There is a question that many cancer patients in South Asia are never asked, even when they are receiving chemotherapy regimens known to affect the heart: is anyone watching your cardiovascular system while you go through this?
Cardio-oncology is the medical field that addresses this question directly. It has nothing to do with cancer of the heart — a separate and considerably less common condition managed by cardiothoracic surgeons. Cardio-oncology focuses on the heart’s vulnerability to cancer treatment itself: protecting cardiovascular function before, during, and after chemotherapy, targeted therapy, immunotherapy, and radiation.
Amrita Hospital, Kochi, operates a dedicated Cardio-Oncology Clinic that its official sources describe as the first initiative of its kind in India. For Sri Lankan patients travelling to Amrita for cancer care, this clinic is part of the clinical infrastructure available to them.
Why Cancer Treatments Can Affect Cardiovascular Health
Several distinct mechanisms connect cancer treatment to cardiovascular harm.
Some chemotherapy drugs are directly toxic to heart muscle cells. The anthracycline class — which includes doxorubicin and epirubicin, used in breast cancer, lymphoma, leukaemia, and soft tissue sarcoma — can cause a gradual and sometimes irreversible reduction in the heart’s pumping function. The effect is dose-dependent and cumulative: small changes accumulate over a treatment course, and the damage may not become apparent for months or years.
HER2-targeted therapies such as trastuzumab, widely used in HER2-positive breast cancer, can cause reversible changes in cardiac function. The risk is considerably higher when these agents follow or are combined with anthracycline chemotherapy, which is a common treatment sequence. Regular cardiac monitoring during this combination is now a recognised standard of care.
Radiation delivered to the chest or mediastinum creates a different problem on a different timeline. Treatment for breast cancer, Hodgkin lymphoma, or thoracic malignancies can accelerate coronary artery disease, damage heart valves, and cause the pericardium — the sac surrounding the heart — to stiffen over time. These effects can emerge five, ten, or twenty years after radiation is completed, long after most oncology follow-up has ended. A patient who received mediastinal radiation in their twenties for Hodgkin lymphoma may present with significant coronary or valvular disease in their forties.
Newer targeted therapies — including some tyrosine kinase inhibitors — can cause significant hypertension or disrupt the heart’s electrical system. Immune checkpoint inhibitors, now standard treatment for melanoma, lung cancer, urothelial cancer, and many other tumours, carry a small but clinically significant risk of myocarditis: an immune-mediated inflammation of the heart muscle that can be severe.
Sri Lankan patients considering treatment for breast cancer can find more information about the treatment landscape in our guide to breast cancer treatment options and surgical approaches available in India.
What the Amrita Cardio-Oncology Clinic Does
The Amrita Cardio-Oncology Clinic integrates cardiology and oncology within the same institutional framework, so the teams managing a patient’s cancer and the team monitoring their heart can coordinate directly. The clinic is led by Dr Navin Mathew and Dr Hisham Ahamed (both cardiologists with MD and DM qualifications), and also involves haematologists and oncologists including Dr Neeraj Sidharthan and Dr Wesley M. Jose.
The clinic’s approach spans three phases.
Before treatment begins, a baseline cardiac assessment establishes the patient’s cardiovascular status. Pre-existing conditions such as heart failure, hypertension, or prior cardiac events are identified and factored into treatment planning. This baseline becomes the reference point against which subsequent assessments are measured. For patients already living with cardiovascular disease, this evaluation can directly influence chemotherapy selection or dosing.
During treatment, monitoring is tailored to the specific agents being used. For patients receiving anthracyclines or trastuzumab, scheduled echocardiography tracks cardiac function throughout the treatment course. Serial cardiac biomarkers — troponin and BNP — can signal cardiac stress before visible functional changes appear on imaging, allowing earlier intervention. The value of this monitoring is that some forms of treatment-related cardiac dysfunction are reversible when identified early, but become permanent if undetected.
After treatment, the clinic continues to follow cancer survivors whose treatment history puts them at ongoing cardiovascular risk. This is one of the less visible aspects of cardio-oncology: the cardiovascular consequences of certain cancer treatments do not end when chemotherapy does, and for patients who received anthracyclines or chest radiation, the most significant effects may still be years away.
