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Adams SC, Rivera-Theurel F, Scott JM, Nadler MB, Foulkes S, Leong D, Nilsen T, Porter C, Haykowsky M, Abdel-Qadir H, Hull SC, Iyengar NM, Dieli-Conwright CM, Dent SF, Howden EJ. Cardio-oncology rehabilitation and exercise: evidence, priorities, and research standards from the ICOS-CORE working group. Eur Heart J 2025:ehaf100. [PMID: 40036781 DOI: 10.1093/eurheartj/ehaf100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2025] Open
Abstract
The aim of this whitepaper is to review the current state of the literature on the effects of cardio-oncology rehabilitation and exercise (CORE) programmes and provide a roadmap for improving the evidence-based to support the implementation of CORE. There is an urgent need to reinforce and extend the evidence informing the cardiovascular care of cancer survivors. CORE is an attractive model that is potentially scalable to improve the cardiovascular health of cancer survivors as it leverages many of the existing frameworks developed through decades of delivery of cardiac rehabilitation. However, there are several challenges within this burgeoning field, including limited evidence of the efficacy of this approach in patients with cancer. In this paper, a multidisciplinary team of international experts highlights priorities for future research in this field and recommends standards for the conduct of research.
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Affiliation(s)
| | - Fernando Rivera-Theurel
- Ted Rogers Cardiotoxicity Prevention Program, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jessica M Scott
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle B Nadler
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Stephen Foulkes
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Darryl Leong
- The Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Tormod Nilsen
- Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | - Charles Porter
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mark Haykowsky
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Husam Abdel-Qadir
- Ted Rogers Cardiotoxicity Prevention Program, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital and Peter Munk Cardiac Centre, Toronto, ON, Canada
| | - Sarah C Hull
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Program for Biomedical Ethics, Yale School of Medicine, New Haven, CT, USA
| | - Neil M Iyengar
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Susan F Dent
- Wilmot Cancer Institute, Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Erin J Howden
- Cardiometabolic Health and Exercise Physiology Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
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Oselinsky KM, Gupta SK, Tiboni H, Goldstein CM. The Psychosocial Benefits of Cardiac Rehabilitation Among Cancer Survivors. J Cardiopulm Rehabil Prev 2025; 45:E1-E3. [PMID: 39602387 DOI: 10.1097/hcr.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Affiliation(s)
- Katrina M Oselinsky
- Author Affiliations: Department of Psychiatry and Human Behavior, The Miriam Hospital and Warren Alpert Medical School of Brown University (Drs Oselinsky, Gupta, and Goldstein); School of Public Health, Brown University (Ms Tiboni); and Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island (Dr Goldstein)
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Chen Y, Xiao J, Gao M, Deng Z, Xie M, Wang R. Effectiveness of cardiac rehabilitation in cancer survivors: A meta-analysis of randomized controlled trials. Eur J Oncol Nurs 2024; 73:102707. [PMID: 39406177 DOI: 10.1016/j.ejon.2024.102707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 09/19/2024] [Accepted: 09/25/2024] [Indexed: 11/26/2024]
Abstract
PURPOSE This meta-analysis aimed to evaluate available data regarding the potential benefits of cardiac rehabilitation (CR) in cancer survivors. METHODS Relevant studies published from inception to April 2024 were retrieved from PubMed, Embase, Web of Science, CENTRAL, CINAHL, PsycINFO, Scopus, CNKI, WanFang, VIP, and CBM databases. Seven randomized controlled trials (RCTs) involving 526 cancer survivors were included in this meta-analysis. RESULTS CR increased muscle strength (standardized mean difference (SMD) = 0.39, 95% confidence interval (CI): 0.06 to 0.72, P = 0.020), quality of life (QoL) (SMD = 0.61, 95% CI: 0.40 to 0.82, P < 0.001), and led to a decrease in Body Mass Index (BMI) (mean difference (MD) = -1.11, 95% CI: -2.02 to -0.19, P = 0.020), total cholesterol (TC) (MD = -0.41, 95% CI: -0.69 to -0.14, P = 0.003), triglyceride (TG) (MD = -0.33, 95% CI: -0.63 to -0.03, P = 0.030) and low-density lipoprotein (LDL) (MD = -0.34, 95% CI: -0.57 to -0.12, P = 0.003). The meta-analysis revealed that CR had no statistically significant impact on cardiorespiratory fitness (CRF) and high-density lipoprotein (HDL) levels. CONCLUSIONS CR may represent an effective strategy to evaluate cancer survivors because it improves muscle strength and QoL and reduces BMI, TC, TG and LDL levels. Further RCTs with strict study designs and larger sample sizes are required to determine the effects of CR on cancer survivors.
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Affiliation(s)
- Yingtong Chen
- Nursing College, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Jingfang Xiao
- Nursing College, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Manzhi Gao
- Nursing College, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Zhihe Deng
- Department of Digestive Endoscopy, The First Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Minjuan Xie
- Nursing Department, Hospital of Zhongluotan Town Baiyun District Guangzhou, Guangzhou, Guangdong, China
| | - Rui Wang
- Nursing College, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China.
