In the research arena, the National Heart, Lung, and Blood Institute (NHLBI) and the National Cancer Institute (NCI) convened a collaborative workshop entitled “Cancer treatment-related cardiotoxicity: Understanding the current state of knowledge and developing future research priorities” in Bethesda, MD, that highlighted scientific priorities regarding cancer treatment-related cardiotoxicity in 2013. This meeting of experts recognized broad scientific efforts spanning basic science and translational research studies, investigating mechanisms of disease and utilization of biomarkers to improve upon CV risk stratification, to clinical trials evaluating the effects of cardioprotective strategies and epidemiologic investigations into the burden of this disease [4]. It also identified gaps and priorities for future research with critical need to validate reported promising study findings in large clinical models and translate the potential of recently elucidated mechanisms of cardiotoxicity into tools for risk stratification, diagnosis, and treatment [4].

As one of the most important consequences of this meeting, new funding opportunity announcements were released in November 2015 as a joint effort and strategic priority of the NCI and the NHLBI to improve outcomes in cancer treatment-related cardiotoxicity (http://​grants.​nih.​gov/​grants/​guide/​pa-files/​PA-16-035.​html and http://​grants.​nih.​gov/​grants/​guide/​pa-files/​PA-16-036.​html). The institutes encouraged “collaborative applications that will contribute to the identification and characterization of patients at risk” and emphasized mandatory collaboration between oncology and cardiology specialties on all applications thus highlighting the critical importance of cross-disciplinary work that will continue to shape this field.

Recent exciting research in cardio-oncology has included presentations of interventional prospective trials in breast cancer patients. Highly active targeted cancer therapeutics have revolutionized cancer care; however they also may introduce unexpected cardiovascular outcomes, and examination of these agents has introduced new paradigms in cancer and cardiovascular treatment. In the well-studied example of trastuzumab, after approval in the metastatic breast cancer setting, the anti-HER2 monoclonal antibody was introduced into clinical trials for early HER2-positive breast cancer. Given the known signal for cardiotoxicity observed in the metastatic setting, stringent cardiac criteria and monitoring schema were incorporated into adjuvant trials, providing the ability to detect, but not prevent, cardiac toxicity [5, 6]. More recent clinical safety investigations are increasingly focused on primary cardiac prevention strategies aimed not only to prevent and/or reduce LV dysfunction but also to decrease clinically meaningful interruptions of trastuzumab treatment [7, 8]. Based on the knowledge of pathogenesis of heart failure, these investigations utilize neurohormonal cascade blocking agents such as beta-blockers , angiotensin-converting enzyme (ACE) inhibitors , and angiotensin receptor blockers (ARBs) concomitantly with anti-HER2 agents with a goal to prevent LV remodeling and LV dysfunction and importantly allow completion of HER2 therapy. Although relatively small in size, these randomized prospective trials represent a major step forward toward integration of cardiovascular safety into major oncology trials. Future confirmatory studies with validation of the initial findings will hopefully lead toward translation of these primary prevention strategies into clinical practice.

Professional medical societies have a long-standing legacy of improving patients’ health by providing and developing education, training, clinical guidance, and research development for their members. In response to the growing member need, the American College of Cardiology (ACC) formed a Cardio-oncology Working Group in 2013 charged to explore existing cardio-oncology practices and identify areas of professional need. This group performed an environmental scan and a nationwide survey of cardio-oncology services and opinions among CV division chiefs and fellowship training directors that identified important challenges including the need for broader educational opportunities and training [1]. In consequence, the newly formed ACC Cardio-oncology Section and Council has set priorities to further develop and disseminate educational content using contemporary tools such as online cardiovascular websites and applications, CME courses, and integration with national and international conferences. In collaboration with the Annual Scientific Sessions 2015 (ACC.15) organizing committee, members designed Cardio-Oncology Intensive, a half-day program focused on highly relevant clinical questions in CV care of patients with cancer and cancer survivors (http://​www.​ajmc.​com/​journals/​evidence-based-oncology/​2015/​june-2015/​Advancing-Patient-Care-in-Cardio-Oncology-The-ACC15-Cardio-Oncology-Intensive). Growing educational opportunities come in the form of monthly webinars and annual meetings of the International Society of Cardioncology (ICOS) , such as the 2015 Global Cardio-Oncology Summit (http://​cardiac-safety.​org/​wp-content/​uploads/​2015/​08/​Global-Cardio-Oncology-Summit-Announcement.​pdf), as well as MD Anderson’s conferences and web-based series discussing topics relevant to heart disease in patients with cancer and cancer survivors.

Collaboration among professional cardiology and oncology societies offers unique opportunities for synergistic initiatives and advancement of the field. The ACC and American Society for Clinical Oncology (ASCO) convened a task group in 2014 that identified shared interest in broad areas including education and training, development of clinical guidance tools, and advancing research initiatives in the field of cardio-oncology. In addition to cardiovascular toxicity of cancer therapies, shared risk factors and etiologic commonalities between cancer, obesity, and cardiovascular disease have been recognized as an important area of need and potential for growth through professional collaboration. Among the proposed actions , joint development and dissemination of practice standards are most likely to critically influence the future of cardio-oncology and ultimately lead to effective incorporation of cardiovascular care into the continuum of cancer treatment, from diagnosis to survivorship (Fig. 13.1). Additional key areas for partnership among societies include shared use of registries, development of clinical practice toolkits, and joint educational and training activities.