CARDIOONCOLOGYEHYANGSECTIONEDITOR - PDF document

1 CARDIO-ONCOLOGY(EHYANG,SECTIONEDITOR) Re
CARDIO-ONCOLOGY(EHYANG,SECTIONEDITOR) ReachingAcrosstheAisle:Cardio-OncologyAdvocacyandProgramBuildingDiegoSadler1 &AnitaArnold2&JoergHerrmann3&AndresDaniele4&CarolinaMariaPintoDominguesCarvalhoSilva5&ArjunKGhosh6&SebastianSzmit7&RoohiIsmailKhan8&LuisRaez9&AnneBlaes10&Sherry-AnnBrown11Accepted:11March2021#TheAuthor(s),underexclusivelicencetoSpringerScience+BusinessMedia,LLC,partofSpringerNature2021AbstractPurposeofReviewThisstudyaimstoassessthecurrentstateofcardio-oncologyinreferencetoadvocacyefforts,accesstocare,andperspectiveofstakeholdersintheirabilitytoprovidepatientcareaswellasdevelopmentof“acrosstheaisle”synergyamongcardiologistsandoncologistsandacademicandnon-academiccentersinvariousworldwidelocations.RecentFindingsDuringthelastdecade,therehasbeenasignificantanddiversegrowthincardio-oncology.Wereviewedtheexperiencefromcardiologistsandoncologistsacrossdifferenthealthcaresystems,theglobaltrends,theroleofcollaborativenetworks,andtheimportanceofadvocacyefforts.SummaryCardio-oncologywillcontinuetogrow,butthereisanunmetneedtoincreaseawareness,improveeducation,andexpandaccesstocaretolargersegmentsofthecancerpopulationinordertohaveamoresignificantimpactontheirhealth.Thegrowingcollaborationthroughprofessionalsocietiesandcollaborativenetworksprovidesanopportunitytoadvancethecardio-vascularcareofcancerpatientstomeettheprojectedneedsinagrowingandmorediversepopulation.KeywordsCardio-oncology.Advocacy.HealthcareIntroductionTherearecurrently17millioncancersurvivorsintheUSA[1].Cancerpatientshavea2–6timeshighercardiovascularmortalityriskthanthegeneralpopulation,andcardiovascularmortalityisevidentthroughoutthecontinuumofcancercare[2].Witheffectivecancertreatmentsanddecliningcancer-relatedmortality,cardiovasculardiseasemanagementandaccesstoitbecomeevenmoreimportant[2,3]Multiplefactorsresultindecreasedhealthcareaccessandpoorout-comesforthesepatients[4].Cardio-oncologyasasubspecial-tyinitiallydevelopedwiththeleadershipofoncologywithinseveralCanadianprovincesthroughtheCanadianCardio-OncologyNetwork(CCON).However,inmostoftheworldandwithintheUSA,cardio-oncologyhasreallygrowninstrengthandnumbersasaresultoftheleadershipof ThisarticleispartoftheTopicalCollectiononCardio-oncology*DiegoSadlersadlerd@ccf.org1HeartandVascularCenter,ClevelandClinicFlorida,Weston,FL,USA2LeeHealth,FloridaStateUniversity,Ft.Myers,FL,USA3DepartmentofCardiovascularDiseases,MayoClinic,Rochester,MN,USA4AngelH.RoffoInstituteoftheUniversityofBuenosAires,BuenosAires,Argentina5UniversidadedeSaoPaulo,SaoPaulo,Brazil6BartsHeartCentre,St.Bartholomew’sHospitalandUniversityCollegeLondon’sHospital,London,UK7CentreofPostgraduateMedicalEducation,Otwock,Poland8H.LeeMoffittCancerCenter&ResearchInstitute,UniversityofSouthFlorida,Tampa,FL,USA9MemorialHealthCare,FloridaInternationalUniversity,Miami,FL,USA10UniversityofMinnesota,Minneapolis,MN,USA11MedicalCollegeofWisconsin,Milwaukee,WI,USACurrentOncologyReports (2021) 23:64 https://doi.org/10.1007/s11912-021-01059-1 cardiologists.Numerouscardio-oncologyprogramshaveemergedtomeetthesedemandneedsbutremainconfinedtolargerinstitutions,whichareoftenacademicreferralcenters[5].TheAmericanCollegeofCardiology(ACC)’sNationalCardio-OncologySurvey[6]identifiedspecificbarrierstotheimplementationofcardio-oncologyprograms,includinglackofeducationalopportunities,limitedinterest,lackofinfra-structure,andlackoffunding.(Table1).Anadditionallimitationtomorewidespreadexpansionofcardio-oncologypracticesisthefactthatseveralcardiovascu-lartestingindicationsmaynotcoveredbymedicalinsuranceprovidersasdesignatedcodesdonotexist.Examplesincludepostradiationnoni

2 nvasivecardiactestingforsurveillance,bio
nvasivecardiactestingforsurveillance,bio-markersduringchemotherapytreatment,andcardiacmagnet-icresonanceusedforearlydetectionofcardiaceffectsofcancer-relatedtherapies.Herein,weprovideanoverviewofthecurrentlandscapeofcardio-oncologyprogramsacrosstheglobeandtheneedstoallowanevenbroaderuptakebyallwhowouldliketostartsuchasprogram.BuildingLocalCardio-OncologyProgramsandNetworkstoImproveAccesstoCareThereisaneedtoimproveaccesstocareatthelocal,state,andnationallevel.Forinstance,inthestateofFlorida,werecentlyreportedapracticalmodeltostartandmaintainasuccessfulcardio-oncologyprogramwithoutadditionalfinancialre-sourcesthatcanbereproducedinavarietyofdifferentpracticesettingstoimproveaccesstothisspecializedlevelofcare[7].Programsinthecommunitycanonlysucceedwithactivepar-ticipationandengagementwithprofessionalsocieties.InSeptember2018,thestateofFloridahostedtheInternationalCardio-OncologySociety(ICOS)GlobalCardio-OncologySummit(GCOS)inTampa.Casepresentationssharedduringthatmeetinghighlightedthewidespreadlackofawarenessandeducationincardio-oncologyinthelargermedicalcom-munity.MembersoftheFloridaChapteroftheAmericanCollegeofCardiology(FCACC)assembledacardio-oncologycommitteeand“reachedacrosstheaisle”tomedicaloncologistswhojoinedtheFCACCtoserveinthecommittee.ThecommitteeengagedonacollaborationbetweentheFCACCandtheFloridaChapteroftheAmericanSocietyofClinicalOncology(FLASCO)anddevelopedacollaborativeprogramtoassesstheeducationalneedsofbothcardiologistsandoncologists(Fig.1).Astatewidesurveyutilizingtheelec-tronicplatformsoftheFCACCandtheFLASCOrevealedthatevenamongthemoreengagedgroupofphysiciansthatrespondedtothesurvey,therewasaremarkablelackofknowledge,awareness,cooperationbetweencardiologistsandoncologists,andevenlackofknowledgeoncardiotoxicityofcommonlyusedchemotherapyregimensincancerpatients[8].Italsoemphasizedtheneedformorecardio-oncologyprograms.Basedonthesurveyresults,educationalmaterialsweredevelopedtohelpbridgingtheidentifiedknowledgegaps.ThosematerialsareasourceforrapidconsultationforpractitionersandareavailableatthewebsitesoftheFCACCandtheFLASCO[9].BasedontheFloridaexperience,thenextstepwastoeval-uatethesamequestionsandconcernsinavarietyofgeograph-iclocationsutilizingalarge,multistatenetworkthatincludesmembersfrom19ACCstatechapters,6ASCOchapters,and9countrieswithchaptersthatareaffiliatedwiththeInternationalCardio-OncologySocietywithparticipantsfrombothacademicandprivatepracticesettings.Thisnetworkisaplatformformultiplecollaborations.Theplansforgrowthofourcollaborativenetworkwerealteredbytheonsetofthe