Almost no one is being trained to do it.
As cancer therapies grow more powerful and more life-extending, they carry with them a quieter danger — the slow erosion of the heart. Cardio-oncology emerged to stand at this crossroads, yet a survey of nearly 400 clinicians across 63 countries, presented at ESC Cardio-Oncology 2026, reveals that the field exists largely in name only: fewer than one in ten physicians received any such training in medical school, and 87 percent work in institutions with no formal program at all. The knowledge needed to protect cancer survivors from cardiovascular harm is not reaching the hands meant to provide it, and the patients who outlive their diagnoses are left exposed to a risk their doctors were never taught to see.
- Cancer patients who survive their disease face a second, largely invisible threat — cardiovascular damage caused by the very therapies that saved them.
- A sweeping international survey finds that cardio-oncology training is nearly absent from medical education, with only 10% of students and 17% of residents ever encountering it.
- 87% of institutions worldwide offer no formal cardio-oncology program, with the sharpest deficits in community hospitals and non-European regions.
- Clinicians themselves know what they are missing — they are asking for dedicated fellowships, webinars, and master's programs to fill a gap that guidelines alone cannot close.
- The ESC is now moving to act, launching a Core Curriculum and certification program designed to standardize training across cardiology, oncology, and primary care before the blind spot widens further.
Cancer treatments are keeping people alive longer than ever — but chemotherapy, radiation, and immunotherapy carry a hidden cost: they damage the heart. A patient might survive their malignancy only to face heart failure or arrhythmia years later. Cardio-oncology exists precisely to prevent this, sitting at the intersection of two specialties. Yet a sweeping international survey presented at ESC Cardio-Oncology 2026 reveals that almost no one is being trained to practice it.
The European Society of Cardiology's Council of Cardio-Oncology, working with a group called COOL — Cardio-Oncologists Of tomorrow Leaders — surveyed nearly 400 healthcare professionals across 63 countries. The findings were stark: only one in ten had received cardio-oncology training in medical school, only 17 percent encountered it during residency, and 87 percent reported that their institutions offered no formal educational program in the field.
The gaps were not uniform — academic hospitals and European institutions fared better than community settings and other regions — but the overall picture was one of profound neglect. A field urgent enough for the ESC to publish expert guidelines on in 2022 remains almost entirely absent from where doctors are actually formed.
Dr. Massimiliano Camilli of Rome's Policlinico Universitario Agostino Gemelli led the effort, describing it as the first comprehensive reckoning with the state of cardio-oncology education worldwide. Respondents said they most needed to learn how to diagnose cardiovascular damage from cancer drugs, assess patient risk, and monitor for complications — and they looked to fellowships, webinars, and scientific society guidance to get there.
Camilli pointed to recent movement: the ESC has released a Core Curriculum and is launching a certification program. But his message was unambiguous — improving cardio-oncology education is not optional. It must reach every stage of training and every specialty involved in cancer care. Without it, cancer survivors will continue to face a blind spot: the very real risk that the cure is quietly damaging their hearts in ways no one was ever taught to recognize.
Cancer treatments are keeping people alive longer than ever before. But those same therapies—chemotherapy, radiation, immunotherapy—carry a hidden cost: they damage the heart. A patient might survive their malignancy only to face heart failure, arrhythmia, or other cardiovascular collapse years later. The field of cardio-oncology exists to prevent exactly this. It sits at the intersection of two specialties, asking how to treat cancer without destroying the organ that keeps you alive. Yet a sweeping international survey presented this month at ESC Cardio-Oncology 2026 reveals that almost no one is being trained to do it.
The European Society of Cardiology's Council of Cardio-Oncology, working with a group called COOL—Cardio-Oncologists Of tomorrow Leaders—distributed an anonymous web survey to cardiologists, residents, and other cancer-treating professionals across 63 countries. Nearly 400 people responded, most of them board-certified cardiologists. What they reported was stark: only one in ten had received any cardio-oncology training during medical school. Only 17 percent encountered it during residency. When asked whether their institutions offered formal cardio-oncology education programs, 87 percent said no.
The gaps are not uniform. Cardiologists working in academic hospitals had better access to training than those in community settings. Respondents from Europe reported more educational opportunities than those from other regions. But the overall picture is one of profound institutional neglect. A field that the ESC itself recognized as urgent enough to publish expert guidelines on—in 2022—remains almost entirely absent from the places where doctors are actually trained.
Doctor Massimiliano Camilli, from Policlinico Universitario Agostino Gemelli in Rome, led the survey effort. He framed it as a reckoning: the COOL group wanted to understand, for the first time comprehensively, what the current state of cardio-oncology education actually was, from medical school through advanced training, across Europe and beyond. What they found was a field in crisis before it had even begun to mature.
When asked what they most needed to learn, respondents identified three areas: how to diagnose cardiovascular damage caused by cancer drugs, how to assess which patients were at highest risk, and how to prevent or monitor for these complications. The preferred ways to learn were fellowships dedicated to cardio-oncology, webinars, university master's degrees, and position statements from major scientific societies addressing unsettled questions. Respondents looked to the ESC and national cardiac societies as the logical leaders for this work.
Camilli acknowledged the severity of the findings but also pointed to recent movement. The ESC has released a Core Curriculum for Cardio-Oncology and is launching a certification program. These tools, he suggested, could standardize training and create a foundation for new specialists. But he was clear about what comes next: improving cardio-oncology education is not optional. It must happen across all stages of medical training and across all the specialties involved in cancer care—oncology, cardiology, primary care. Without it, cancer patients will continue to face a blind spot in their treatment: the very real risk that the cure will damage their hearts in ways no one was trained to see coming.
Citas Notables
The survey identified profound gaps in cardio-oncology education during medical school and residency and in structured institutional programmes.— Dr. Massimiliano Camilli, Policlinico Universitario Agostino Gemelli, Rome
Improving cardio-oncology education is a must—across all stages of medical training and all specialities involved—to enable prevention and early management of cardiovascular complications in patients with cancer.— Dr. Massimiliano Camilli
La Conversación del Hearth Otra perspectiva de la historia
Why does this gap exist? Cardio-oncology isn't brand new—the ESC published guidelines in 2022.
The field is new enough that it hasn't yet been woven into the standard curriculum. Medical education moves slowly. By the time a guideline is published, it still takes years to filter into residency programs and medical schools. Most cardiologists trained before 2020 never saw it at all.
So this is a generational problem.
Partly. But it's also structural. There's no mandate. No one is requiring medical schools to teach cardio-oncology. There's no certification pathway yet—until now. Without those formal structures, it stays optional, which means it disappears.
The survey shows access is better in academic hospitals. Why?
Academic centers have the resources and the research infrastructure to support specialized training. They have cardiologists doing cardio-oncology research, which creates teaching opportunities. Community hospitals don't have that luxury. They're stretched thin.
What happens to a patient if their cardiologist doesn't know about cardio-oncology?
They might not get screened for heart damage before starting chemotherapy. They might not be monitored during treatment. By the time symptoms appear, the damage could be irreversible. Prevention and early detection are everything in this field.
The survey mentions webinars and master's degrees as preferred learning formats. Are those realistic for busy clinicians?
Webinars are accessible—you can do them in your own time. Master's degrees are harder; they require real commitment. But the fact that people want them suggests there's hunger for this knowledge. The infrastructure just hasn't been built yet.
What does the new ESC certification actually change?
It gives cardiologists a formal pathway to specialize in cardio-oncology. It legitimizes the field. Once certification exists, institutions will start hiring for it, training programs will develop, and medical schools will feel pressure to include it. That's how specialties mature.