ideasIdea
A risk-stratified cardio-oncology pathway for everyone receiving heart-toxic cancer therapy
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.
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.
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.
What would test it
A cluster-randomised implementation across 20 hospitals with heart failure incidence, treatment completion, and cardiovascular death as endpoints.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks
- Survivorship and late effects are neglected · Tens of millions of people live after cancer with heart damage, infertility, second cancers and fear, and few services.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.