Table1Cardio-oncologybarriers(AmericanCollegeofCardiologySurvey)BarriersExamplesSolutions-Lackofnationalguidelines-NoformalACCAHAguidelines-ASCOguidelines-SCAIdocuments-ASEEACVIconsensusdocumentmultimodalityimaging-Absenceoffunding-Lackofinstitutionalresourcesforprograms-Lackofresearchfunding-Increasedinstitutionalawarenessbasedonpatientdata-AdvocacyandengagementwithNIHandfundingagencies-Limitedinterest-Currentlylessofaproblem,givenrapidgrowthofcardio-oncology-HasbeenreversedbydedicatedcommitteesbytheACC,ASCO,AHA,ESC,BCOS,andothers-Limitededucationalopportunities-Thenumberofeducationalactivitiesincreaseddramaticallyinthelast5years-ACCCardio-OncologyConference,MSKCC,GCOSAnnualConferences-DedicatedACC,AHA,ASCO,andESCsessionsinscientificmeetings-Multipleconferencesandwebinars-Journals:JACCCardio-Oncology,andCardio-OncologyJournal(ICOS)ACC,AmericanCollegeofCardiology;AHA,AmericanHeartAssociation;ASCO,AmericanSocietyofClinicalOncology;SCAI,:SocietyforCardiovascularAngiographyandIntervention;ASE,AmericanSocietyofEchocardiography;NIH,NationalInst

3 itutesofHealth;ESC,EuropeanSocietyofCard
itutesofHealth;ESC,EuropeanSocietyofCardiology;BCOS,BritishCardio-OncologySociety;MSKCC,MemorialSloanKetteringCancerCenter;GCOS,GlobalCardio-OncologySummit;JACC,JournaloftheAmericanCollegeofCardiology;ICOS,InternationalCardio-OncologySociety 64 Page2of13CurrOncolRep (2021) 23:64 COVID-19pandemicinearly2020.Therefore,thefirstpro-jectwastoassesstheimpactoftheCOVID-19pandemiconthepracticesofcardiologistsandoncologistsanditseffectsonthereallocationofresourcesforelectiveprocedures,testing,scheduling,accesstotelemedicineservices,theearlyutiliza-tionofnewCOVID-19therapies,andproviders’opinionsonhealthcarenationalhealthcarepolicies[10].Theresultsexposedsomeoftheshortcomingsoftheexistinghealthcaresystemanditsimpactonhealthcareprovidersandtheirabilitytoprovideoptimalcaretotheirpatientsinthecontextofahealthcarecrisis.Therewasanalmostunanimoussupportbycardiologistsandoncologists,academicandnon-academicdoc-tors,anddoctorsinavarietyofgeographicsettings,fortheneedfornationalhealthcarepoliciesforcontainmentoftheepidemicaswellasthestrongsupportforfurtherinvolvementandpartic-ipationofprofessionalmedicalsocietiesondecision-makingtodrivedata-basedhealthcarepoliciestobeimplementedbygov-ernmentsforpreparednessandresponseforcurrentandfuturehealthcarecrisis.Theseinitialprojectsbyourcardio-oncologymultistateandinternationalcollaborativenetworkhighlightstheroleofcollaborativenetworksinbeingactiveplayersinexpandingadvocacyandeducationincardio-oncology(Fig.2).TheRoleofSocialMediainAdvocacyFortheoutlinedprojectontheimpactofCOVID-19oncar-diologyandoncologypractices,socialmediawascriticaltodisseminatethesurvey,particularlyonTwitter(Table2).Twitterisasocialnetworkandmicrobloggingwebsiteandmobileapp(www.twitter.com).Userscanpostandrespondtomessagesknownas“tweets,”whicharelimitedto280characters.Userscanfollowotherusersororganizations.Tweetscanbecategorizedbyhashtags,whichcanalsobesearchedandfollowed,forexample,#CardioOnc.Asampleof5tweetsaboutthesurveyoriginatedintheUSAyieldedalmost8000impressions(numberoftimestweetwasseenbyotherindividualsonTwitter)combined,withengagementofcardiologistsandoncologistsincardio-oncologyreachingacrosstheUSAandaroundtheworld.Tweetswerecraftedinmultiplelanguagestoreflecttheinternationalnatureofthe Statewide SurveyFlorida ChapterAmerican College ofCardiology(FCACC)Florida ChapterAmerican Society ofClinical Oncology(FLASCO)FCACC & FLASCOElectronicEducational PlatformExpanded State,National, andInternationalAdvocacy NetworkChallenges Cardio-Oncology committee Participants from 10 state locations Board of Directors support Oncologist participates in FCACC Cardiologist participates in FLASCO Board of Directors Support Surveyed over 300 cardiologistsand oncologists Assessed challenges andshortcomings Resulted in increased membership Based on results from surveyfindings 11 short documents prepared bycardiologists and oncologists Available for quick reference inFCACC and FLASCO websites cardio-oncology knowledge available services Cooperation between Card. & Onc. Educational Programs FundingLack of: Expanded network: 17 states, 12countries COVID-19 Impact in Cardio-Oncology Survey Further network expansion forglobal registry Fig.1ThisfiguredescribesthecollaborativepartnershipbetweencardiologistsandoncologistsinitiatedinthestateofFloridaandexpandedtoformanationalandinternationaladvocacynetwork CurrOncolRep (2021) 23:64 Page3of13 64 survey.Thesentimentsexpressedinthetweetswereliterallyinvitingandalsosharedthoughtsofgratitude,collaboration,andcommunity.BoththeInternationalCardio-OncologySociety(@ICOSociety)andtheAmerica

4 nCollegeofCardiology(@ACCInTouch),long-t
