Onco-cardiology: the time has come.

On 3 and 4 November 2010, more than 200 physicians, scientists, and healthcare professionals from 14 countries gathered in Houston, Texas, for the First International Conference on Cancer and the Heart. This event was co-sponsored by The University of Texas MD Anderson Cancer Center and the Texas Heart Institute, two international leaders in the treatment of cancer and heart disease. Although similar meetings have been sponsored in the past, by us and by others, this meeting was remarkable for its scope and ambition. It was our intent to show that basic science can be used successfully to guide translational and clinical research. This First International Conference has heralded the coming of onco-cardiology as a research and clinical subspecialty. In this conference, cardiovascular complications were discussed in modules that comprised heart failure, imaging, radiation, thrombocytopenia, cardiac masses, and hypertension. Clinical experts from MD Anderson and other institutions presented updates on timely clinical topics, followed by question-and-answer sessions. A significant portion of the conference was devoted to basic mechanisms that drive paradigm shifts in this emerging field. Major discoveries were reported on a new paradigm for anthracycline-induced cardiotoxicity and vascular complications caused by some targeted agents. The role of prior exposure to doxorubicin in trastuzumab-induced cardiotoxicity was also discussed. Early identification of cardiotoxicity using biomarkers or left ventricular strain imaging has commanded significant attention. The proceedings of these modules are summarized concisely in the accompanying articles. This conference was not designed to cover the entire field, but rather to create a model for future conferences. Consequently, there are many important clinical issues and basic mechanisms that remain to be covered in future meetings. In addition to the clinical and basic-science modules, there was a session on the dialogue between patient and doctor. As physicians, we are in our comfort zone when illness is defined by medical terms and laboratory numbers. It is refreshing to hear about it from a patient's perspective: illness is a personal affliction that alters one's sense of wellness and self-esteem. Indeed, this conference is dedicated to all cancer patients who have suffered cardiovascular complications. A decade ago, MD Anderson had 2 in-house cardiologists and referred most cardiovascular complications to surrounding hospitals in the Texas Medical Center. As the complexity of our patient population grew, it became difficult to obtain timely consultation and treatment for our patients. Consequently, the Department of Cardiology at The University of Texas MD Anderson Cancer Center was established in 2000. I was recruited as the founding chair with the charge to develop a comprehensive cardiology service and to develop basic and clinical research relevant to cancer and the heart. The service now consists of 11 cardiologists, 7 physician extenders, 2 pharmacists, and 5 rotating cardiology fellows who provide comprehensive cardiac care to cancer patients. We have also built a cardiac catheterization laboratory that performs cardiac biopsies, diagnostic studies, and the implantation of pacemakers. We have strong basic research laboratories that have published their findings in prestigious scientific journals. Our experience is not unique because several institutions in the United States and Europe have already established “onco-cardiology” (or “cardio-oncology”) units. These centers include Memorial Sloan-Kettering Cancer Center (New York) and the European Institute of Oncology (Milan). Each onco-cardiology unit faces different challenges that are associated with the size of the hospital, its affiliation with other general hospitals, and the scope of cancer treatments. Smaller onco-cardiology units are also emerging within major medical centers in the United States. These small units usually have cardiologists who have developed an interest in taking care of the heart problems of cancer patients, in addition to the problems encountered in a general cardiology practice. As these onco-cardiology units proliferate, it is important to establish communications between them in order to share common experiences and extraordinary challenges. Onco-cardiology is a medical subspecialty concerned with the diagnosis and treatment of heart disease in cancer patients. Clearly, this field is not limited to cardiologists, but also includes medical oncologists, radiation oncologists, surgical oncologists, and all others who are interested in caring for cancer patients with cardiac problems. A major issue that our field must define is the scope of the core knowledge that needs to be shared by all practitioners. Furthermore, we must educate our cardiology and oncology colleagues about the importance of providing optimal cardiac care to cancer patients. These efforts should bring about improved clinical outcomes and enhance the development of new anticancer therapies. As cancer therapy becomes more effective and as more cancer patients become cancer survivors, it is the goal of the “onco-cardiologist” to ensure that our patients will have healthy hearts to enjoy their new lives.