As cancer treatments continue to evolve, cardio-oncology – a subspecialty that sits at the intersection of cardiology and oncology – is playing an increasingly important role in supporting patients before, during and after treatment.

Wesley cardio-oncologist Dr Jonathan Sen is one of only a handful of specialists in the field in Queensland. He recalls the moment that changed how he thinks about medicine and what drew him to this work.

“I met a patient who had survived breast cancer, endured years of treatment, lived with the fear of recurrence and finally achieved hard-won remission, only to develop heart failure from the chemotherapy that saved her life,” Dr Sen said.

“Sitting with her in clinic, I realised that victories against one disease sometimes come at the cost of another. I didn’t want patients forced to choose. Everything I do now aims at achieving both together; the best cancer outcome while protecting the heart,” he said.

Here, Dr Sen answers common questions about the role of cardiology in cancer care.

What is cardio-oncology?

Cardio-oncology is a subspecialty of cardiology dedicated to preventing, detecting and managing cardiovascular complications that may arise before, during or after cancer therapy. My role is to protect and strengthen the heart so patients can safely receive the most effective cancer therapy and go on to live well. That care continues beyond treatment, into survivorship.

Cardio-oncology relies on close collaboration between cardiologists, oncologists and haematologists, GPs and allied health professionals. For patients, this means being cared for by a multidisciplinary team that considers the whole person, looking after the heart and the cancer together.

How can cancer treatments affect the heart?

Different cancer treatments, from traditional chemotherapy to newer targeted therapies and immunotherapy, can affect the heart in different ways. Examples can include high blood pressure, arrhythmias such as atrial fibrillation, cardiomyopathy (weakening of the heart muscle), myocarditis (inflammation of the heart muscle), and, in the longer term, disease of the heart’s arteries and valves. What’s reassuring is that many of these problems are uncommon, and when we pick them up early, most can be treated or even prevented. That’s why it helps to have a cardiologist in the treating team.

When should patients be referred to a cardio-oncologist?

The aim is to bring cardiac care into the cancer treatment plan as early as we can. Ideally, we’d like to meet patients before they start treatment. This allows us to review their current heart health, establish a baseline and identify patients who may benefit from cardio-protective strategies and closer monitoring.

Of course, this is not always possible, as the priority is often to start treatment quickly. Patients can also be referred at any time during or after treatment if there are abnormal cardiac test results or new cardiac symptoms.

Long-term follow-up is also available for patients after cancer treatment as part of survivorship care. Cardiovascular care doesn’t stop when cancer treatment does. For many survivors, keeping on top of everyday heart health, such as blood pressure, cholesterol and heart rhythm, becomes just as important as watching for any late effects of treatment.

Patients can speak with their oncologist, haematologist or GP about a referral.

What symptoms should patients, families or carers watch out for during or after treatment?

Symptoms that should prompt medical review can include chest discomfort or tightness, breathlessness that seems out of keeping with what you’re doing, palpitations lasting minutes or hours, fainting or near-fainting episodes, and new or clearly worsening fatigue. These symptoms can sometimes be difficult to differentiate and may occur for reasons unrelated to your current or past cancer treatment, but they always warrant a visit to the doctor for further investigation.

People often don’t like to feel as though they are complaining, but I encourage everyone to speak up about any symptoms they are experiencing so their treating team can consider whether they may be significant. If symptoms continue or progress, we need to look into them.

What do you find most meaningful about working in cardio-oncology?

Many of the patients I see are dealing with more than their cancer. Some also have valve disease, a heart rhythm problem or another heart condition alongside it. What I enjoy most is taking the time to talk things through, to help someone understand their treatment and what it might mean for their heart, and to play a key role in their treating team by bringing all of it together and looking at the whole picture.

How is cardio-oncology evolving and what advances are you most excited about?

Cancer care is advancing quickly, and every advance opens up new questions to work on. My own research looks at how artificial intelligence can help us predict, before treatment even starts, which patients are most at risk of heart problems, so we can keep a closer eye on them and step in earlier. Being able to help protect someone’s heart while they receive these new therapies is one of the most exciting parts of my work. The field is also growing into a specialty in its own right, with formal fellowship training now giving clinicians the depth this work really needs.

What’s your message to patients and families?

A cancer diagnosis can be frightening enough without having to worry about your heart as well. I want patients and families to know that our treatments are good, and that when we pick up heart problems early, we can usually help to manage them well.

Cardio-oncology is a growing field, and although dedicated services are still uncommon in Australia, there is more help available now than ever before. If you have any concerns about your heart at any stage of cancer treatment, please speak up. It is worth asking your oncologist, haematologist or GP whether a cardio-oncology review would be helpful, working alongside your existing cancer care and heart teams.

About Dr Jonathan Sen

Dr Jonathan Sen is a clinical and academic cardiologist with subspecialty training and expertise in cardio-oncology, valvular heart disease (in particular aortic stenosis), heart failure, general cardiology and advanced cardiovascular imaging. He is also a clinician-scientist, with a PhD from the University of Melbourne and a research affiliation with the Baker Heart and Diabetes Institute.

Formal fellowship training in cardio-oncology remains uncommon in Australia. Dr Sen completed his in Toronto with the University Health Network, working alongside the breast, lung, lymphoma and bone-marrow transplant teams at the Princess Margaret Cancer Centre, one of the world’s leading cancer centres. Over that time he carried out around a thousand cardio-oncology consultations across a wide range of cancers. He cares for patients before, during and after cancer treatment.

Alongside his subspecialty interests, he manages the full breadth of general cardiology conditions. Many people facing cancer are also living with valve disease, heart failure or other heart conditions, so he can look after all of a patient’s heart health at once. He provides inpatient and outpatient consultations and specialist echocardiography (heart ultrasound) services at The Wesley Hospital in Brisbane through Premier Cardiology.