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Cardio-Oncology in Greece

The first dedicated Cardio-Oncology (CO) clinic in Greece started in 2014 at Attikon University Hospital in Athens. Before that, cardiology clinics serving oncology patients existed in Greece for over 30 years within dedicated oncology hospitals with long and noteworthy experience and expertise.

Distribution of dedicated cardio-oncology (CO) clinics

For a total population of 10,5 million, there are currently 8 dedicated CO clinics in Greece, 7 in the greater Athens area (covering a population of nearly four million) and 1 in Thessaloniki, in Northern Greece (Figure 1). Among these clinics, 3 are located at university hospitals (Attikon, Alexandra and Hippokration hospitals, all in Athens), 4 in dedicated oncology hospitals (Metaxa, Agioi Anargyroi and Agios Savvas hospitals in the greater Athens area, and Theagenio Hospital in Thessaloniki), and 1 in a tertiary public hospital (Thriassio Hospital, in the greater Athens area). CO clinics also begin to appear in hospitals of the private sector, mainly in Athens. In terms of geographic distribution, large regions in Greece remain without a dedicated CO clinic and oncology patients in these regions attend general cardiology clinics and in some cases are being referred to the existing CO clinics for periodic consultation.


Figure 1: Distribution of dedicated Cardio-Oncology clinics in Greece


Education and training on cardio-oncology

The need for CO training is unquestionable in Greece, particularly for the large number of general cardiologists who treat oncology patients on a regular or occasional basis. At the same time, the interest on CO among Greek cardiologists is rapidly growing. As a result, an increasing number of CO lectures and sessions have been included in the programme of national and regional cardiology congresses held by the Hellenic Society of Cardiology, the Hellenic Heart Failure Association, the Hellenic College of Cardiology and other scientific societies of the country over the last 3-4 years. These lectures and sessions are usually attended by a large number of participants.

In terms of training programs, one CO clinic in Athens, at Alexandra University Hospital, offers a program for hands-on training on CO to be attended by cardiologists in training.

A position paper on CO, prepared by a panel of Greek experts, is soon to be published in the Hellenic Journal of Cardiology. This paper attempts to familiarise Greek cardiologists with the field of CO and provide them with guidance on the cardiovascular evaluation and management of oncology patients in everyday clinical practice, based on current evidence. 


Research activities

In terms of research, several local and collaborative projects on clinical and basic research are currently running in the country, while Greek CO experts participate in international CO projects, such as the European COT Registry or the CardioTox Registry, as well as in consortia formed in the context of European Commission calls such as the Horizon 2020. These research efforts have resulted in an increasing number of relevant publications in international literature published by or with the participation of Greek authors [1-13]. In addition, a national CO survey, the Greek Multicenter Cardio-Oncology Registry, runs for the last 3 years under the auspices of the Hellenic Society of Cardiology and registers patients with cancer, cardiac amyloidosis and cardiac tumors who are treated and followed in CO clinics and cardiology departments all over Greece. Preliminary results of this registry have been presented at the European congresses [14].


A Hellenic Working Group on CO has recently been formed within the Hellenic Society of Cardiology and is currently preparing and will soon launch its first 2-year program for education and research on CO in Greece. This Working Group is expected to enhance the establishment of a network of CO clinics in Greece and serve as a core for training and research in this growing field. In addition, Greek CO experts participate in CO bodies of the European Society of Cardiology (ESC), being members of the Board of ESC CO Council ESC and members of the ESC Heart Failure Association Study Group on CO, as well as in European expert panels on specific CO topics [15-17].

About the Authors

Dimitrios Farmakis

University of Cyprus Medical School, Nicosia, Cyprus.

Cardio-Oncology Clinic, Heart Failure Unit, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.

Address for correspondence:

Dimitrios Farmakis, MD, PhD, FESC, FHFA, Assoc. Professor, University of Cyprus Medical School, Shakolas Educational Center for Clinical Medicine, Palaios dromos Lefkosias Lemesou No.215/6, 2029 Aglantzia, Nicosia, Cyprus; tel: +357 22 895235; fax: +357 22 895396; email: /

Kalliopi Keramida

Cardio-Oncology Clinic, Heart Failure Unit, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.


