, López-Fernández T, Galderisi M, Lyon AR, Van der Meer P, et al. Cardio-oncology services: rationale, organization, and implementation. A report from the ESC Cardio-Oncology council. Eur Heart J. 2018;2018:ehy453 A comprehensive review article by the European Society of Cardiology Cardio-Oncology Council that discusses the rationale, organization, and implementation of cardio-oncology services. Google Scholar
  6. 6.
    Barac A, Murtagh G, Carver JR, Chen MH, Freeman AM, Herrmann J, et al. Cardiovascular health of patients with cancer and cancer survivors: a roadmap to the next level. J Am Coll Cardiol. 2015;65(25):2739–46.CrossRefGoogle Scholar
  7. 7.
    Herrmann J, Lerman A, Sandhu NP, Villarraga HR, Mulvagh SL, Kohli M. Evaluation and management of patients with heart disease and cancer: cardio-oncology. Mayo Clin Proc. 2014;89(9):1287–306.CrossRefGoogle Scholar
  8. 8.
    Armenian SH, Lacchetti C, Barac A, Carver J, Constine LS, Denduluri N, et al. Prevention and monitoring of cardiac dysfunction in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol : official journal of the American Society of Clinical Oncology. 2017;35(8):893–911.CrossRefGoogle Scholar
  9. 9.
    Zamorano JL, Lancellotti P, Rodriguez Munoz D, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(36):2768–801.CrossRefGoogle Scholar
  10. 10.
    Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2014;15(10):1063–93.CrossRefGoogle Scholar
  11. 11.
    Okwuosa TM, Barac A. Burgeoning cardio-oncology programs: challenges and opportunities for early career cardiologists/faculty directors. J Am Coll Cardiol. 2015;66(10):1193–7.CrossRefGoogle Scholar
  12. 12.
    Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer. 2003;97(11):2869–79.CrossRefGoogle Scholar
  13. 13.
    Suter TM, Procter M, van Veldhuisen DJ, Muscholl M, Bergh J, Carlomagno C, et al. Trastuzumab-associated cardiac adverse effects in the herceptin adjuvant trial. J Clin Oncol : official journal of the American Society of Clinical Oncology. 2007;25(25):3859–65.CrossRefGoogle Scholar
  14. 14.
    Guarneri V, Lenihan DJ, Valero V, Durand JB, Broglio K, Hess KR, et al. Long-term cardiac tolerability of trastuzumab in metastatic breast cancer: the M.D. Anderson Cancer Center experience. J Clin Oncol : official journal of the American Society of Clinical Oncology. 2006;24(25):4107–15.CrossRefGoogle Scholar
  15. 15.
    Jovenaux L, Cautela J, Resseguier N, Pibarot M, Taouqi M, Orabona M, et al. Practices in management of cancer treatment-related cardiovascular toxicity: a cardio-oncology survey. Int J Cardiol. 2017;241:387–92.CrossRefGoogle Scholar
  16. 16.
    Salem JE, Manouchehri A, Moey M, Lebrun-Vignes B, Bastarache L, Pariente A, et al. Cardiovascular toxicities associated with immune checkpoint inhibitors: an observational, retrospective, pharmacovigilance study. Lancet Oncol. 2018;19(12):1579–89.CrossRefGoogle Scholar
  17. 17.
    Johnson DB, Balko JM, Compton ML, Chalkias S, Gorham J, Xu Y, et al. Fulminant myocarditis with combination immune checkpoint blockade. N Engl J Med. 2016;375(18):1749–55.CrossRefGoogle Scholar
  18. 18.
    Gulati G, Heck SL, Ree AH, Hoffmann P, Schulz-Menger J, Fagerland MW, et al. Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2 x 2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol. Eur Heart J. 2016;37(21):1671–80.CrossRefGoogle Scholar
  19. 19.
    Avila MS, Ayub-Ferreira SM, de Barros Wanderley MR Jr, das Dores Cruz F, Goncalves Brandao SM, Rigaud VOC, et al. Carvedilol for prevention of chemotherapy-related cardiotoxicity: the CECCY trial. J Am Coll Cardiol. 2018;71(20):2281–90.CrossRefGoogle Scholar
  20. 20.
    Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82.CrossRefGoogle Scholar
  21. 21.
    Armstrong GT, Oeffinger KC, Chen Y, Kawashima T, Yasui Y, Leisenring W, et al. Modifiable risk factors and major cardiac events among adult survivors of childhood cancer. J Clin Oncol : official journal of the American Society of Clinical Oncology. 2013;31(29):3673–80.CrossRefGoogle Scholar
  22. 22.
    Kenigsberg B, Wellstein A, Barac A. Left ventricular dysfunction in cancer treatment: is it relevant? JACC Heart Fail. 2018;6(2):87–95.CrossRefGoogle Scholar
  23. 23.
    American College of Cardiology. Advancing the Cardiovascular Care of the Oncology Patient [Available from: Accessed 10 Dec 2018.
  24. 24.
    United States Food and Drug Administration. FDA Public Workshop: cardiovascular toxicity assessment in oncology trials [Available from: Accessed 10 Dec 2018.
  25. 25.
    United States Food and Drug Administration. FDA Public Workshop: assessment of cardiovascular toxicities in immuno-oncology trials [Available from: Accessed 10 Dec 2018.
  26. 26.
    NIH. Department of Health and Human Services [Available from: Accessed 10 Dec 2018.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Tolulope A. Agunbiade
    • 1
  • Yvonne Ottaviano
    • 2
  • Debolina Goswami
    • 3
  • George Ruiz
    • 1
  • Ana Barac
    • 4
    Email author
  1. 1.Cardio-Oncology ProgramMedStar Union Memorial HospitalBaltimoreUSA
  2. 2.Division of Breast OncologyMedStar Franklin Square HospitalBaltimoreUSA
  3. 3.Division of Oncology, MedStar Washington Hospital CenterWashington Cancer InstituteWashingtonUSA
  4. 4.Cardio-Oncology Program, MedStar Heart and Vascular InstituteGeorgetown UniversityWashingtonUSA

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