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Batalik L, Chamradova K, Winnige P, Dosbaba F, Batalikova K, Vlazna D, Janikova A, Pepera G, Abu-Odah H, Su JJ. Effect of exercise-based cancer rehabilitation via telehealth: a systematic review and meta-analysis. BMC Cancer 2024; 24:600. [PMID: 38760805 PMCID: PMC11100177 DOI: 10.1186/s12885-024-12348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE Exercise-based cancer rehabilitation via digital technologies can provide a promising alternative to centre-based exercise training, but data for cancer patients and survivors are limited. We conducted a meta-analysis examining the effect of telehealth exercise-based cancer rehabilitation in cancer survivors on cardiorespiratory fitness, physical activity, muscle strength, health-related quality of life, and self-reported symptoms. METHODS PubMed, Web of Science, and reference lists of articles related to the aim were searched up to March 2023. Randomized controlled clinical trials were included comparing the effect of telehealth exercise-based cancer rehabilitation with guideline-based usual care in adult cancer survivors. The primary result was cardiorespiratory fitness expressed by peak oxygen consumption. RESULTS A total of 1510 participants were identified, and ten randomized controlled trials (n = 855) were included in the meta-analysis. The study sample was 85% female, and the mean age was 52.7 years. Meta-analysis indicated that telehealth exercise-based cancer rehabilitation significantly improved cardiorespiratory fitness (SMD = 0.34, 95% CI 0.20, 0.49, I2 = 42%, p < 0.001) and physical activity (SMD = 0.34, 95% CI, 0.17, 0.51, I2 = 71%, p < 0.001). It was uncertain whether telehealth exercise-based cancer rehabilitation, compared with guideline-based usual care, improved the quality of life (SMD = 0.23, 95%CI, -0.07, 0.52, I2 = 67%, p = 0.14) body mass index (MD = 0.46, 95% CI, -1.19, 2.12, I2 = 60%, p = 0.58) and muscle strength (SMD = 0.07, 95% CI, -0.14, 0.28, I2 = 37%, p = 0.51). CONCLUSION This meta-analysis showed that telehealth exercise cancer rehabilitation could significantly increase cardiorespiratory fitness and physical activity levels and decrease fatigue. It is uncertain whether these interventions improve quality of life and muscle strength. High-quality and robust studies are needed to investigate specific home-based exercise regimens in different cancer subgroups to increase the certainty of the evidence.
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Affiliation(s)
- Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic.
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Katerina Chamradova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Petr Winnige
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Katerina Batalikova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Daniela Vlazna
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic
| | - Andrea Janikova
- Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Research Laboratory Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
- School of Nursing, Tung Wah College, Hong Kong, China.
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Chang A, Boyd A, Leung I, Trejo E, Dixit N, Mallidi J, Win S, Beatty AL. Formative research to adapt a cardiac rehabilitation program to breast cancer survivors: the heart health after cancer treatment (HEART-ACT) study. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:28. [PMID: 38760873 PMCID: PMC11100255 DOI: 10.1186/s40959-024-00228-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/15/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Breast cancer survivors are disproportionately at risk for cardiovascular disease; exercise-based interventions may improve cardiovascular health. The objective of this formative research is to better understand the needs of patients and barriers to participation in an adapted cardiac rehabilitation program for diverse breast cancer survivors in an urban safety net setting. METHODS We recruited 30 participants (10 English-speaking, 10 Spanish-speaking, and 10 Cantonese-speaking) who had received treatment with curative intent for breast cancer from an urban safety net hospital between November 9, 2021, to August 30, 2022. Participants completed surveys and interviews about perspectives on health behaviors and participating in an adapted cardiac rehabilitation program. Interviews were qualitatively analyzed using rapid template analysis with pre-selected constructs from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and Consolidated Framework for Implementation Research, as well as emergent codes. We developed a Participant User Journey for a program based on responses and conducted human-centered design sessions with 8 participants to iteratively revise the Participant User Journey. RESULTS Among 30 participants, mean age was 56.7 years (standard deviation [SD] 10.2) with 100% female sex assigned at birth; 1 participant withdrew before completing study procedures. Most participants had limited health literacy (18/29, 62%). Mean body mass index was 31.4 (SD 8.3), 21/29 (72%) had blood pressure below 140/90 mmHg, and 12/29 (41%) had blood pressure below 130/80. Mean 6-minute walk distance was 384.9 meters (SD 78.3). The desired benefits of a program included healthy living and prevention of cancer recurrence. Barriers to participation included motivation, social support, transportation, and concerns about exercise safety. Participants emphasized the need for practicality, such as fitting physical activity into daily life and nutrition support, including recipes and shopping lists. Trusted experts and cultural and language concordance were viewed as important aspects of the program. CONCLUSIONS Through participant interviews and human-centered design sessions, we developed the HEART-ACT program, a 12-week multi-disciplinary program addressing physical activity, nutrition, emotional well-being, cardiovascular risk, survivorship, and other components if indicated (e.g., tobacco cessation). Future research will test the effects of this program on patient-centered outcomes.
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Affiliation(s)
- Alison Chang
- School of Medicine, University of California, San Francisco, USA
| | - Alisa Boyd
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Ivan Leung
- Division of Hematology Oncology, Department of Medicine, University of California, San Francisco, USA
- Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Evelin Trejo
- Division of Hematology Oncology, Department of Medicine, University of California, San Francisco, USA
- Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Niharika Dixit
- Division of Hematology Oncology, Department of Medicine, University of California, San Francisco, USA
- Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Jaya Mallidi
- Department of Medicine, University of California, San Francisco, USA
- Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Sithu Win
- Department of Medicine, University of California, San Francisco, USA
- Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Alexis L Beatty
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
- Department of Medicine, University of California, San Francisco, USA.
