Cardiovascular risk assessment in oncologic patients. A narrative review

Systematic cardiovascular risk assessment and stratification across the entire cancer care continuum is essential among cancer patients, largely due to potential cardiotoxic effects of oncologic therapeutic regiments. Prior to initiation of cancer therapy, cardiotoxicity risk assessment should include comprehensive evaluation of baseline cardiovascular status and baseline measurement of cardiac biomarkers. Patient-related factors should be integrated with therapy-related risks associated with specific oncologic regiments and/or radiotherapy. During cancer treatment, continuous cardiovascular surveillance is necessary to detect early or subclinical myocardial dysfunction. Monitoring strategies involve periodic clinical evaluation, serial echocardiographic assessment and biomarker measurements. Surveillance protocols should be adapted according to the cardiotoxic potential of the administered regimen; as early detection of cardiotoxicity allows prompt cardioprotective interventions and adjustment of oncologic treatments. Cardiovascular assessment after cancer therapy is crucial due to potential delayed cardiotoxic effects. During the first year, post-treatment, structured follow-up is recommended to identify persistent or emerging cancer therapy-related cardiotoxicities. Long-term surveillance is also particularly important for cancer survivors exposed to cardiotoxic agents, given their increased risk of chronic cardiovascular complications. Digitalization improves cardio-oncology risk assessment through artificial intelligence, electronic health records, and remote monitoring enabling earlier detection and personalized cardiovascular surveillance. A multidisciplinary cardio-oncology approach and structured surveillance across the entire cancer care continuum is crucial to reduce cardiovascular morbidity and improve long-term outcomes.