nCollegeofCardiology(@ACCInTouch),long-timepartnersincardio-oncology,weretaggedormentionedinthetweets,aswerethenationalcardiologysocietiesforvariouscountriesappro-priatelymatchedtothelanguageofthetweet.Forexample,theArgentinianCardiologySociety(@SAC_54),theArgentinianCardio-OncologyCouncil(@CardioOncoSAC),andtheMexicanCardiologySociety(@SMexCardiologia)weretaggedormentionedinthetweetscraftedinSpanish.Similarly,forthetweetsinEnglish,regionalgroupswerementionedortagged.TheFloridachaptersoftheAmericanCollegeofCardiology(@FloridaACC)andtheAmericanSocietyforClinicalOncology(@FLASCO_ORG)weretaggedinthetweetsencouragingandthankingFloridapartic-ipantswhileatthesametimeverballyreferringtothenationalandglobalcommunityofstatesandcountriesbandingtogeth-ertoovercometheimpactoftheCOVID-19pandemic.Tweetsfromothercountriesdisseminatingthesurveyalsoreachedacrossboundaries.Atweetfromacardio-oncologyleaderinMexicowascraftedinSpanish,informingreadersofthetweetthattheirparticipationwasvitaltosharingtheirvoicesinthesurveyresults.ParticipantsintheUSA,Mexico,theUK,Canada,Argentina,andJapanweretaggedormentionedinthetweet,asweretheInteramericanSocietyofCardiology(@SIAC_cardio)andtheInternationalCardio-OncologySociety(@ICOSociety).Suchinternationalunitymayhavehelpedwithsurveyparticipation.Onemaythereforeconcludethatcommunity,collaboration,andnetworkingonsocialmediamayalsohelptodisseminateknowledgeincardio-oncologyingeneral.TheOncologyPerspectiveThereareabout12millioncancerpatientsandover15millioncancersurvivors,and1of3adultshavecardiovasculardisease(nearly82millionpatients).Approximately30%patientsre-ceivingcancertherapywillhavecardiovascular(CV)compli-cations.SomeoftheseCVcomplicationsmaynotbecomeapparentuntilmorethan10yearsaftercompletionofmulti-disciplinarytreatments(chemotherapy,targetedtherapy,im-munotherapy,radiationtherapy).Therearenumerousaddi-tionalconcernsforoncologistsmanagingcancertreatmentinpatientswithCVdisease:thesepatientsmaynotbeabletotoleratetheappropriatetherapy,andthismayadverselyaffecttheirsurvival.Ontheotherhand,manyofthepatientsthataretreatedwithpotentiallycardiotoxictherapyareatriskforthedevelopmentofCVdisease.Theseexamplesillustratewhytheneedforcardio-oncologycollaborationisofutmostim-portanceandhasmadeahugeimpactinimprovingthecareofourpatients.Thegoalofamultidisciplinarycardio-oncologyteam(bothintheacademicandthecommunitysetting)isthreefold.First,itisimportanttoidentifyshort-termandde-layedcardiotoxiceffectsofcancertreatments.Second,itisimportanttodevelopstrategiesforscreeningandmonitoringofcancerpatientsforCVtoxicitybefore,during,andaftercancertreatment.Lastly,itisimperativetooutlinea Fig.2Thisfigureillustratestheinteractionbetweenstakeholdersincardio-oncologyandthecollaborationsneededtooccuramongphysicians,professionalmedicalassociations,academicandcommunitycenters/practices,andcollaborativenetworkstoexpandeducation,awareness,andaccesstocareincardio-oncology.ICOS,InternationalCardio-OncologySociety 64 Page4of13CurrOncolRep (2021) 23:64 Table2TweetsdisseminatingthesurveyinEnglishandSpanishnationallyandinternationally TweetDescripon (hyperlinked)Tweet Reach Survey about the impact of COVID-19 on Cardiology and Oncology pracces, needs, and resources Naonal, internaonal Tweet in Spanish from the Mexican Society of Cardiology Cardiology society (@ACCInTouch), Oncology society (@ASCO), Cardio- Oncology society (@ICOSociety), mullingual, internaonal Tweet shared by Hematologist/Oncologist Hematology/Oncology community (@HemOncWomenDocs), naonal, internaonal A Cardio-Oncology coll

5 eague in Chicago shares the tweet Cardi
eague in Chicago shares the tweet Cardiology society (@ACCInTouch), mul-regional, oncology Tagging/menoning Cardio- Oncologists from mulple statesin America & the Internaonal Cardio-Oncology Society to encourage parcipaon and disseminaon Cardiology society (@FloridaACC), Oncology Society (@FLASCO_ORG), Cardio-Oncology Society (@ICOSociety), mul- regional, naonal, internaonal A Cardio-Oncology colleague in Mexico shares/replies to the tweet in Spanish tagging sociees and Cardio-Oncologists from around the world Cardiologysociety (@ACCInTouch), Cardio-Oncology society (@ICOSociety), mullingual, internaonal CurrOncolRep (2021) 23:64 Page5of13 64 multidisciplinaryapproachtomanagingcardio-oncologypa-tientsusingcurrentrecommendationstooptimizesurvivor-shipoutcomes.Thegoalofthecardio-oncologynetworkistoeducatethecardiologistsandoncologistsinourcommuni-tiesandimprovethecareofpatientswhohavebothcancerandheartdisease.Cardio-oncology,eventhoughinitiallydevelopedwiththeleadershipofoncology,hasreallygrowninstrengthandnumbersasaresultoftheleadershipofcardiologists.Engagingtheoncol-ogycommunityhasbeenandcontinuestobeaprioritythroughadvocacy,collaborativeresearch,andeducation,aswellasthroughcancersurvivorshipresearchandclinics.Fromanadvo-cacyperspective,nationalleadershipgroupsincludingtheAmericanHeartAssociation(AHA),theACC,andtheInternationalCardio-OncologySocietyhaveincludedbothcar-diologistsandoncologistsontheirexecutivecommittees,inanefforttobridgecollaborationsbetweenoncologyandcardiology.ThejournalsCardio-OncologyandJACCCardio-Oncologyhavebothcardiologistsandoncologistsontheireditorialboards.Nationaloncologyguidelinesnowalsoincludecardio-oncologyguidelines.BoththeNationalComprehensiveCancerNetwork(nccn.org)andtheAmericanSocietyofClinicalOncology(ASCO)havecardio-oncologyguidelinesoutliningmonitoringandpreventionacrossthespectrumofcancercare[11].LargeoncologymeetingssuchastheASCOandtheAmericanAssociationofCancerResearch(AACR)havealsohadeduca-tionsessionsspecificallydedicatedtocardio-oncology.Inordertocontinueoncologypatientsoncurativetherapiesorlife-extendingtherapieswhileminimizingtheburdenoftoxicity,closecollaborationbetweenoncologyandcardiologyneedstocontinueacrossthespectrumofprevention,treatment,andsurvivorship.Cancersurvivors,evenwhencuredfromtheircancer,donothavethesamelifeexpectancyasindividualsnotdiag-nosedwithcancer.Increasedmortalityoccursasaresultofdiseaserecurrence,buttheoccurrenceofcardiovasculardis-easeandsecondmalignanciescontinuestohaveanenormousimpactoncancersurvivors[3,12,13].Asaresult,cardio-oncologyandcardiovasculardiseaseriskassessmentneedtobeaddressednotonlyduringtreatmentbutalsothroughoutthesurvivorshipperiodthroughmultidisciplinaryapproachesnotonlywithcardiologybutalsophysicalmedicineandrehabil-itationandphysicaltherapy[14].Additionally,asmanypa-tientsarelivingforyearswiththeircancer,understandingtheimpactofcardiovascularcomplicationsofcancertherapyisvitalnotonlyforoncologistsbutalsoprimarycareproviders.Asaresult,educationaltoolscontinuetobedeveloped(Cancer.netthroughASCO,CardiosmartthroughACC)toeducatepatientsandproviders.Incorporatingcardio-oncologyintomedicaleducationacrossnursing,graduateschool,andmedicalschoolwillalsoenhancetheworkforceinbetterunderstandingthecomplexissuesrelatedtocardio-vasculardiseaseincancersurvivors.TheAcademicPerspective:TheCaseforAcademicAdvocacyAcademiccentershaveplayedacriticalroleintheadvocacyforthedisciplineofcardio-oncology.Theyareuniquelyplacedtodosofornumerousreasons.Themultidisciplinaryconceptandnatur