  1. Farmakis D, Parissis J, Filippatos G. Insights into Onco-Cardiology: atrial fibrillation. J Am Coll Cardiol 2014;63:945-953.
  2. Herrmann J, Yang EH, Iliescu CA, Cilingiroglu M, Charitakis K, Hakeem A, Toutouzas K, Leesar MA, Grines CL, Marmagkiolis K. Vascular Toxicities of Cancer Therapies: The Old and the New--An Evolving Avenue. Circulation. 2016;133:1272-1289.
  3. Lancellotti P, Galderisi M, Donal E, Edvardsen T, Popescu BA, Farmakis D, Filippatos G, Habib G, Lestuzzi C, Santoro C, Moonen M, Jerusalem G, Andarala M, Anker SD; ESC Cardiac Oncology Toxicity Long-Term Registry Investigators. Protocol update and preliminary results of EACVI/HFA Cardiac Oncology Toxicity (COT) Registry of the European Society of Cardiology. ESC Heart Fail. 2017;4:312-318. 
  4. Paraskevaidis IA, Makavos G, Tsirigotis P, Psarogiannakopoulos P, Parissis J, Gkirkas K, Pessach I, Ikonomidis I. Deformation Analysis of Myocardial Layers Detects Early Cardiac Dysfunction after Chemotherapy in Bone Marrow Transplantation Patients: A Continuous and Additive Cardiotoxicity Process. J Am Soc Echocardiogr. 2017;30:1091-1102.
  5. Kapelakis I, Toutouzas K, Drakopoulou M, Michelongona A, Zagouri F, Mpamias A, Pliatsika P, Dimopoulos MA, Stefanadis C, Tousoulis D. Bevacizumab increases the incidence of cardiovascular events in patients with metastatic breast or colorectal cancer. Hellenic J Cardiol. 2017;58:215-219.
  6. Farmakis D, Mantzourani M, Filippatos G. Anthracycline-induced cardiomyopathy: secrets and lies. Eur J Heart Fail. 2018;20:907-909.
  7. Farmakis D, Keramida K, Filippatos G. How to build a cardio-oncology service? Eur J Heart Fail. 2018;20:1732-1734. 
  8. Koutsoukis A, Ntalianis A, Repasos E, Kastritis E, Dimopoulos MA, Paraskevaidis I. Cardio-oncology: A Focus on Cardiotoxicity. Eur Cardiol. 2018;13:64-69.
  9. Oikonomou E, Anastasiou Μ, Siasos G, Androulakis E, Psyrri A, Toutouzas K, Tousoulis D. Cancer Therapeutics-Related Cardiovascular Complications. Mechanisms, Diagnosis and Treatment. Curr Pharm Des. 2018;24:4424-4435.
  10. Efentakis P, Varela A, Chavdoula E, Sigala F, Sanoudou D, Tenta R, Gioti K, Kostomitsopoulos N, Papapetropoulos A, Tasouli A, Farmakis D, Davos CH, Klinakis A, Suter T, Cokkinos DV, Iliodromitis EK, Wenzel P, Andreadou I. Levosimendan prevents doxorubicin-induced cardiotoxicity in time- and dose dependent manner: Implications for inotropy. Cardiovasc Res. 2019. pii: cvz163.
  11. Keramida K, Farmakis D, Bingcang J, Sulemane S, Sutherland S, Bingcang RA, Ramachandran K, Tzavara C, Charalampopoulos G, Filippiadis D, Kouris N, Nihoyannopoulos P. Longitudinal changes of right ventricular deformation mechanics during trastuzumab therapy in breast cancer patients. Eur J Heart Fail. 2019;21:529-535.
  12. Keramida K, Parissis JT, Chioncel O, Farmakis D. Cardiogenic shock in cancer. Heart Fail Rev. 2019;24:997-1004.
  13. López-Sendón J, Álvarez-Ortega C, Zamora Auñon P, Buño Soto A, Lyon AR, Farmakis D, Cardinale D, Canales Albendea M, Feliu Batlle J, Rodríguez Rodríguez I, Rodríguez Fraga O, Albaladejo A, Mediavilla G, González-Juanatey JR, Martínez Monzonis A, Gómez Prieto P, González-Costello J, Serrano Antolín JM, Cadenas Chamorro R, López Fernández T. Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry. Eur Heart J 2020 Feb 4 [Epub ahead of print]
  14. Ntalianis A, Zografos N, Roumpi E, Tsiakou A, Mpisxiniotis T, Aggelopoulou E, Marketou M, Koutsoukis A, Goudevenos I, Kalafatis I, Kalogeropoulos P, Avgeropoulos G, Parthenakis F, Dimopoulos MA, Paraskevaidis I. Biomarkers and imaging modalities for the diagnosis of cardiotoxicity after chemotherapy; data from the Greek Multicenter Cardio-Oncology Registry. Heart Failure 2019: P1162
  15. Anker MS, Lena A, Hadzibegovic S, Belenkov Y, Bergler-Klein J, de Boer RA, Cohen-Solal A, Farmakis D, von Haehling S, López-Fernández T, Pudil R, Suter T, Tocchetti CG, Lyon AR; Heart Failure Association Cardio-Oncology Study Group of the European Society of Cardiology. Modern-day cardio-oncology: a report from the 'Heart Failure and World Congress on Acute Heart Failure 2018'. ESC Heart Fail. 2018;5:1083-1091.
  16. Ameri P, Canepa M, Anker MS, Belenkov Y, Bergler-Klein J, Cohen-Solal A, Farmakis D, López-Fernández T, Lainscak M, Pudil R, Ruschitska F, Seferovic P, Filippatos G, Coats A, Suter T, Von Haehling S, Ciardiello F, de Boer RA, Lyon AR, Tocchetti CG; Heart Failure Association Cardio-Oncology Study Group of the European Society of Cardiology. Cancer diagnosis in patients with heart failure: epidemiology, clinical implications and gaps in knowledge. Eur J Heart Fail. 2018;20:879-887.
  17. Anker MS, Hadzibegovic S, Lena A, Belenkov Y, Bergler-Klein J, de Boer RA, Farmakis D, von Haehling S, Iakobishvili Z, Maack C, Pudil R, Skouri H, Cohen-Solal A, Tocchetti CG, Coats AJS, Seferović PM, Lyon AR; Heart Failure Association Cardio-Oncology Study Group of the European Society of Cardiology. Recent advances in cardio-oncology: a report from the 'Heart Failure Association 2019 and World Congress on Acute Heart Failure 2019'. ESC Heart Fail. 2019;6:1140-1148