Research Priorities and Future Directions in Cardio-Oncology

The subspecialty of cardio-oncology has undergone significant growth in recent years, alongside major advances in the management of both cardiovascular disease and cancer, the leading causes of morbidity and mortality in the United States and many countries around the world. Contemporary clinical guidelines and scientific statements have outlined evidence-based strategies for reducing the risk of cancer therapy-related cardiovascular toxicity among cancer survivors across the treatment continuum. These approaches broadly include tailoring assessment and treatment of shared risk factors before therapy; minimizing cardiac radiation exposure, integrating baseline and repeat echocardiography for those receiving anthracyclines and targeted therapies, and assessing troponins and electrocardiography for patients starting immune checkpoint inhibitors during therapy; and considering long-term cardiac surveillance and promoting healthy lifestyle behaviors after therapy. This review outlines key evidence gaps and future directions in cardio-oncology with an emphasis on contemporary trends in cardiovascular disease and cancer risk factors, current and novel approaches for risk estimation and stratification, innovative clinical trials and largescale observational registries, quality-of-care metrics and cardio-oncology rehabilitation, social determinants of health and health equity, and artificial intelligence and machine learning for precision medicine. As the number of cancer survivors continues to grow and is projected to exceed 26 million by 2040, multidisciplinary collaboration between cardiology, oncology, and other health disciplines is critical to not only improve individuals' health outcomes and quality of life associated with cardiovascular disease and cancer, but also to further elucidate the bi-directional relationship and underlying pathophysiologic mechanisms underpinning both chronic diseases.