6 eofacademiccen-tersgenerateboththeneedan
eofacademiccen-tersgenerateboththeneedandopportunityforexchangeonmultiplelevels.Beingtypicallycomposedofhighlyspecial-izedproviderswithexpertknowledgeintheirrespectiveareas,thesecentersseetheneedforcollaboration,consultation,andreferral.Oncologistsandhematologists,forinstance,mayratherreferpatientstocardiologiststhantryingtotreatthemontheirown.Thisisdrivenbythevolumeoftheirpracticeaswellasthevastincreaseinknowledgeandconstantinflowofnewdataandinformationthatdoesnotallowtobeanexpertineveryfieldanylonger.Evenwithineachsubspecialty,thesedynamicscallforfurtherspecializationtomaintainfluencyandup-to-dateexpertise.Thismovetowardssub-specializationisnurturedatacademiccenters,andnewdevel-opmentsarenaturallyembracedandsupportedasitwasinthebeginningofthefieldofcardio-oncology.Theacademicmindsetalsolendsitselftotherecognitionoftrendsanddiscoveriesastheonesmadeintheintersectionofcardiologyandoncology/hematology.Academiccentersoftenhavetheopportunityforcross-talkbetweenclinicians,clini-cianscientists,andbasicscientistsforabroadportfolioofresearchactivitiesthatengagemorethanonegroup.Thecom-moninvolvementinpharmaceuticalstudiesatvariousphasesofdrugdevelopmentfurthermoreallowsforexposureto(new)sideeffectsandtheirassessmentandadjudication,suchascardiovasculartoxicitiesinoncologyandhematologytrials,includingphase1trialswherecardiacsafetyisamajorend-point.TheseengagementsenableinteractionandadvocacyontheleveloftheFoodandDrugAdministration(FDA)aswellasfundingagenciessuchastheNationalInstitutesofHealth(NIH).Inaddition,researchactivitieslendthemselvestopub-licationsandpresentationsatprofessionalsocietymeetingstothepointoftheintroductionofsubsections,evendedicatedjournalsforcardio-oncologysessionsatmajorcardiology,on-cology,andhematologymeetings.Activitiesinthisareahaveledtotheformationofspecificcardio-oncologychaptersorcouncilsatleadingprofessionalsocietiesliketheACC,theAHA,andtheEuropeanSocietyofCardiology(ESC),aswellastheformationofinternationalandnationalcardio-oncologysocieties,whichprovideadditionalopportunitiesforinterac-tion,collaboration,andadvancementforthefieldofcardio-oncology.Withalargeenoughvolumeofpatientsundergoingcross-disciplinarystudiesandcareandthenecessaryinfrastructureandinstitutionalsupport,academiccenterswerealsothefirsttoconceptualizeandoperationalizecardio-oncologyclinics.Thishaslinkedtoadvocacyonthelevelofclinicalpractice 64 Page6of13CurrOncolRep (2021) 23:64 wellbeyondinternalconfinestoincludegovernmentandnon-governmentpayors,policyadvisors,andpatientgroups.Theclinicalpracticeorganizationandexperiencemoreoverhaveprovidedaconnectionwithpractitionersatnon-academicin-stitutions.Academiccentersoftenserveastertiaryreferralcentersandpointofcontactandresource.Theconnectionwithnon-academicpracticeshasbeenen-hancedbytheabilityofacademiccenterstoorganizeeduca-tionalcoursesincardio-oncology.Academiccentersarealsoinauniquepositiontoallowforexposureandtrainingintheareaofcardio-oncologyincludingadvocacyforcardio-oncologyeducationinresidentandfelloweducationalcurric-ula.Thisveryaspectnaturallylendsitselftoeducationalin-teractionsacrossinstitutionsandeffortsofstandardization.Theseeffortsextendtopatientpracticeingeneralandthepursuitofpracticeguidelines.Thus,insummary,academiccentersbytheirmandateandresourcesforresearch,education,andtheadvancementofclinicalpracticehavebeencriticalinoutlining,developing,andadvancingthefieldofcardio-oncologyandplayacriticalroleinadvocacybyfullengagementinallthesedescribedactivities.AcrosstheOcean:Europe—TheUKinCardio-OncologyCardio-oncologyintheUKisarapidlydevelopingfield.Withagrowingappreciationo

7 fthemultitudeofcardiotoxicities,especial
fthemultitudeofcardiotoxicities,especiallywithnewercancertreatments,theUK’sfirstcardio-oncologyclinicwassetupattheRoyalBromptonHospitalbyDrAlexanderLyonandDrStuartRosen[15].Thiswassoonfollowedbyacollaborativeeffortfromoncol-ogistsandcardiologistsacrossthecountrytoformtheUKCardio-OncologyConsortiumin2012whichdemonstratedtheearlybuy-inachievedamongmanyoncologists.ThisbodyexpandedandfoundedtheBritishCardio-OncologySociety(BOCS)in2014topromoteresearchandclinicalexcellenceinthisnewfieldandtoadvocateforcancerpatientswithcardiacissues[16].FurthergrowthinthefieldledtotheappointmentoftheUK’sfirstconsultantcardiologistspecificallyincardio-oncology,DrArjunKGhosh[17].HisjointappointmentatEurope’slargestcardiaccenter(BartsHeartCentre)[18]andEurope’sprojectedlargestcancercenter(UniversityCollegeLondonHospital)[19]emphasizedthecollaborativeandcross-disciplinarynatureofcardio-oncologyintheUK.TheBCOSpartneredwiththeInternationalCardio-OncologySocietytohosttheGlobalCardio-OncologySummit(GCOS)attheRoyalCollegeofPhysiciansinLondonin2017toeducateparticipantsfrom31countriesonallaspectsofcardio-oncology.Additionally,theUniversityCollegeLondonCancerAcademyCardio-OncologyCourseisanationalcardio-oncologycoursenowinitsthirdyear[20].Thenatureofthiscourseisverymultidisciplinarywithsignif-icantparticipationfromhematologist-oncologists,oncolo-gists,trainees,specialistnurses,cardiacphysiologists,phar-macists,andprimarycaredoctors.SeveralhospitalsintheUKnowhaveestablishedcardio-oncologyfellowshipprogramsfortheUKandinternationaltrainees,andassuch,thefutureofcardio-oncologyintheUKlooksbright.Table3summarizestheleadingcardio-oncologyprogramsandscientificsocietiesintheUK.AcrosstheOcean:Europe—PolandforCentral/EasternEuropeinCardio-OncologyThebasesfornationwidecooperationbetweencardiologistsandoncologistsinPolandbeganin2009,whenthenationalconsultantincardiology(Prof.GrzegorzOpolski)andthena-tionalconsultantinclinicaloncology(Prof.MaciejKrzakowski)establishedaworkinggrouptodevelopstan-dardsofcardio-oncologycareinbreastcancer[21].Dr.SebastianSzmitwasappointedexecutiveeditor.TheCentreofPostgraduateMedicalEducation(CMKP)isauniquemed-icalacademicinstitutioninPoland,workingunderauspicesoftheMinistryofHealth,andisresponsibleforpostgraduateeducationforallphysicians.Thecardio-oncologydidacticcurriculumincludes“OncologyinCardiology,”obligatorycoursewithinspecialtyprogramincardiology,and“BasicsofCardio-Oncology,”obligatorylecturesduringspecialtyprogramininternalmedicineandclinicaloncology.Polandhasacharacteristicorganizationofoncologycarebasedonanoncologyhospital’snetwork.ThefirstoncologycenterinPolandwasestablishedonMay29,1932,basedonaninitiativebyMariaSkodowska–Curie,thedoubleNobelPrizelaureate,whodonatedagramofradium,usedasthebasisforstartingtheRadiumInstitute,currentlythemainon-cologycenterinPoland:theMariaSkodowska–CurieNationalResearchInstituteofOncologyinWarsaw.SubsequentlyeverymajorPolishcitybuiltanindependentoncologycenter.ThePolishNationalOncologyNetworkde-signedacommonalgorithmofmultidisciplinarymanage-ment,includingcardio-oncology,forallPolishhospitalstreatingcancerpatients,nowapprovedbytheNationalCouncilofOncologyatthePolishMinistryofHealth.Therefore,cardio-oncologyservicesarenowstaffedwithmorethan50cardiologistsemployedinoncologycenters,cooperatingcloselywithuniversity-basedcardiologydepart-ments.Anexpertgroupforcardio-oncologywasestablished:thegrouporganizedthreePolishcardio-oncologycongressesandcardio-oncologysessionsduringeachannualcongressofthePolishCardiacSocietyandpublishedtheirresearchfind-ings,someofthemincooperationwiththePolishLymphomaResear

8 chGroup[22–29].In2012,Dr.AdamTorbickiand
chGroup[22–29].In2012,Dr.AdamTorbickiandDr. CurrOncolRep (2021) 23:64 Page7of13 64 SebastianSzmitstartedtheICOS-EastEuropeanBranch,andin2019,theICOS-PolandChapterwasestablished.Polishcardiologistsparticipatedinthe2016ESCPositionPaperoncancertreatmentsandcardiovasculartoxicity,Thisdocument Table3Leadingprogramsandprofessionalsocietiesincardio-oncologyintheUKOrganizationActivityWebsite/contactinfoUniversityCollegeLondonHospital(UCLH)CancerAcademyOrganizedthefirstnationalcardio-oncologysymposiumintheUKledbyDrArjunKGhoshandDrAndrewWilsonhttps://www.uclh.nhs.uk/our-services/find-service/cancer-services/cancer-academyhttps://www.uclh.nhs.uk/our-services/find-service/cancer-services/cancer-academy/cancer-academy-schools/school-cancer-professionals/course-template-4BritishCardiovascularSociety(BCS)Ensuredthatcardio-oncologywasincludedinthenewUKcardiologytrainingcurriculumhttps://www.britishcardiovascularsociety.org/Hasbecomeaco-organizeroftheUCLHCancerAcademyCardio-OncologysymposiumalongwiththeBritishCardio-OncologySociety.https://www.bcs.com/education/BCOS-Cardio-Oncology.aspBritishCardio-OncologySociety(BCOS)AlongwiththeBritishSocietyofEchocardiographyhasproducedtheUK’sfirstcardio-oncologyguidelines(inpress)BCOSmembershavepublishedwidelyinthefieldincludinginternationalcardio-oncologyguidelinesTheBCOSwebsitehostsdetailsofUKCardio-OncologyClinicalandResearchFellowshipopportunitieshttp://bc-os.org/BCOSmembersareinanumberofleadershippositionsintheEuropeanSocietyofCardiologyCardio-OncologyCouncilhttps://www.escardio.org/Councils/council-of-cardio-oncologyBCOSistheUKrepresentativeoftheInternationalCardio-OncologySocietyhttps://members.ic-os.org/UCLH,UniversityCollegeLondonHospital;UK,UnitedKingdom;BCOS,BritishCardio-OncologySociety Table4Cardio-oncologyinPolandSubjectMaincharacteristicActivitiesforcardio-oncologyCentreofPostgraduateMedicalEducationThecentralmedicalacademicinstitutionresponsibleforthepreparationofprogramsandconductingandcoordinatingpostgraduatemedicaleducationinPoland.“OncologyinCardiology”—obligatorycourseswithinthespecialtyprogramincardiologyBasicsofCardio-Oncology”—obligatorylecturesduringintroductorycoursesininternalmedicineandclinicaloncologyPolishCardiacSociety(PolskieTowarzystwoKardiologiczne,PTK)PartoftheEuropeanSocietyofCardiology(ESC)PolishmembersautomaticallybecomemembersoftheESCESCguidelinesareimplementedineverydayclinicalpracticeinPolandThe2016ESCPositionPaperoncancertreatmentsandcardiovasculartoxicitytranslatedintoPolishonthePolishHeartJournalafterpublicationintheEuropeanHeartJournalPolishcardiologistsarepartoftheESCCouncilofCardio-OncologyPolishLymphomaResearchGroup(PLRG)ThematicsectionsdedicatedtospecificclinicalproblemsinlymphomasEachsectionmeetssemi-annuallytodiscusstheachievementsanddefinenewpurposesThecardio-oncologysectionmeetsregularlysince2011Anthracycline-inducedcardiotoxicityEarlyuseofechocardiographyinhighriskDLBCLduringR-CHOP/R-COMPchemotherapyCardiovascularsafetyofpixantroneCardiotoxicityoffirstandsecondgenerationBTKinhibitorsPolishNationalOncologyNetwork19hospitalswithoncologyserviceSupportofPolishLungCancerGroup(PLCG)Since2016threeannualnationwidePolishcardio-oncologycongressesand2sessionsduringcongressesofPolishCardiacSocietyhavebeenorganizedOngoingprogram:Cardiologybaselineassessmentandevaluationduringanticancertreatmentinfiveselectedtypesofcancerdisease(1)breastcancer,(2)lungcancer,(3)ovariancancer,(4)colorectalcancer,(5)prostatecancerESC,EuropeanSocietyofCardiology;DLBCL,diffuselargeB-celllymphoma;R-CHOP,rituximab-cyclophosphamide,doxorubicinhydrochloride,Oncovin(vincristine),pre

9 dnisone;R-COMP,rituximab-cyclophosphamid