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Hollings M, Gordon N, Redfern J, Thomas L, Singleton A, Tu Q, Zecchin R. Characteristics and Outcomes of Cardiac Rehabilitation Patients With and Without Cancer: Insights From Western Sydney. Heart Lung Circ 2024; 33:730-737. [PMID: 38233306 DOI: 10.1016/j.hlc.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 01/19/2024]
Abstract
AIM Increased cardiovascular events are common in cancer survivors and contribute to an emerging cardio-oncology patient group requiring secondary prevention strategies including cardiac rehabilitation (CR). This study aimed to compare characteristics and outcomes for patients participating in CR with and without an existing cancer diagnosis. METHOD Observational cohort study including consecutive patients enrolled in a single-centre outpatient CR program in Western Sydney between 2018-2022. Clinical history, demographics and CR outcome data were collected as part of standard care at program enrolment and completion. Patients with and without a cancer diagnosis were compared at enrolment and outcomes were analysed in both groups. RESULTS A total of 1,792 patients enrolled in CR, 191 (11%) had a documented history of cancer; prostate (18%), skin (12%), colon (9%) and breast (8%) malignancies were most prevalent. The most common treatments were surgical resection (80%) and chemotherapy or radiotherapy (37%). Cardio-oncology patients were older (68.8±10.6 vs 59.8±13.7yrs, p<0.001), more likely female (33% vs 21%, p<0.001), born in Australia (46% vs 35%, p=0.004), non-partnered (34% vs 25%, p=0.002) and had a prior history of hypertension (65% vs 56%, p=0.010) or stroke (8% vs 5%, p=0.045). After adjusting for age and sex, the overall cohort improved their mean peak exercise capacity and waist circumference after CR, however there were no differences between groups. There were also no between-group differences for adherence and completion of CR program or any other cardiovascular risk factors. Sub-analyses revealed a clinically meaningful improvement in waist circumference for cancer patients with a history of radiation therapy and a blunted peak exercise capacity adaptation for those with a history of chemotherapy treatment. CONCLUSIONS Despite differences in demographic and clinical characteristics of CR patients with and without cancer, all patients showed significant and clinically relevant improvements in peak exercise capacity and waist circumference after CR. Results also highlighted potential associations between specific cancer treatments and changes in fitness outcomes, which warrants further evaluation.
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Affiliation(s)
- Matthew Hollings
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Nicole Gordon
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; South West Clinical School, School of Clinical Medicine, University of NSW, Sydney, NSW, Australia
| | - Anna Singleton
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Qiang Tu
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Robert Zecchin
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
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Bisceglia I, Venturini E, Canale ML, Ambrosetti M, Riccio C, Giallauria F, Gallucci G, Abrignani MG, Russo G, Lestuzzi C, Mistrulli R, De Luca G, Maria Turazza F, Mureddu G, Di Fusco SA, Lucà F, De Luca L, Camerini A, Halasz G, Camilli M, Quagliariello V, Maurea N, Fattirolli F, Gulizia MM, Gabrielli D, Grimaldi M, Colivicchi F, Oliva F. Cardio-oncology rehabilitation: are we ready? Eur Heart J Suppl 2024; 26:ii252-ii263. [PMID: 38784673 PMCID: PMC11110456 DOI: 10.1093/eurheartjsupp/suae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Cardio-oncology rehabilitation (CORE) is not only an essential component of cancer rehabilitation but also a pillar of preventive cardio-oncology. Cardio-oncology rehabilitation is a comprehensive model based on a multitargeted approach and its efficacy has been widely documented; when compared with an 'exercise only' programme, comprehensive CORE demonstrates a better outcome. It involves nutritional counselling, psychological support, and cardiovascular (CV) risk assessment, and it is directed to a very demanding population with a heavy burden of CV diseases driven by physical inactivity, cancer therapy-induced metabolic derangements, and cancer therapy-related CV toxicities. Despite its usefulness, CORE is still underused in cancer patients and we are still at the dawning of remote models of rehabilitation (tele-rehabilitation). Not all CORE is created equally: a careful screening procedure to identify patients who will benefit the most from CORE and a multidisciplinary customized approach are mandatory to achieve a better outcome for cancer survivors throughout their cancer journey. The aim of this paper is to provide an updated review of CORE not only for cardiologists dealing with this peculiar population of patients but also for oncologists, primary care providers, patients, and caregivers. This multidisciplinary team should help cancer patients to maintain a healthy and active life before, during, and after cancer treatment, in order to improve quality of life and to fight health inequities.
