For someone diagnosed with cancer, the immediate priority is understandably clear: treat the cancer. But as treatments become more effective and people live longer after diagnosis, another question is gaining importance, how can we protect the heart while treating the cancer?

Some chemotherapy drugs, targeted therapies and immunotherapies can affect the heart or blood vessels. Radiation involving the chest can also increase cardiovascular risk, sometimes years after treatment. The risk, however, varies considerably depending on the cancer, treatment, dose, duration and a patient's existing cardiovascular health.

This is where cardio-oncology comes in. The specialised field brings cardiologists and oncologists together to assess cardiovascular risk before treatment, monitor patients during therapy and provide follow-up after cancer treatment.

As Dr Ashish Jai Kishan, Senior Consultant, Cardiology, Fortis Hospital Okhla, says, "treating cancer and protecting the heart can go hand in hand." The aim is not to make patients afraid of cancer treatment. It is to ensure that the heart does not become an overlooked part of cancer care.

How can cancer treatment affect the heart?

Cardiovascular complications associated with cancer treatment can include reduced heart function, heart failure, abnormal heart rhythms, high blood pressure, coronary artery disease and blood-clotting problems.

The type of risk depends on the treatment. Anthracyclines, a class of chemotherapy drugs, can cause damage to heart muscle in some patients. HER2-targeted treatments, including trastuzumab, can also affect heart function. The 2022 European Society of Cardiology (ESC) cardio-oncology guidelines recommend specific cardiovascular risk assessment and monitoring protocols for patients receiving these therapies. 

Some targeted drugs can raise blood pressure, while certain treatments can increase the risk of blood clots or cardiovascular disease. Immune checkpoint inhibitors, which harness the immune system to attack cancer cells, can rarely cause inflammatory conditions affecting the heart, including myocarditis.

Radiotherapy involving the chest is another consideration. Radiation-related cardiovascular effects can emerge years after treatment, making long-term follow-up important for some cancer survivors.

Who needs extra heart monitoring? Not every cancer patient has the same cardiovascular risk. Patients who already have high blood pressure, diabetes, high cholesterol, obesity, smoking history or previous heart disease may need particular attention. Age, previous cancer treatment and the specific therapy being considered also influence risk.

"Before starting treatment, the patient's cardiovascular health and the planned cancer therapy should be assessed," says Dr Kishan. The ESC recommends cardiovascular risk stratification before potentially cardiotoxic cancer treatment. Depending on individual risk, assessment can include medical history and examination, blood pressure measurement, an ECG, cardiac biomarkers and cardiovascular imaging such as echocardiography.

This is important because some cardiac changes can occur before obvious symptoms appear.

Does cardiotoxicity mean cancer treatment must stop?

Not necessarily. This is one of the most important messages for patients.

Finding a cardiovascular problem during cancer treatment does not automatically mean that effective cancer therapy has to be abandoned. Instead, the oncology and cardiology teams can assess the severity of the problem, treat cardiovascular risk factors and decide whether cancer therapy can continue, needs modification or requires temporary interruption.

The objective of cardio-oncology is precisely this balance: maximise the benefit of cancer treatment while reducing cardiovascular harm. Dr Kishan emphasises that "the possibility of cardiac side effects does not automatically mean cancer treatment has to be stopped." Close communication between the oncologist and cardiologist can allow problems to be identified and managed earlier.

Why heart health still matters after cancer treatment

Completing cancer treatment does not necessarily mark the end of cardiovascular monitoring. The ESC guidelines include dedicated recommendations for cardiovascular assessment at the end of cancer therapy and long-term follow-up of cancer survivors. 

The American Heart Association has also highlighted the cardiovascular burden among cancer survivors, noting that cancer and its treatments can contribute to cardiovascular disease through direct effects as well as indirect factors such as weight gain and physical deconditioning. 

A 2026 AHA scientific statement further noted that cancer and atherosclerotic cardiovascular disease share risk factors such as ageing, inflammation and lifestyle factors, while some cancer therapies may accelerate atherosclerosis. It recommends cardiovascular risk assessment beginning at cancer diagnosis and a multidisciplinary approach to care. 

That makes long-term prevention important: managing blood pressure, cholesterol and blood sugar, avoiding tobacco, maintaining physical activity and following an appropriate diet can all contribute to cardiovascular health.

What is cardio-oncology?

Cardio-oncology is essentially teamwork between cancer care and heart care. Instead of treating the two as separate problems, specialists assess how the patient's cancer, cancer treatment and cardiovascular health interact.

This approach can involve:

  • Assessing heart risk before cancer therapy
  • Monitoring heart function during treatment
  • Managing blood pressure and other cardiovascular risk factors
  • Detecting treatment-related heart problems early
  • Supporting cardiovascular rehabilitation and long-term follow-up

The AHA describes multidisciplinary cardio-oncology care as an important way to minimise cardiovascular toxicity while supporting cancer outcomes.

Cancer treatment has changed dramatically, giving many patients the opportunity to live longer after a diagnosis. That success creates a new responsibility: survival should not be the only measure of successful cancer care. Quality of life and long-term cardiovascular health matter too.

As Dr Kishan puts it, "The goal is therefore not simply to help patients survive cancer, but to help them live well after cancer, with a healthy heart and the best possible quality of life." The message for patients is reassuring: cancer treatment and heart protection do not have to be opposing goals. With appropriate risk assessment, monitoring and collaboration between oncology and cardiology teams, cardiovascular complications can often be identified and managed as part of comprehensive cancer care.



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