dnisone;R-COMP,rituximab-cyclophosphamide,Oncovin,Myocet,prednisone;BTK,Brutontyrosinekinase 64 Page8of13CurrOncolRep (2021) 23:64 waspublishedintheEuropeanHeartJournalandthePolishHeartJournal[30].Table4summarizesthecurrentcardio-oncologystructureinPoland.Cardio-OncologyinLatinAmericaCardio-oncologyisrapidlygrowinginLatinAmerica.However,therearesomenationaldifferencesmainlyrelatedtoresourcesavailabilityanddisparitiesbetweendifferentcountries.Overall,therearefewcardio-oncologistsacrossLA,mainlyconfinedtoacademiccenters,whilecommunitydoctorsaretypicallynotinvolvedincardio-oncologycare.Patients’accesstocardio-oncologycareisdependentuponthereferralbytheoncologists,andinsomecountries,thelackofinterestbythecancerteamsandoncologyservicesresultsintheabsenceofandlimiteddevelopmentofcardio-oncologypracticeandservices.WhilesomecountrieslikeCubaandGuatemalaarejustgettingstartedwiththeirfirststepsoncardio-oncology,otherslikeBrazilandArgentinastarteditsimplementationadecadeagoandnowhavereachedalargeexpansionanddisseminationofthefield.Asaresult,BrazilandArgentinacancountonabetterdistributionofcardio-oncologyunitsacrosstheirterritoriesandhavethesupportofstrongnationalsocietiesincardiologyandoncologywithcardio-oncologycommitteesandstrongpresenceintheinter-nationalcommunity,havingrecentlyhostedinternationalsci-entificsessions.ManyBrazilianandArgentineancardio-oncologistshaveanactiveroleininternationalcardio-oncologyprofessionalorganizationslikeICOSandhavehadveryproductivescientificoutputwithpublicationsinmajorcardiovascular,oncology,andcardio-oncologyjournalsandparticipationintheireditorialboards.Theimplementa-tionofcardio-oncologychaptersinLatinAmericancountriesandthecreationofdedicatedmultidisciplinaryassociations,liketheAsociaciondeCardio-OncologiadelaRepublicaArgentina(ACORA)andtheCardio-OncologyInstituteofUniversityofSaoPaulo(Brazil),havegreatlycontributedtotheinterestinthisfield,yetsomecountriesstilllackthiscardio-oncologystructureandprofessionalorganizations.OthercountriesinLatinAmericalikeMexicoandCostaRicahavealsodevel-opedcardio-oncologyprogramsandcurrentlyhaveICOSChapters.Overall,LatinAmericahasanurgentneedforawareness,promotion,education,andaccesstocareincardio-oncology(bothbycardiologistsandoncologists)tomeetcurrentguide-linesandrecommendations.Therefore,furtherinvolvementofmedicalprofessionalsocietiestoprovidesupportandfacilitateeducationandexpansionofcardio-oncologyservicesinLatinAmericancountriesisessentialinordertoachievethisgoal(Table5). Table5Cardio-oncologyinLatinAmericaLocaldedicatedCOsociety/associationCOsectiononlocalcardiology/oncologysocietiesICOSnationalchapterLocalfellowship/trainningprogramHostinternationalCOmetingParticipationineditorialboardofmajorCOjorunalBrazilYes(websiteunderconstruction)Yeshttps://www.portal.cardiol.br/estaduais-depart-e-grupo-estudoYeshttps://ic-os.org/icos-brazil/Yeshttps://www.fm.usp.br/ccex/complementacao-especializada/cardio-oncologiaYeshttps://www.cardio-oncology.cardiol.br/Yeshttps://www.jacc.org/pb-assets/documents/Editorial-Board/jco/jacc-cardio-oncology-editorial-board-1604499314040.pdfArgentinaYeswww.cardio-oncologia.orgYes(Nolinkprovided)Yeshttps://ic-os.org/chapters/Yeswww.institutoroffo.uba.arYeswww.acoravirtual.comYeshttps://www.jacc.org/pb-assets/documents/Editorial-Board/jco/jacc-cardio-oncology-editorial-board-1604499314040.pdfCubaNoinformationavailableChileNoNoNoNoYes(Nolinkprovided)NoGuatemalaNoNoNoNoNoNoColombiaNoinformationavailableMexicoNoinformationavailableYesNoNoCostaRicaNoYeshttps://acc.co.cr/comisiones/Yeshttps://ic-os.org/costa-rica/NoNoNoCO,cardio-oncolo

10 gy;ICOS,InternationalCardio-OncologySoci
gy;ICOS,InternationalCardio-OncologySociety CurrOncolRep (2021) 23:64 Page9of13 64 Table6Advocacyissues/concernsandpotentialproposedsolutions/strategiesStakeholderIssues/concernsProposedsolutions/strategiesLegislatorsHealthcarepolicyandlegislationcomefromspecificcommitteesintheUSHouseandSenate.AdvocatesprovideinsightintothespecialtyandadvocateforspecificbillsorpolicyissuessuchaslimitingpreauthorizationandonerousdocumentationBuildingrelationshipsandarticulatingpatientneedsarecriticalandtakeanongoingeffort.MeetinglegislatorsinDCaswellasindistrictiscriticaltobuildingtheserelationships.Local,state,andfederalrepresentativesshouldbeengagedtoeducatethemonthechallengesofpractitionersandpatientsalikeResearchersOncologicdrugdevelopmentneedsspecificmeasurementsofcardiovasculartoxicityincludedinadverseeventsprotocolsFDAhasacceptedthisneedandhasheldmeetingswithcardio-oncologystakeholderstoaddressthescopeofcardiotoxicityPhysiciansintrainingIncreasedgraduatemedicaleducationpositionsandhelpwitheducationcostsfortheloomingshortageofcardio-oncologistsWhileuniversalacrossallspecialtyprograms,cardio-oncologyisanewfieldthatneedstobechampioned.IntheUSA,delineationofthesefellowshipprogramsisongoingPractitionersRelievingadministrativeburden,preauthorizationrequirements,appropriatereimbursement,andprescriptiondrugcostshavebeenaconcernwithcancerandheartdiseaseconsumingagreatdealofthehealthcareresourcesPartneringwithotherspecialtygroupsisimportanttospeakwithaunifiedvoice.Constantchangesinfederalandstateregulations,patientprivacyrights,andpractitionerburnoutallimpactdeliveryofcareSurvivorshipgroupsOngoingeffortstoaddressuniquepatientissueswithneedforawarenessonlatepresentation/long-termcardiovasculareffectsofcertaincancertreatmentsCancerandcardiovascularprofessionalassociationshavedevelopedprogramsforpatientstolearnthedelayedeffectsofcancertreatment,particularlyinsurvivorsofcancerexperiencedduringchildhoodPayorsNewtechnologiesrequirespecificcodesandvaluesforreimbursement.WorkwiththeAmericanMedicalAssociationRUCCommitteeandtheCentersforMedicareandMedicaidservices(CMS)aimstoensurecardio-oncologyrepresentationwitheducationforpayorsaboutwhatcardio-oncologyisandhowitimpactspatientscareTaxonomycodesspecificforcardio-oncologyandreimbursementforconsultativeservicesandproceduressuchasMRIorstrainechocardiographyhavebeensuccessful.ThecostofprescriptiondrugsanddrugshortagesareadvocacyissuesthatneedconstantremindersforpayorstobeproperlyaddressedUS,UnitedStates;DC,DistrictofColumbia;FDA,FoodandDrugAdministration;RUC,RelativeValueScaleUpdateCommittee;MRI,magneticresonanceimaging 64 Page10of13CurrOncolRep (2021) 23:64 