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Affiliation(s)
- Irma Bisceglia
- Integrated Cardiology Services, Cardio-Thoracic-Vascular Department, Azienda Ospedaliera San Camillo Forlanini, C.ne Gianicolense, 87 00152 Rome, Italy
| | - Elio Venturini
- Department of Cardiac Rehabilitation, Cecina Civil Hospital, Via Montanara, 52, 57023 Cecina (LI), Italy
| | - Maria Laura Canale
- Division of Cardiology, Azienda USL Toscana Nord-Ovest, Versilia Hospital, Via Aurelia, 335, 55041 Lido di Camaiore (LU), Italy
| | - Marco Ambrosetti
- Unità Operativa Complessa di Riabilitazione Cardiologica, ASST Crema Ospedale Santa Marta, Rivolta D'Adda, 26027 Cremona, Italy
| | - Carmine Riccio
- Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Giulia Russo
- SC Patologie Cardiovascolari, Ospedale Maggiore, Via Slataper, 9, 34125 Trieste, Italy
| | | | - Raffaella Mistrulli
- Cardiology Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Giovanni De Luca
- Health Activities and Epidemiologic Observatory Division, Health Department, Sicily Region, Piazza O. Ziino, 24, 90145 Palermo, Italy
| | - Fabio Maria Turazza
- Director of Cardiology, IRCCS Foundation, National Cancer Institute, via G Venezian, 1, 20133 Milano, Italy
| | - Gianfrancesco Mureddu
- Cardiology Division, S. Giovanni Hospital, Via dell'Amba Aradam, 8, 00184 Rome, Italy
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, Via Martinotti, 20, 00135 Roma, Italy
| | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio di Calabria, Italy
| | - Leonardo De Luca
- SC Cardiologia, Fondazione IRCCS San Matteo, Viale Camillo Golgi, 19, 27100 Pavia, Italy
| | - Andrea Camerini
- Department of Medical Oncology, Azienda USL Toscana Nord-Ovest, Versilia Hospital,Via Aurelia, 335, 55041 Lido di Camaiore (LU), Italy
| | - Geza Halasz
- Dipartimento Cardio-Toraco-Vascolare, U.O.C. Cardiologia, Azienda Ospedaliera San Camillo-Forlanini, C.ne Gianicolense, 87, 00152 Rome, Italy
| | - Massimiliano Camilli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go A. Gemelli, 1, 00168 Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, L.go Francesco Vito, 00168 Rome, Italy
| | - Vincenzo Quagliariello
- Division of Cardiology, National Cancer Institute, Sen. Pascale Foundation, via Mariano Semmola, 80131 Napoli, Italy
| | - Nicola Maurea
- Division of Cardiology, National Cancer Institute, Sen. Pascale Foundation, via Mariano Semmola, 80131 Napoli, Italy
| | - Francesco Fattirolli
- Azienda Ospedaliero - Universitaria Careggi, Largo Brambilla, 3, 50134 Firenze, Italy
| | | | - Domenico Gabrielli
- Dipartimento Cardio-Toraco-Vascolare, U.O.C. Cardiologia, Azienda Ospedaliera San Camillo-Forlanini, C.ne Gianicolense, 87, 00152 Rome, Italy
- Fondazione per il Tuo cuore—Heart Care Foundation, Firenze, Via A. La Marmora, 36, 50121 Firenze, Italy
| | - Massimo Grimaldi
- Regional General Hospital F. Miulli, Strada Prov. 127 Acquaviva – Santeramo Km, 4, 100.70021 Acquaviva delle Fonti (BARI), Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, Via Martinotti, 20, 00135 Roma, Italy
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica Dipartimento Cardiotoracovascolare ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
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Viamonte SG, Joaquim AV, Alves AJ, Vilela E, Capela A, Ferreira C, Duarte BF, Rato ND, Teixeira MP, Tavares A, Santos M, Ribeiro F. Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk: A Randomized Clinical Trial. JAMA Cardiol 2023; 8:1119-1128. [PMID: 37819656 PMCID: PMC10568446 DOI: 10.1001/jamacardio.2023.3558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/03/2023] [Indexed: 10/13/2023]
Abstract
Importance Cardiovascular disease is a leading cause of morbidity in cancer survivors, which makes strategies aimed at mitigating cardiovascular risk a subject of major contemporary importance. Objective To assess whether a center-based cardiac rehabilitation (CBCR) framework compared with usual care encompassing community-based exercise training (CBET) is superior for cardiorespiratory fitness improvement and cardiovascular risk factor control among cancer survivors with high cardiovascular risk. Design, Setting, and Participants This prospective, single-center, randomized clinical trial (CORE trial) included adult cancer survivors who had exposure to cardiotoxic cancer treatment and/or previous cardiovascular disease. Enrollment took place from March 1, 2021, to March 31, 2022. End points were assessed at baseline and after the 8-week intervention. Interventions Participants were randomly assigned in a 1:1 ratio to 8 weeks of CBCR or CBET. The combined aerobic and resistance exercise sessions were performed twice a week. Main Outcomes and Measures The powered primary efficacy measure was change in peak oxygen consumption (V̇o2) at 2 months. Secondary outcomes included handgrip maximal strength, functional performance, blood pressure (BP), body composition, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), lipid profile, plasma biomarker levels, physical activity (PA) levels, psychological distress, quality of life (QOL), and health literacy. Results A total of 75 participants completed the study (mean [SD] age, 53.6 [12.3] years; 58 [77.3%] female), with 38 in the CBCR group and 37 in the CBET group. Participants in CBCR achieved a greater mean (SD) increase in peak V̇o2 than those in CBET (2.1 [2.8] mL/kg/min vs 0.8 [2.5] mL/kg/min), with a between-group mean difference of 1.3 mL/kg/min (95% CI, 0.1-2.6 mL/kg/min; P = .03). Compared with the CBET group, the CBCR group also attained a greater mean (SD) reduction in systolic BP (-12.3 [11.8] mm Hg vs -1.9 [12.9] mm Hg; P < .001), diastolic BP (-5.0 [5.7] mm Hg vs -0.5 [7.0] mm Hg; P = .003), and BMI (-1.2 [0.9] vs 0.2 [0.7]; P < .001) and greater mean (SD) improvements in PA levels (1035.2 [735.7] metabolic equivalents [METs]/min/wk vs 34.1 [424.4] METs/min/wk; P < .001), QOL (14.0 [10.0] points vs 0.4 [12.9] points; P < .001), and health literacy scores (2.7 [1.6] points vs 0.1 [1.4] points; P < .001). Exercise adherence was significantly higher in the CBCR group than in the CBET group (mean [SD] sessions completed, 90.3% [11.8%] vs 68.4% [22.1%]; P < .001). Conclusion and Relevance The CORE trial showed that a cardio-oncology rehabilitation model among cancer survivors with high cardiovascular risk was associated with greater improvements in peak V̇o2 compared with usual care encompassing an exercise intervention in a community setting. The CBCR also showed superior results in exercise adherence, cardiovascular risk factor control, QOL, and health literacy. Trial Registration ClinicalTrials.gov Identifier: NCT05132998.
