# A risk-stratified cardio-oncology pathway for everyone receiving heart-toxic cancer therapy

Source: https://onco.cc/ideas/idea-acc-risk-stratified-cardio-oncology-pathway/  
OnCo record `idea-acc-risk-stratified-cardio-oncology-pathway` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some chemotherapy and antibody drugs damage the heart. Checking heart function before and during treatment and starting protective drugs early for those at risk could prevent much of that damage.

## Summary

Anthracyclines, HER2-targeted therapy, and some kinase inhibitors cause cardiac dysfunction that is often detected late. Guidelines (ESC 2022 cardio-oncology) recommend baseline risk assessment, biomarker and strain-imaging surveillance, and cardioprotective therapy for high-risk patients, but implementation is inconsistent and cardio-oncology clinics are rare outside academic centres. A pathway with automatic risk scoring at prescription, scheduled surveillance, and protocolised initiation of protective therapy would standardise this.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Systematic risk-stratified cardio-oncology care will reduce the incidence of symptomatic heart failure within five years of treatment by at least 30% and reduce premature discontinuation of HER2-targeted therapy.
- Rationale: Early detection of subclinical dysfunction and prompt cardioprotection improve recovery in trials; the gap is systematic application rather than evidence.
- Proposed test: A cluster-randomised implementation across 20 hospitals with heart failure incidence, treatment completion, and cardiovascular death as endpoints.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- Bottleneck evidence (Survivorship and late effects are neglected): NCI Office of Cancer Survivorship statistics: https://cancercontrol.cancer.gov/ocs/statistics

## Connected records

- cancers: [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Cardio-oncology](https://onco.cc/technologies/cardio-oncology/)
- drugs: [Trastuzumab](https://onco.cc/drugs/trastuzumab/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- roadmaps: [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)

---
JSON: https://onco.cc/api/v1/entities/idea-acc-risk-stratified-cardio-oncology-pathway.json