Advocacy,Policy,andEconomicsinCardio-OncologyRisingdemandsandcoststohealthcaredeliveryremainuni-versalissuesamongnations,andthepercentageofgrossdo-mesticproduct(GDP)devotedtohealthcarecontinuestorise[31].TherecentpandemiccausedbySARS-CoV-2hasaddedtremendouslytothatconcern[32],furtherstraininghealthcarebudgetsandputtinggreatstressontheeconomicsofbothdevelopedandemergingnations[33].PatientswithcardiovasculardiseaseandcancerareamongthegroupsathighriskorpooroutcomesofCOVID-19andareatthehighestriskofsevereillnessandmortality.AdvocacyinthisareahasbeenaddressedinanICOSconsen-susstatementoncardio-oncologycareintheeraoftheCOVID-19pandemicrecentlypublished[34].Ascancerandheartdiseaseareresponsibleforthemajorityofdeathsintheworld,collaborativeadvocacyeffortsinthisareashouldexpand.Thisinvolvesanumberofvitalstake-holders(Table6)[35]withthegoalofraisingawarenessandsupportsothatcardio-oncologycarecanbecomemorewidelyavailableandthatbothpatientsandph

11 ysicianshavethere-sourcestheyneedforsucc
ysicianshavethere-sourcestheyneedforsuccessfuloutcomes.Cardio-oncologyadvocacyhasalsobeendirectedtowardsinformingandeducatingthosestakeholderswhocontrolhealthcarebudgetsandmayimpactresourcesavailableforpatientcare.(Table6).ConclusionsCardio-Oncologyhasgrownsignificantlyinthelastdecade.Thegrowthofcardio-oncologyhasdifferedinmanycountriesandgeographicareas.Eventhoughthereareoutstandinglargeacademiccentersandcardio-oncologistsleadingthethisgrowth,theawarenessandknowledgeofcardio-oncologyamongthepracticingmedicalcommunitycaringforalargesegmentofthepopulationarestilllimited,andthismaylimitthepositiveimpactofcardio-oncologyontheoverallpopula-tionhealthcareoutcomes.Thedevelopmentofcollaborativeeducational,advocacy,andresearchnetworksmaybeinstru-mentaltoimprovethissituation.Toachievethisgoalthereisneedfor:(1.)Oncologists“buy-in”:Morecooperationbetweencar-diologistsandoncologistsatthelocal,state,andnationallevelbyengagingviaexistingprofessionalsocietiesandbyperson-alengagementateachinstitutionwithorganizationofcom-binedclinicalandeducationalactivities.(2.)Education:Increaseactiveinvolvementofnewcomerstothefieldinthelargenumberofexistingeducationaloppor-tunitiesincludingconferences,webinars,andpublicationscurrentlyavailablethroughprofessionalorganizationsliketheACC,ASCO,AHA,ESC,ICOS,andotherstohelpguideandsustainthegrowth.(3.)Increasethenumberofcardio-oncologyprogramsinthecommunity:Byhavingphysiciansinvolvedinthefirsttwostepsequippedwiththeknowledgeandthrivetoleadapro-gram,becominga“champion”toengageleadershipinbothcardiologyandoncologyintheirinstitutionstofinanciallysupportandprovidestructureandresourcesfortheseprograms.(4.)Research:Theresearchdatabasesateachinstitutionprovideanopportunityfornewlyestablishedprogramstocol-laboratewithothers,participateinthelargercardio-oncologycommunity,andprovidedatathatimprovespatientcareandalsoprovidesinformationforadministratorstosupportandsustaintheseprograms.(5.)Advocacy:Theparticipationinprofessionalorganiza-tioncommitteesprovidingopportunityfortheinteractionwithotherstakeholderslikeinsurancepayors,governmentalagen-cies,healthcareregulators,andotherswillallowtoimprovecardio-oncologycareanddecreasegapsinaccesstocare.DeclarationsHumanandAnimalRightsandInformedConsentThisarticledoesnotcontainanystudieswithhumanoranimalsubjectsperformedbyanyoftheauthors.ConflictofInterestDiegoSadler,AnitaArnold,JoergHerrmann,AndresDaniele,CarolinaMariaPintoDominguesCarvalhoSilva,ArjunK.Ghosh,RoohiIsmail-Khan,LuisRaez,AnneBlaes,andSherry-AnnBrowndeclarenoconflictofinterest.SebastianSzmithasreceivedclinicaltrialfundingfromBristol-MyersSquibbandPfizerfortheCARAVAGGIOtrialandtheAPI-CATstudy;hasreceivedcompen-sationfromClinigenGroupforparticipationonamultinationalEuropeanUnionadvisoryboard;andhasreceivedcompensationforserviceasaconsultantfromAmgen,Angelini,AstraZeneca,Bayer,Berlin-ChemieAG,Bristol-MyersSquibb,Janssen-Cilag,Pfizer,Roche,andTEVA.ReferencesPapersofparticularinterest,publishedrecently,havebeenhighlightedas:OfimportanceOfmajorimportance1.SiegelRL,MillerKD,JemalA.Cancerstatistics,2018.CACancerJClin.2018;68:7–30.2.HerrmannJ.Fromtrendstotransformation:wherecardio-oncologyistomakeadifference.EurHeartJ.2019;40:3898–900Thiseditorialhighlightstheincreasedcardiovasculardiseasemortalitypersistentforlifeincancerpatientsandtheroleofcardiooncologyparticularlyinthosewithbettercancerprog-nosis(3). CurrOncolRep (2021) 23:64 Page11of13 64 3.SturgeonKN,DengL,BluethmanSL,etal.ApopulationbasedstudyofcardiovasculardiseasemortalityriskinUScancerpatients.EurHeartJ.2019;40:3889–97.4.BluethmannSM,MariottoAB,RowlandJH.A

12 nticipatingthe“SilverTsunami”.CancerEpid
nticipatingthe“SilverTsunami”.CancerEpidemiolBiomarkPrev.2016;25:1029–36.5.FradleyMG,BrownAC,ShieldsB,etal.Developingacompre-hensivecardio-oncologyprogramatacancerinstitute:theMoffittexperience.OncolRev.2017;11:340.6.BaracA,MurtaghG,DouglasP,etal.Healthofpatientswithcancerandcancersurvivors.JACC.2015;65:2739.7.SadlerD,ChaugalianC,CubedduR,StoneE,SamuelT,etal.Practicalandcosteffectivemodeltobuildandsustainacardio-oncologyprogram.CardioOncolJ.https://doi.org/10.1186/s40959-020-00063-xThisstudydescribeshowtosetupandsustainaprogramutilizingexistinginstitutionalresourceswithoutadditionalinvestment.Describesthekey4componentsforaprogram.8.SadlerD,FradleyM,IsmailKhanR,RaezL,BhandareD,ElsonL,etal.FloridaInter-SpecialtyCollaborativeProjecttoimprovecar-diooncologyawarenessandidentifyexistinggaps.JACCCardioOnc.2020;2(3):535–8Itdescribesthecollaborativeeffortbe-tweencardiologistsandoncologistsandintegrationoftheACCandASCOstatechaptersasamodeltoidentifygapsinaccesstocareinthecommunity.9.SadlerD,ArnoldA,Ismail-KhanR,FradleyM,GuerreroPetal.FCACCandFLASCOCardioOncologyOnlineEducationalplat-form.2020https://accfl.org/Cardio-Oncology10.SadlerD,DeCaraJ,HerrmannJ,ArnoldA,GhoshA,Abdel-QuadirH,etal.COVID-19pandemicanditsimpactoncardiooncology:resultsfromtheCOVID-19InternationalCollaborativeNetworkSurvey.CardioOncol.2020.https://doi.org/10.21203/rs.3.rs-88776/v1ThisisthefirstcollaborativeprojectcompletedbytheCardio-OncologyCollaborativeNetworkandaresultofaninternationalcooperationbetweencardiologistsandoncologists.11.ArmenianS,LacchettiC,BaracA,etal.Preventionandmonitoringofcardiacdysfunctioninsurvivorsofadultcancers:AmericanSocietyofClinicalOncologyClinicalPracticeGuideline.JClinOncol.2017;35(8):893–1.12.BlaesA,KonetyS.Cardiovasculardiseaseinbreastcancersurvivors:animportanttopicinbreastcancersurvivorship.JNCI.2020.https://doi.org/10.1093/jnci/djaa097Thiseditorialhighlightstheincreasedcardiovascularmortalityamongbreastcancersurvivorscomparedtocancer-freewomen,particularlyinelderlypatientsandinthosewithestrogenreceptor-positivestatusandreviewsothercohortsandriskfactorsinthispopulation.13.BradshawPT,StevensJ,KhankariN,TeitelbaumSL,NeugutAI,GammonMD.Cardiovasculardiseasemortalityamongbreastcan-cersurvivors.Epidemiology.2016;27(1):6–13.14.GilchristS,BaracA,AdesP,etal.OnbehalfoftheAmericanHeartAssociationExercise,CardiacRehabilitationandSecondaryPreventionCommittee.Circulation.2019;139:e997–e1012.15.PareekN,CevallosJ,MolinerP,ShahM,TanLL,ChambersV,etal.Activityandoutcomesofacardio-oncologyserviceintheUnitedKingdom—afive-yearexperience.EurJHeartFail.2018;20(12):1721–31.https://doi.org/10.1002/ejhf.1292.15.16.Cardio-OncologyintheUnitedKingdom.Availableat:https://www.escardio.org/Councils/council-of-cardio-oncology/cardio-oncology-in-the-united-kingdom.AccessedNovember3,2020.17.GhoshAK,ManistyC,WoldmanS,CrakeT,WestwoodM,WalkerJM.Settingupcardio-oncologyservices.BrJCardiol.2017;24(1):1.https://doi.org/10.5837/bjc.2017.003Inthisarticletheydescribetherequirementsforcardio-oncologyservicesandreflecttheirexperiencesinsettinguptheseservicesatlargeacademichospitalsinLondon,UK.18.TaylorJ.BartsHeartCentreisontracktobecomethelargestcar-diovascularcentreinEurope.EurHeartJ.2016;37:2968–9.https://doi.org/10.1093/eurheartj/ehw417.19.Anewclinicalfacility-protonbeamtherapy,blooddisordersandsurgery.Availableat:https://www.uclh.nhs.uk/aboutus/NewDev/NCF/Pages/Home.aspx.AccessedNovember3,2020.20.BritishCardiovascularSociety.Availableat:https://www.bcs.com/education/BCOS-Cardio-Oncology.asp.AccessedNovember3,2020.21.OpolskiG,KrzakowskiM,SzmitS,BanachJ,ChudzikM,Cygankiewic

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zI,etal.RecommendationsofNationalTeamofCardiologicandOncologicSupervisiononcardiologicsafetyofpatientswithbreastcancer.Thepreventionandtreatmentofcar-diovascularcomplicationsinbreastcancer.TheTaskForceofNationalConsultantsinCardiologyandClinicalOncologyfortheelaborationofrecommendationsofcardiologicproceedingwithpatientswithbreastcancer.KardiolPol.2011;69(5):520–30Describestheset-up,requirements,andguidelinesforcardio-oncologyclinicsandprogramsinPoland.22.Zaborowska-SzmitM,KrzakowskiM,KowalskiDM,SzmitS.Cardiovascularcomplicationsofsystemictherapyinnon-small-celllungcancer.JClinMed.2020Apr27;9(5):1268.23.SzmitS,Grela-WojewodaA,TalerczykM,Kufel-GrabowskaJ,StrebJ,Smok-KalwatJ,etal.Predictorsofnew-onsetheartfailureandoverallsurvivalinmetastaticbreastcancerpatientstreatedwithliposomaldoxorubicin.SciRep.2020Oct28;10(1):18481.24.StyczkiewiczK,StyczkiewiczM,MdrekS,JankowskiP,SzmitS,StecS.Telecardio-oncoAID:anewconceptforacoordinatedcareprograminbreastcancer(BREAST-AID):rationaleandstudypro-tocol.PolArchInternMed.2019;129(4):295–29.25.JurczakW,SzmitS,SobociskiM,MachaczkaM,Drozd-SokoowskaJ,JoksM,etal.Prematurecardiovascularmortalityinlymphomapatientstreatedwith(R)-CHOPregimen-anationalmulticenterstudy.IntJCardiol.2013Oct15;168(6):5212–7.26.SzmitS,JurczakW,ZauchaJM,Drozd-SokoowskaJ,SpychaowiczW,JoksM,etal.Pre-existingarterialhypertensionasariskfactorforearlyleftventricularsystolicdysfunctionfol-lowing(R)-CHOPchemotherapyinpatientswithlymphoma.JAmSocHypertens.2014Nov;8(11):791–9.27.SzmitS,JurczakW,ZauchaJM,Dugosz-DaneckaM,Sosnowska-PasiarskaB,ChmielowskaE,etal.Acutedecompensatedheartfailureasareasonofprematurechemotherapydiscontinuationmaybeindependentofalifetimedoxorubicindoseinlymphomapatientswithcardiovasculardisorders.IntJCardiol.2017May15;235:147–53.28.Dugosz-DaneckaM,GruszkaAM,SzmitS,OlszaneckaA,OgórkaT,SobociskiM,etal.Primarycardioprotectionreducesmrtalityinlymphomapatientswithincreasedriskofanthracyclinecardiotoxicity,treatedbyR-CHOPregimen.Chemotherapy.2018;63(4):238–45.29.JurczakW,Dugosz-DaneckaM,SzmitS.Cardio-oncologyforbetterlymphomatherapyoutcomes.LancetHaematol.2020Apr;7(4):e273–5.30.ZamoranoJL,LancellottiP,MuñozDR,AboyansV,AsteggianoR,GalderisiM,etal.2016ESCPositionpaperoncancertreatmentsandcardiovasculartoxicitydevelopedundertheauspicesoftheESCCommitteeforPracticeGuidelines.KardiolPol.2016;74(11):1193–233.31.Accessed10/25/2020:https://www.statista.com/statistics/268826/health-expenditure-as-gdp-percentage-in-oecd-countries32.BusinessofMedicine|TakingCareofPatients’HeartsDuringCancerTreatment:CollaborativeOncologyandCardiovascularCarehttps://www.acc.org/latest-in-cardiology/articles/2020/10/01/01/42/taking-care-of-patients-hearts-during-cancer-treatment-collaborative-oncology-and-cv-careAccessed10/25/2020 64 Page12of13CurrOncolRep (2021) 23:64 33.Accessed10/25/2020:https://www.worldbank.org/en/news/feature/2020/06/08/the-global-economic-outlook-during-the-covid-19-pandemic-a-changed-world34.LenihanD,CarverJ,HerrmannJ,etal.Cardio-oncologycareintheeraofcoronavirusdisease2019(COVID-19)pandemic.AnInternationalCardio-OncologySocietystatement.CACancerJClin.2020;70(6):480–5040:1-25.ThisisaverycomprehensivedocumentbyICOSidentifyingpathwaysforcareofcardio-oncologypatientsaccordingtotheircardiovascularrisk,cancerrisk,andCOVID-19risk.35.SklarDP.Whyeffectivehealthcareadvocacyissoimportanttoday.AcadMed.2016;91:1325–8.Publisher’sNoteSpringerNatureremainsneutralwithregardtojurisdic-tionalclaimsinpublishedmapsandinstitutionalaffiliations. CurrOncolRep (2021) 23:64 Page13of13