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Affiliation(s)
- Sofia Gonçalves Viamonte
- North Rehabilitation Center, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
| | - Ana Vieira Joaquim
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Alberto Jorge Alves
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- University of Maia, Research Center in Sports Sciences, Health Sciences and Human Development, Maia, Portugal
| | - Eduardo Vilela
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Andreia Capela
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Cristina Ferreira
- Hematology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Barbara Fresco Duarte
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
| | - Nuno Dias Rato
- ONCOMOVE–Associação de Investigação de Cuidados de Suporte em Oncologia, Vila Nova de Gaia, Portugal
- University of Maia, Research Center in Sports Sciences, Health Sciences and Human Development, Maia, Portugal
| | | | - Aida Tavares
- ISEG, Lisbon School of Economics and Management, University of Lisbon, Lisbon, Portugal
| | - Mário Santos
- Cardiology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Investigation in Biomedicine, School of Medicine and Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Fernando Ribeiro
- Institute of Biomedicine, School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Chen MH, Epstein SF. Tailored to a Woman's Heart: Gender Cardio-Oncology Across the Lifespan. Curr Cardiol Rep 2023; 25:1461-1474. [PMID: 37819431 PMCID: PMC11034750 DOI: 10.1007/s11886-023-01967-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Females outnumber males among long-term cancer survivors, primarily as a result of the prevalence of breast cancer. Late cardiovascular effects of cancer develop over several decades, which for many women, may overlap with reproductive and lifecycle events. Thus, women require longitudinal cardio-oncology care that anticipates and responds to their evolving cardiovascular risk. RECENT FINDINGS Women may experience greater cardiotoxicity from cancer treatments compared to men and a range of treatment-associated hormonal changes that increase cardiometabolic risk. Biological changes at critical life stages, including menarche, pregnancy, and menopause, put female cancer patients and survivors at a unique risk of cardiovascular disease. Women also face distinct psychosocial and physical barriers to accessing cardiovascular care. We describe the need for a lifespan-based approach to cardio-oncology for women. Cardio-oncology care tailored to women should rigorously consider cancer treatment/outcomes and concurrent reproductive/hormonal changes, which collectively shape quality of life and cardiovascular outcomes.
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Affiliation(s)
- Ming Hui Chen
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Boston Children's Hospital/Dana Farber Cancer Institute, Boston, MA, USA.
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.
| | - Sonia F Epstein
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
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10
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Kendall SJ, Heinze S, Blanchard C, Chiekwe JC, Melvin J, Culos-Reed N, McNeely ML, Keats MR, Grandy SA. Exercise Programming Modelling a Standard of Care Approach Improves Physical Health and Patient-Reported Outcomes in Individuals Living with Breast Cancer: A Pilot Study. Curr Oncol 2023; 30:7203-7217. [PMID: 37623003 PMCID: PMC10453864 DOI: 10.3390/curroncol30080522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Controlled study designs widely report that exercise improves the health of individuals living with breast cancer. Still, many individuals living with breast cancer are not active enough to experience the benefits of exercise. The Activating Cancer Communities through an Exercise Strategy for Survivors study was developed to reach more individuals living with cancer. This report describes the effects of a 12-week individualized exercise program that models a standard-of-care approach on body composition, physical fitness, and patient-reported outcomes in individuals living with breast cancer. Individuals living with breast cancer were recruited for the study and completed an exercise program twice weekly overseen by a Clinical Exercise Physiologist. A total of 43 participants completed the exercise intervention, and 36 withdrew from the study. All participants had significantly improved aerobic fitness, waist circumference, hip circumference, lower body endurance, physical activity behaviour, health-related quality of life, emotional status, and fatigue levels after completing the program. Flexibility, balance, and sleep scores did not change. The results from the 12-week individualized exercise program largely align with the results from more controlled study designs. These results support future initiatives integrating exercise therapy into the standard of care for individuals living with breast cancer.
