TABLE 6.

The Importance of Inpatient and Outpatient CO Training Experience

Outpatient training
CV risk assessment and mitigation strategies before cancer therapy	Anticipation for high-risk cancer treatment Perform a comprehensive baseline CV risk and disease assessment Review medication- and patient-related risks for negative effects on cardiac function, the vascular system, arrhythmias including drug-drug interactions and QTc prolongation Individualize preventive strategies as well as type and timing of follow-up based on expected CV risk profile and disease burden
	Optimization of pre-existing CVD Assess for the presence, type and extent of CVDs as well as prior and current management of these Determine repeat evaluation and optimization Anticipate impact of pre-existing CVD on cancer therapy and vice versa
Evaluation and management of common CVDs in cancer patients on active therapy (pre-existing and newly arising)	Left ventricular dysfunction Evaluate the contribution from cancer treatment and guide ongoing treatment in collaboration with the oncologist Institute appropriate HF guideline-directed medical therapy
	CAD Determine when and how to work up and treat CAD in this population
	PAD Assess whether cancer treatment is contributing to PAD
	VTE and PE Identify patients at risk of VTE and PE, and provide therapeutic recommendations to minimize such risk Guide need for anticoagulation and medical management
	Arrhythmias Assess whether current cancer treatment is contributing to arrhythmia burden Guide need for anticoagulation and medical management Recognize potential drug-drug interactions between anti-arrhythmic drugs and chemotherapy, targeted therapy and immunotherapy
	Cardiac masses Contribute to the diagnostic work-up and the management of patients with cardiac masses
Survivorship	Understand long-term CV and oncological risk in survivors of cancer Provide aggressive CV risk factor reduction in this population Plan appropriate cardiac follow-up/monitoring based on the specific risk of the patient
Inpatient training
Evaluation and management of cardio-oncological emergencies	Cardiac tamponade Appraise the risks/benefits of emergent pericardiocentesis in critically ill patients, including those with hematologic complications (e.g., thrombocytopenia)
	SVC syndrome Provide recommendations for the management of symptomatic SVC syndrome including endovenous recanalization, surgery, and/or thrombolysis
	ACS Select the best treatment option in patients presenting with ACS and malignancy
	Cardiac arrhythmias Diagnose and manage hemodynamically significant arrhythmias Recognize potential drug-drug interactions between anti-arrhythmic drugs and chemotherapy/targeted therapy/immunotherapy
	VTE and PE Identify patients at risk of VTE and PE, and provide therapeutic recommendations to minimize such risk Guide need for anticoagulation and medical management
	Acute heart failure Recognize potential causes of acute heart failure in the oncology patient Apply evidence-based strategies in the diagnosis and treatment of acute heart failure
	Myocarditis Diagnose and manage myocarditis due to cancer therapy
	Cardiac masses Diagnose and contribute to the management of patients with primary or metastatic cardiac masses
Evaluation and management of bone marrow transplant patients	Provide cardiovascular risk stratification for candidates in which bone marrow transplantation is planned, including potential drug-drug interactions Recognize and manage cardiovascular complications due to acute and chronic graft-versus-host disease
Evaluation and management of the oncology patient in the intensive care unit	Provide expert recommendations on the cardiovascular care of the critically ill oncology patient Demonstrate proficiency in the management of cardiogenic shock in the oncology patient considering a patient’s cancer diagnosis, treatment, and prognosis

ACS = acute coronary syndrome; CAD = coronary arterydisease; PAD = peripheral arterialdisease; PE = pulmonary embolism; SVC = superior vena cava; VTE = venous thromboembolism; other abbreviations as in Table 1.