Medication Experts on the Frontline: Pharmacists in Cardio-Oncology Care Pathways

Cardiovascular disease (CVD) and cancer remain the 2 leading causes of morbidity and mortality in the Western world. With the increasing recognition of cancer therapy-related cardiovascular toxicity (CTR-CVT) as a significant driver of long-term morbidity among cancer survivors, the need for a multidisciplinary approach to patient care has become apparent. Multidisciplinary cardio-oncology (CO) teams are uniquely positioned to address these challenges by integrating expertise from cardiology, oncology, pharmacy, and nursing. Within these models, the pharmacist’s contributions have emerged as essential, yet the specifics remain underdefined and inconsistently recognized across practice settings.^1,2

Pharmacists contribute to CO care in several critical ways | Image credit: Chanelle Malambo/peopleimages.com | stock.adobe.com

Pharmacists contribute to CO care in several critical ways. One of their primary responsibilities is optimizing complex medication regimens, which often become increasingly burdensome once anticancer therapy is initiated. Through pharmacist-led medication reconciliation and comprehensive medication reviews, pharmacists can identify and resolve drug-drug and drug-disease interactions, address inappropriate or missing therapies, and support adherence to evidence-based treatments. These interventions reduce medication-related harm and improve communication between prescribers, pharmacists, and patients, thereby facilitating safer and more coordinated care.^1,2

In addition to medication management, pharmacists contribute significantly to direct patient care. They provide education on the risks of CTR-CVT, counseling on pharmacological and lifestyle strategies to manage comorbidities such as hypertension and dyslipidemia, and tools for self-monitoring to improve patient engagement. Pharmacists also act as liaisons between oncology and cardiology teams, ensuring that treatment goals, such as blood pressure targets in patients receiving angiogenesis inhibitors, are incorporated into cancer care plans. By empowering patients with knowledge and consistent follow-up, pharmacists improve health literacy, reduce treatment-related anxiety, and enhance survivorship outcomes.²

Recent innovations, such as virtual-hybrid models of care and telepharmacy, have further highlighted pharmacists’ potential reach within CO. Evidence demonstrates that remotely delivered pharmacist interventions can expand access to high-quality care in rural or underserved areas, while still supporting medication optimization, patient counseling, and adherence monitoring. This adaptability underscores the pharmacist’s flexibility and the opportunity to integrate their expertise into a wide variety of clinical settings.²

Despite these demonstrated benefits, several challenges remain. The lack of clear role recognition continues to hinder full integration of pharmacists into CO multidisciplinary teams. Furthermore, intentional training in cardio-oncology for pharmacists is limited. Structured education programs, fellowships, and interdisciplinary training opportunities are needed to equip pharmacists with the knowledge and skills required for this evolving specialty. The American Heart Association has emphasized pharmacists’ critical utility in managing pharmacokinetic and pharmacodynamic interactions between anticancer and cardiovascular agents, highlighting the necessity of dedicated training pathways.²

Overall, the literature strongly supports the value of pharmacists in CO. By leveraging their expertise in pharmacotherapy, pharmacists help to optimize treatment safety, improve patient education, and strengthen collaboration between cardiology and oncology disciplines. With clearer role definition, increased recognition, and targeted training, pharmacists can continue to advance the quality of CO care and ultimately improve outcomes for patients living with, through, and beyond cancer.²

REFERENCES

1. Bisceglia I, Canale ML, Silvestris N, et al. Cancer survivorship at heart: a multidisciplinary cardio-oncology roadmap for healthcare professionals. Front Cardiovasc. 2023;10. doi:10.3389/fcvm.2023.1223660

2. Bennetts JD, Williams TD, Beavers CJ, et al. The cardio-oncology multidisciplinary team: beyond the basics. Cardiooncology. 2025;11(1):69. doi:10.1186/s40959-025-00369-8