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Affiliation(s)
- Stephanie J. Kendall
- School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada; (S.J.K.); (J.C.C.); (M.R.K.)
- Beatrice Hunter Cancer Research Institute, Halifax, NS B3H 4R2, Canada;
| | - Stefan Heinze
- Beatrice Hunter Cancer Research Institute, Halifax, NS B3H 4R2, Canada;
- Cancer Care Program, Nova Scotia Health Authority, Halifax, NS B3H 2Y9, Canada
| | - Chris Blanchard
- Department of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Joy C. Chiekwe
- School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada; (S.J.K.); (J.C.C.); (M.R.K.)
| | - Jennifer Melvin
- Department of Medicine, Division of Medical Oncology, Nova Scotia Health, Halifax, NS B3H 2Y9, Canada;
| | - Nicole Culos-Reed
- Department of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Margaret L. McNeely
- Physical Therapy, University of Alberta, Edmonton, AB T6G 2G4, Canada;
- Supportive Care, Cancer Care Alberta, Edmonton, AB T5J 3E4, Canada
| | - Melanie R. Keats
- School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada; (S.J.K.); (J.C.C.); (M.R.K.)
- Beatrice Hunter Cancer Research Institute, Halifax, NS B3H 4R2, Canada;
- Department of Medicine, Division of Medical Oncology, Nova Scotia Health, Halifax, NS B3H 2Y9, Canada;
| | - Scott A. Grandy
- School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada; (S.J.K.); (J.C.C.); (M.R.K.)
- Beatrice Hunter Cancer Research Institute, Halifax, NS B3H 4R2, Canada;
- Department of Medicine, Division of Medical Oncology, Nova Scotia Health, Halifax, NS B3H 2Y9, Canada;
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11
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Viamonte SG, Joaquim A, Alves A, Vilela E, Capela A, Ferreira C, Costa AJ, Teixeira M, Duarte B, Rato N, Tavares A, Santos M, Ribeiro F. Adherence, safety, and satisfaction of a cardio-oncology rehabilitation program framework versus community exercise training for cancer survivors: findings from the CORE trial. Support Care Cancer 2023; 31:173. [PMID: 36800020 PMCID: PMC9936479 DOI: 10.1007/s00520-023-07638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE To assess safety, satisfaction, and overall adherence of a center-based cardiac rehabilitation (CBCR) program for cancer survivors at increased cardiovascular (CV) risk, compared to community-based exercise training (CBET). METHODS The CORE study was a single-center, prospective, randomized controlled trial enrolling cancer survivors exposed to cardiotoxic cancer treatment and/or with previous CV disease. Participants were randomized to an 8-week CBCR program or CBET, twice a week. Overall feasibility (consent, retention, and completion rates), intervention adherence (percentage of exercise sessions attended), and safety were assessed. Adverse events (AEs) were registered, and participants' satisfaction was measured at the end of the study. RESULTS Eighty out of 116 potentially eligible individuals were included; consent rate was 72.4%, and 77 (96.2%) started the study (retention rate 100% in CBCR vs 92.5% in CBET); completion rate was 92.5%. Intervention adherence was higher in CBCR (90.3 ± 11.8% vs 68.4 ± 22.1%, p < 0.001). Exercise-related AEs were mainly related to musculoskeletal conditions in both groups (7 in CBCR vs 20 in CBET, p < 0.001), accounting for exercise prescription modification in 47 sessions (18 (3.3%) in CBCR vs 29 (7.2%) in CBET, p = 0.006), none motivating exercise discontinuation. No participants reported major CV events. Overall, the satisfaction with the different aspects of the programs (e.g., expectations, monitoring) was higher in the CBCR. CONCLUSION This exploratory analysis of the CORE trial suggests that both exercise-based interventions are feasible and safe in this setting. The higher intervention adherence and patient satisfaction in CBCR suggest that this comprehensive approach could be of interest in this population.
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Affiliation(s)
- Sofia Gonçalves Viamonte
- North Rehabilitation Center, Centro Hospitalar Vila Nova de Gaia/Espinho, Avenida Infante Sagres 22, 4250-076, Vila Nova de Gaia, Portugal.
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal.
- Research Center in Sports Sciences, Health Sciences and Human Development, University of Maia, Maia, Portugal.
- Institute of Biomedicine (iBiMED), School of Health Sciences, University of Aveiro, Aveiro, Portugal.