For context on the broader range of cardiac services at Amrita, including surgical and interventional options, see our article on heart valve repair and minimally invasive cardiac surgery options available to patients from Sri Lanka.
Who Should Consider a Cardio-Oncology Assessment
Not every cancer patient requires specialist cardio-oncology input from the outset. However, certain circumstances generally warrant a structured cardiovascular evaluation alongside cancer care:
- A prior history of heart disease, heart failure, or coronary artery disease
- Poorly controlled or long-standing hypertension or diabetes
- Treatment plans involving anthracyclines, trastuzumab, or mediastinal or breast radiation
- New or unexplained breathlessness, ankle swelling, palpitations, or reduced exercise tolerance during cancer treatment
- Cancer survivors who received cardiotoxic treatment years ago and have not had a recent cardiac review
For Sri Lankan patients, the elevated background rates of diabetes and hypertension in the population mean that a higher proportion of those seeking cancer care have pre-existing cardiovascular risk factors. A treatment plan appropriate for a younger patient with no cardiovascular history may require a meaningfully different monitoring approach for someone with long-standing diabetes and borderline cardiac function.
Patients exploring immunotherapy and newer cancer treatments can also find useful background in our overview of CAR T-cell therapy and what patients need to understand about this form of cancer treatment.
A Note on the Cardio-Oncology Distinction
It is worth being direct about what cardio-oncology is not, because the name sometimes causes confusion.
Cardio-oncology does not treat tumours of the heart. Primary cardiac tumours — including cardiac myxomas, fibromas, and the rare cardiac sarcoma — are managed through cardiothoracic surgery and oncology services in a different clinical pathway. Cardio-oncology is the subspecialty concerned with patients whose cancer originates elsewhere in the body and who are receiving treatment that can affect cardiovascular function. This distinction matters in practice because the clinical questions, the monitoring, and the interventions involved are entirely different.
The field also encompasses cardiac rehabilitation for cancer survivors and — an area of growing clinical interest — cancer screening in patients who present with unexplained cardiovascular conditions, since some malignancies can present with cardiac manifestations before they are diagnosed.
Practical Information for Sri Lankan Patients
Sri Lankan patients travelling to Amrita Hospital for cancer care can ask their treating team whether a cardio-oncology assessment is appropriate for their specific situation and treatment plan. The Amrita Info Centre Sri Lanka team can assist with the coordination and logistics of seeking cancer care and cardiac monitoring at Amrita, including help with medical travel arrangements.
You can explore the range of specialist cancer and cardiology services available at Amrita Hospital on the website, read about how the Amrita Info Centre supports patients travelling from Sri Lanka for treatment in India, or send your enquiry directly through the Amrita Info Centre Sri Lanka consultation form.
Frequently Asked Questions
Is cardio-oncology the same as treating cancer of the heart? No. Cardio-oncology manages cardiovascular health in patients whose cancer originates in other parts of the body and who are undergoing treatment that can affect the heart. Primary cardiac tumours are a separate clinical area handled through cardiothoracic surgery. The two fields share the “cardio” prefix but address entirely different clinical problems.
Which treatments most commonly require cardiac monitoring? Anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, and mediastinal or chest radiation are the treatments with the most established evidence for cardiovascular effects. Some targeted therapies and immune checkpoint inhibitors also carry relevant cardiac risks. The specific monitoring approach depends on the combination of agents used, the cumulative doses, and the individual patient’s baseline cardiovascular status.
Can cancer survivors from years ago still benefit from a cardiac assessment? Yes. The most significant cardiovascular effects of anthracyclines and chest radiation can emerge years or even decades after treatment. Cancer survivors who received these treatments and have not had a recent cardiac assessment are appropriate candidates for evaluation, even if they currently have no symptoms.
How do I find out whether I need a cardio-oncology assessment at Amrita? The appropriate starting point is the treating oncologist or the Amrita Info Centre Sri Lanka team, who can help determine whether a referral to the Cardio-Oncology Clinic is warranted for a specific situation.