In recent decades cancer survival rates have improved as a result of increased screening, better diagnostic techniques, earlier diagnosis, multidisciplinary working and innovations in treatment. Despite these improvements, long-term and late effects of cancer therapy have increased since more people are living with and beyond a cancer diagnosis. Endothelial damage and metabolic changes are common toxicities associated with many cancer therapies, and these can have profound effects on an individual’s cardiovascular risks, quality of life and overall survival. This article outlines the cardiovascular and metabolic effects that can be induced by cancer treatment, and explains the important role of cancer nurses in risk assessment, monitoring and secondary prevention of these effects.