| | - Ana Joaquim
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Alberto Alves
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Research Center in Sports Sciences, Health Sciences and Human Development, University of Maia, Maia, Portugal
| | - Eduardo Vilela
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Andreia Capela
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Cristina Ferreira
- Hematology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana João Costa
- North Rehabilitation Center, Centro Hospitalar Vila Nova de Gaia/Espinho, Avenida Infante Sagres 22, 4250-076, Vila Nova de Gaia, Portugal
| | - Madalena Teixeira
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Barbara Duarte
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Nuno Rato
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Research Center in Sports Sciences, Health Sciences and Human Development, University of Maia, Maia, Portugal
| | - Aida Tavares
- Lisbon School of Economics and Management, ISEG, University of Lisbon, Lisbon, Portugal
| | - Mário Santos
- Cardiology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Unit for Multidisciplinary Investigation in Biomedicine (UMIB), Institute for Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Fernando Ribeiro
- Institute of Biomedicine (iBiMED), School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Ho S, Culligan M, Friedberg J, Goloubeva O, Marchese V. Examining the impact of physical function performance in predicting patient outcomes after lung-sparing surgery for malignant pleural mesothelioma. Disabil Rehabil 2022; 44:6676-6683. [PMID: 34455883 DOI: 10.1080/09638288.2021.1970256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to examine the impact of physical function performance and pulmonary function on patient outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM). MATERIALS AND METHODS A retrospective review of 54 patients with MPM from 2015 to 2020 was performed. The primary objective was to assess whether physical function, as measured by the Eastern Cooperative Oncology Group Performance Status (ECOG), and pulmonary function tests were predictive of postoperative patient outcomes (ventilator days, chest tube days, hospital length of stay). A secondary objective was to explore demographic and preoperative variables that best predict postoperative physical function and patient outcomes. RESULTS Data include 54 patients who underwent extended pleurectomy-decortication. Preoperative ECOG was a significant predictor of postoperative patient outcomes while preoperative lung function lacked predictive ability. Preoperative ECOG was also predictive of preoperative lung function. Age on the day of surgery was the best predictor of postoperative physical function, which was significantly reduced postoperatively. CONCLUSIONS Preoperative physical function performance was a significant predictor of postoperative outcomes. The results of our study highlight the importance of physical function in patients with MPM and support the need for early rehabilitation and further research to determine optimal rehabilitation interventions.IMPLICATIONS FOR REHABILITATIONPreoperative physical function can predict outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM).Physical function in patients with MPM should be carefully examined.To accurately reflect patients' abilities, patient assessment should include both patient-reported outcomes and performance-based measures.Patients with MPM should receive rehabilitation early after diagnosis and throughout the continuum of care.
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Affiliation(s)
- Simon Ho
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa Culligan
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Joseph Friedberg
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Olga Goloubeva
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.,Division of Biostatistics and Bioinformation, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
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13
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Exercise and Cardio-Oncology Rehab. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022. [DOI: 10.1007/s11936-022-00968-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fakhraei R, Peck, BKin SS, Abdel-Qadir H, Thavendiranathan P, Sabiston CM, Rivera-Theurel F, Oh P, Orchanian-Cheff A, Lee L, Adams SC. Research Quality and Impact of Cardiac Rehabilitation in Cancer Survivors: A Systematic Review and Meta-Analysis. JACC CardioOncol 2022; 4:195-206. [PMID: 35818551 PMCID: PMC9270627 DOI: 10.1016/j.jaccao.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/17/2022] [Accepted: 03/23/2022] [Indexed: 11/03/2022] Open
Abstract
Background Cardiac rehabilitation (CR) is endorsed to improve cardiovascular outcomes in cancer survivors. The quality of CR-based research in oncology has not been assessed. Objectives The aim of this study was to evaluate the quality of reporting and evidence from CR-based intervention studies in oncology and to explore associations between intervention participation and outcomes. Methods Systematic searches of 5 databases were conducted (January 2020) and updated (September 2021). Randomized and nonrandomized studies evaluating CR-based interventions in adult cancer survivors during and after treatment were eligible. Independent reviewers extracted data using 2 reporting guidelines (Template for Intervention Description and Replication and Consolidated Standards for Reporting Trials Harms extension), risk of bias (ROB) assessment tools (Cochrane ROB 2.0 and Cochrane Risk of Bias in Non-Randomized Studies of Interventions), and a combined inventory (Tool for the Assessment of Study Quality and reporting in Exercise). A meta-analysis was used to explore pre-intervention/post-intervention differences for commonly assessed outcomes. Results Ten studies involving data from 685 survivors were included. The mean quality scores for intervention reporting (Template for Intervention Description and Replication) and harms (Consolidated Standards for Reporting Trials Harms extension) were 62% and 17%, respectively. There was moderate-to-high ROB across nonrandomized (Cochrane Risk of Bias in Non-Randomized Studies of Interventions score: 25%) and randomized (ROB 2.0 score: 50%) studies. The mean standardized cardiorespiratory fitness was higher (0.42; 95% CI: 0.27-0.57), fatigue was lower (-0.45; 95% CI: -0.55 to -0.34), and percent body fat (0.07; 95% CI: -0.23 to 0.38) was not different in survivors completing CR compared with those not completing CR. Conclusions CR-based studies in oncology have low-to-moderate reporting quality and moderate-to-high ROB limiting interpretation, reproducibility, and translation of this evidence into practice.
