ESC has launched a new journal as part of a strategy which responds to the significant increase in cancer survival rates over several decades. The European Heart Journal – Cardio-Oncology (EHJ-CO) will have a strong emphasis on implementation, accessibility, and global equity in care delivery. It is viewed as a natural next step in a rapidly maturing field. But why has cardio-oncology become such a hot topic?
In the most advanced European countries, more than 90% of people diagnosed with prostate, breast, thyroid and melanoma skin cancer are alive after five years. There has been progress too on blood cancers, where outcomes are generally poorer than for some solid tumours. In the mid-1990s, the five-year survival rate for multiple myeloma was 30%. By 2020, this figure had doubled to 60%.
These striking achievements in oncology have helped to transform many cancers into chronic diseases. At the same time, increases in life expectancy – thanks, in part, to improved cardiovascular disease outcomes – mean growing numbers of people are at risk of cancer due to their age. Taken together, this means millions more people are living with cancer or have been successfully treated and are now in remission.
Good news on cancer survival has sharpened the focus on how oncology treatments affect cardiovascular health. For example, anthracyclines – an established treatment for several types of cancer – can cause cancer therapy-related cardiac dysfunction or heart failure. The impact of several newer therapies on cardiac risk is not yet known. On the other hand, cardiovascular conditions, including heart failure or ischaemic heart disease, have been associated with elevated cancer risks. All of which has made researchers and clinicians keen to understand the two-way connections between cardiology and oncology.
That is why cardio-oncology, which was once a niche subspeciality, is moving into the mainstream. The field brings together cardiologists, oncologists and others to collaborate on research, share evidence and improve clinical practice. In so doing, the overarching goal is to improve the lives of patients.
‘New era’ in cancer is shaping CVD
‘We are living in a new era of cancer care,’ explains Dr. Teresa López-Fernández, University Hospital of La Paz, Madrid. ‘As cancer therapies can induce cardiovascular problems during or after therapy, it is essential to build a cardio-oncology community that can respond to these challenges.’
Dr. López-Fernández is chair of the ESC Council of Cardio-Oncology, established by ESC in 2018. The Council has been driving progress in cardio-oncology based on four pillars: education and training, research, quality of care and advocacy.
‘Our first annual ESC Cardio-Oncology conference, held in Florence last year, was an important step and reflects ESC’s commitment to the speciality,’ she says. ‘It was the first new ESC conference to be launched in the past ten years and is helping to bring together a global community of cardiology and oncology experts while educating the wider clinical community.’
The second conference, held in Vienna in June, provided an opportunity to showcase the new open access EHJ-CO journal. As part of the ESC journal family, the new publication offers a platform for impactful research in an area where evidence is needed.
‘The ESC Guidelines on cardio-oncology from 2022 are largely based on expert consensus,’ explains Dr López-Fernández, who is one of the Deputy Editors. ‘There are a lot of areas where we need new science, which is why ESC decided to stimulate research in this area.’
Fostering a multidisciplinary specialty
As Editor-in-Chief of the new ESC journal, Prof. Tom Marwick sees a major role for the publication in translating knowledge into practice at scale. ‘There’s space to build better evidence that can inform guidelines and impact patient care,’ he says.
Prof. Marwick, of Baker Heart and Diabetes Institute, Melbourne, says patient outcomes and perspectives will be at the heart of EHJ-CO, supporting research that embeds the full trajectory of patient experience, from prevention and treatment to survivorship and long-term cardiovascular risk.
‘We will champion clinically transformative science by publishing rigorous trials, implementation research, and validated innovations that directly influence patient care rather than incremental or descriptive findings,’ he explains.
A diverse community of specialists
In exploring the interplay between cardiovascular health and oncology, EHJ-CO will serve a growing and diverse community which includes not only cancer and heart specialists, but also experts in information technology, cardiac imaging and new biomarkers. The journal can play a valuable role in breaking down barriers between several fields.
‘Cardiovascular disease and cancer are two major causes of death, yet we don’t have many journals focused on the interface between the two,’ says Prof. Marwick. By bringing these together, the publication can be the missing piece of the puzzle.’
The journal is for the whole cardio-oncology community, and the editors have already received submissions with input from more than one specialty.
‘We are really keen to engage with oncologists, not least because they are an important source of information about new cancer drugs coming online,’ he says. ‘We are also open to papers on topics which influence oncology and cardiology, such as inflammatory disease; as well as work by nurses who have deep expertise in survivorship care; and bioinformatics specialists interested in this field.’
What to expect from EHJ-CO
The new journal is a welcome addition to a landscape where the opportunities for publishing new data is currently limited. The JACC Cardio-Oncology, based in the United States, has established a high impact factor in recent years, illustrating the strong interest in the field but there are too few outlets in Europe.
EHJ-CO is already accepting submissions, with online publishing as they are accepted, compiled into a quarterly edition. The first issue will be published in the autumn and, Prof. Marwick says, research papers are already rolling in. ‘We’ve already had some very high-quality papers which I take as an index of pent-up demand in this field,’ he says.
As a new publication, EHJ-CO aims to be nimble, with swift response times, according to the Editor-in-Chief. ‘We’re aiming to return to authors within 30 days with a decision, depending on the number of submissions we receive.’
Researchers, Prof. Marwick adds, have grown used to the idea that doing a trial takes a long time, invariably followed by a protracted publishing process. ‘Technical developments mean that’s not true anymore. The tools for doing science are sharper than ever, and reviewing and editing papers is also more efficient. In an emerging field, that can help to build the evidence base we need.
It’s an exciting moment for cardio-oncology as Prof. Marwick and colleagues prepare the first edition of EHJ-CO. As one of several developments in the field, the journal is well-placed to curate high-impact science that will translate into practical algorithms and real improvement in patient outcomes.
Learn more and submit here.