Another Perspective on Cardio-Oncology: Insights from Houston, Texas

Another Perspective on Cardio-Oncology: Insights from Houston, TexasWe had the pleasure of reviewing "A minimalist cardio-oncology service: A personal experience from Wales 1 ," in which the authors report indications, access to care, provided services, and challenges for patients with cancer and heart disease in Wales.Our group faced similar challenges almost two decades ago, in a different health care system.This editorial will try to relive this journey on a different longitude and latitude to hopefully provide an optimistic second perspective.As the field of oncology expands, cardio-oncology will hopefully parallel the trajectory of cancer as a disease.From the now classical cardiotoxicities -anthracycline and trastuzumab or radiation induced heart disease, we now face an explosion of novel cancer therapies, paramount being the Bruton tyrosine kinase (BTK) inhibitors, monoclonal antibodies (Bevacizumab), tyrosine kinase inhibitors (TKIs), immune check point inhibitors (ICIs), and CAR T-cell therapy, all of which are associated with some degree of cardiac toxicity.Our perspective and approach can hopefully provide opportunities to expand the scope of practice and overall improve cardiovascular care.Recognized under multiple names, Cardiology-Oncology, Onco-Cardiology, "Cancer and the Heart," etc., the roots of this field date back to 1967 when daunorubicin-induced cardiotoxicity was first recognized.Medical practice in the 1970's included recognizing toxicities from "life-saving" cancer therapies, predominantly chemotherapy (anthracycline based) 2 and radiation therapy 3 , with the aid of physical examination, imaging (CXR), and cardiovascular studies (electrocardiogram or ECG and echocardiography). 4reatments were either continued at prohibitive risk for the patient, held indefinitely, or alternatively, less cardiotoxic therapies were considered.Physicians were internal medicine doctors with particular interest in patients with cancer.The "beginnings" period spanned from 1970-2000, and the field was coined "Cardio-Oncology" in 1996. 5D Anderson Cancer Center in Houston, Texas has been one of the top two cancer hospitals in the United States since the U.S. News & World Report survey began in 1990, holding the number one rank for the last 16 years.MD Anderson is one of the largest cancer centers in the world, with 25,000 employees including more than 1,900 faculty members working in more than 25 buildings across Houston and Central Texas (Figure 1).The Department of Cardiology at MD Anderson was founded in 2000 as the first cardio-oncology unit in the world.Its goal is to provide comprehensive cardiac care to patients with cancer and address cardiovascular complications following cancer therapy and co-existing cardiac conditions.At first, the department was comprised of three clinical cardiologists and a comprehensive research team.