IPM Take
Personalised oncology does not stop at tumour profiling. It also depends on whether patients can receive the right cancer treatment without preventable cardiovascular harm. The ESC Cardio-Oncology 2026 survey is important because it shows a gap between clinical ambition and system capacity. Guidelines exist. Scientific awareness is growing. But if medical schools, residency programmes and hospitals do not train clinicians to recognise and manage cancer therapy-related cardiovascular toxicity, personalised cancer care remains incomplete. The next access gap may not be a drug. It may be the absence of trained cardio-oncology teams.
Executive Summary
An international survey presented at ESC Cardio-Oncology 2026 has revealed major gaps in cardio-oncology training. The survey included 398 respondents from 63 countries, most of whom were board-certified cardiologists. Only 10% reported exposure to cardio-oncology during medical school, 17% during residency and 87% reported no structured cardio-oncology educational programme at their institution. The findings come as cancer therapies become more effective, cancer survivorship increases and cardiovascular complications linked to cancer treatment become a growing clinical and policy concern. For IPM, the signal is clear: cardio-oncology is moving from specialist interest to health-system readiness test.
Why it matters
- Clinicians: Many doctors are expected to manage cardiovascular risks in cancer patients without formal cardio-oncology training.
- Oncology teams: Cancer treatment decisions increasingly require cardiovascular risk assessment, monitoring and coordination with cardiology.
- Hospital leaders: Cardio-oncology services need workforce planning, referral protocols, imaging capacity and multidisciplinary pathways.
- Policymakers: Cancer strategies that ignore cardiovascular toxicity risk underestimating the real cost of modern oncology care.
- Patients: Better cardio-oncology capacity could help patients stay on effective cancer treatment while reducing avoidable heart damage.
Cancer survival is improving.
That is the good news.
The harder news is that more patients are now living long enough to face the cardiovascular consequences of cancer treatment.
Some anticancer therapies can damage the heart or worsen existing cardiovascular disease. For patients, that can mean heart failure, arrhythmias, hypertension, treatment interruption or long-term survivorship burden. For health systems, it creates a new delivery problem: cancer care increasingly needs cardiology built into the pathway.
But the workforce is not ready.
At ESC Cardio-Oncology 2026 in Vienna, new international survey findings revealed major gaps in cardio-oncology education. The survey included 398 respondents from 63 countries. Most respondents were board-certified cardiologists, yet formal training exposure was limited.
Only 10% reported cardio-oncology training during medical school. Only 17% reported exposure during residency. Most strikingly, 87% said there was no structured cardio-oncology educational programme at their institution.
That is not a small training gap.
It is a system readiness warning.
Cardio-oncology sits at the intersection of two rapidly changing fields. Oncology is becoming more precise, more targeted and more effective. Cardiology is increasingly focused on prevention, risk stratification and long-term outcomes. The patient sits in the middle, often moving between oncologists, cardiologists, haematologists, radiologists, primary care teams and survivorship services.
If that pathway is not coordinated, the risk is obvious.
Cardiovascular toxicity may be detected too late. Cancer treatment may be interrupted unnecessarily. Patients with pre-existing cardiovascular risk may not be identified before therapy starts. Survivors may leave oncology care without proper long-term heart monitoring.
Guidelines have already recognised the problem.
The European Society of Cardiology published its first cardio-oncology guidelines in 2022, covering prevention, diagnosis and management of cardiovascular toxicity before, during and after cancer treatment. The ESC has also developed a cardio-oncology core curriculum and certification pathway.
But guidance alone does not change practice.
The survey suggests that many clinicians are still being trained in systems where cardio-oncology is not embedded in medical education, residency or hospital programmes. That matters because the field is not just about specialist centres. The cardiovascular risks of cancer therapy are showing up across routine care.
This is where personalised medicine becomes practical.
Before cancer treatment starts, some patients need cardiovascular risk stratification. During treatment, some need imaging, biomarkers and blood pressure monitoring. After treatment, some need long-term follow-up for heart failure risk or other late effects.
Those decisions require trained people.
They also require hospital systems to decide who owns the pathway. Is cardio-oncology led by cardiology? Oncology? A shared service? A survivorship clinic? A virtual multidisciplinary team? Without clear ownership, patients can fall between specialties.
The equity risk is also real.
Major academic hospitals may build cardio-oncology programmes first. Smaller hospitals, rural regions and lower-resource systems may lag behind. That would create a familiar pattern: patients treated in high-capacity centres get risk stratification and monitoring, while others receive cancer treatment without the same cardiovascular safety net.
For policymakers, this is not a niche specialty issue.
Cancer plans increasingly talk about innovation, survivorship and quality of life. But if cardiovascular toxicity is not included in workforce planning, reimbursement and service design, those plans miss part of the real patient journey.
For IPM, the message is simple.
Personalised oncology cannot only mean matching the right drug to the right tumour.
It must also mean protecting the right patient, at the right time, from avoidable harm.
Cardio-oncology is where that promise is being tested.
