Cardio-oncology in Japan: a nursing perspective on education, practice and the path forward

As cancer survival rates improve globally, managing the cardiovascular consequences of oncologic therapy has become a critical challenge. In Japan—the world’s most aged population, where cancer has been the leading cause of death since 1981—the intersection of cancer and cardiovascular disease is particularly urgent. Although cardio-oncology is rapidly emerging in Japan, its integration into clinical nursing practice and nursing education remains limited. This viewpoint argues that nurses, as healthcare professionals with the most sustained patient contact, are uniquely positioned to detect subclinical cardiotoxicity and life-threatening immune-related adverse events (irAE) such as immune-mediated myocarditis, and to support long-term cardiovascular surveillance after cancer treatment. The formal integration of cardio-oncology into the Japanese Circulation Society/Japanese Heart Failure Society 2025 Heart Failure Guideline, which endorses a multidisciplinary care approach incorporating specialized nurses, marks a pivotal milestone. Cardio-oncology rehabilitation—an evidence-based intervention enhancing cardiorespiratory fitness in cancer survivors—remains not yet fully integrated into oncology care pathways. This article calls for a structured nursing education framework encompassing cardiotoxicity recognition, irAE management, and rehabilitation principles, consistent with international best practices, to strengthen nursing’s role and improve patient outcomes.