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Key Words
- CONSORT, Consolidated Standards for Reporting Trials
- CR, cardiac rehabilitation
- CRF, cardiorespiratory fitness
- CVD, cardiovascular disease
- RCT, randomized controlled trial
- ROB, risk of bias
- ROBINS-I, Cochrane Risk of Bias in Non-Randomized Studies of Interventions
- TESTEX, Tool for the Assessment of Study Quality and Reporting in Exercise
- TIDieR, Template for Intervention Description and Replication
- Vo2peak, peak oxygen consumption
- bias
- biomedical research standards
- cardiology
- data reporting
- exercise therapy
- oncology
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Affiliation(s)
- Reza Fakhraei
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Serena S. Peck, BKin
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ted Rogers Cardiotoxicity Prevention Program, University Health Network, Toronto, Ontario, Canada
| | - Husam Abdel-Qadir
- Ted Rogers Cardiotoxicity Prevention Program, University Health Network, Toronto, Ontario, Canada
- Cardiology, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology and Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada
| | - Paaladinesh Thavendiranathan
- Ted Rogers Cardiotoxicity Prevention Program, University Health Network, Toronto, Ontario, Canada
- Cardiology, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
- Cardiology, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Catherine M. Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Rivera-Theurel
- Ted Rogers Cardiotoxicity Prevention Program, University Health Network, Toronto, Ontario, Canada
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Paul Oh
- Cardiology, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Leanna Lee
- Ted Rogers Cardiotoxicity Prevention Program, University Health Network, Toronto, Ontario, Canada
- Cardiology, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Scott C. Adams
- Ted Rogers Cardiotoxicity Prevention Program, University Health Network, Toronto, Ontario, Canada
- Cardiology, Toronto General Hospital Research Institute, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
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Bhatia R, Holtan S, Jurdi NE, Prizment A, Blaes A. Do Cancer and Cancer Treatments Accelerate Aging? Curr Oncol Rep 2022; 24:1401-1412. [PMID: 35796942 PMCID: PMC9606015 DOI: 10.1007/s11912-022-01311-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW This review focuses on describing the mechanisms and clinical manifestations that underlie accelerated aging associated with cancer and its treatment. RECENT FINDINGS The direct and indirect effects of cancer and its treatment are associated with late occurrence of comorbidities that happen earlier or more frequently in cancer survivors compared to cancer-free individuals, otherwise known as accelerated aging. Use of senolytics and dietary and exercise interventions including prehabilitation, caloric restriction, and rehabilitation are currently under investigation to reverse or decelerate the aging process and will be covered in this review. Further research on how to decelerate or reverse aging changes associated with cancer and its treatment will be of paramount importance as the number of cancer survivors continues to grow.
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Affiliation(s)
- Roma Bhatia
- grid.38142.3c000000041936754XMassachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA
| | - Shernan Holtan
- grid.17635.360000000419368657Division of Hematology, Oncology and Transplantation, University of Minnesota, 425 E River Pkwy, Minneapolis, MN 55455 USA
| | - Najla El Jurdi
- grid.17635.360000000419368657Division of Hematology, Oncology and Transplantation, University of Minnesota, 425 E River Pkwy, Minneapolis, MN 55455 USA
| | - Anna Prizment
- grid.17635.360000000419368657Division of Hematology, Oncology and Transplantation, University of Minnesota, 425 E River Pkwy, Minneapolis, MN 55455 USA
| | - Anne Blaes
- grid.17635.360000000419368657Division of Hematology, Oncology and Transplantation, University of Minnesota, 425 E River Pkwy, Minneapolis, MN 55455 USA
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Williamson T, Moran C, Chirico D, Arena R, Ozemek C, Aggarwal S, Campbell T, Laddu D. Cancer and cardiovascular disease: The impact of cardiac rehabilitation and cardiorespiratory fitness on survival. Int J Cardiol 2021; 343:139-145. [PMID: 34506825 DOI: 10.1016/j.ijcard.2021.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/04/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cancer survivors are at increased risk for cardiovascular disease (CVD)-related morbidity and mortality. Exercise-based cardiac rehabilitation (CR) programs improve CVD risk factors, including cardiorespiratory fitness (CRF). The purpose of this study was to investigate: (1) the association between CR completion and survival, and (2) whether CRF improvements translate to increased survival among patients with comorbid cancer and CVD. METHODS Patients with CVD and pre-existing cancer (any type) were referred to a 12-week exercise-based CR program between 01/1996 and 03/2016. Peak metabolic equivalents (METs) were assessed by graded exercise test pre-CR and at 12-weeks. Kaplan-Meier survival and multivariate cox regressions were performed to evaluate impact of CR completion and clinically-meaningful CRF improvements [ΔMETs≥1] on survival, adjusting for relevant covariates. RESULTS Among 442 patients with CVD and cancer referred to CR (67 ± 10 years; 22% women), 361 (82%) completed CR. 102 deaths were recorded during the 12-year observation period. Compared to patients who did not complete CR, patients with comorbid cancer who completed CR demonstrated a survival advantage (63% vs 80.1%, p < .001). CRF improved among completers during the 12-week program (mean change = 0.87 ± 0.93 METs, p < .001); 41% experienced a clinically-meaningful ΔMETs≥1. A survival advantage was not observed in completers who experienced a ΔMETs≥1 improvement (p = .254). CONCLUSION Completing a 12-week exercise-based CR program improved CRF and increased survival in patients with CVD and comorbid cancer. The results highlight the survival benefits of completing a CR program among CVD patients who experience added barriers imposed by cancer treatment and survival.
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Affiliation(s)
- Tamara Williamson
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Daniele Chirico
- TotalCardiology™ Rehabilitation, Calgary, AB, Canada; TotalCardiology Research Network, Calgary, AB, Canada; Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Ross Arena
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Sandeep Aggarwal
- TotalCardiology™ Rehabilitation, Calgary, AB, Canada; TotalCardiology Research Network, Calgary, AB, Canada; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada; TotalCardiology Research Network, Calgary, AB, Canada; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA; Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Deepika Laddu
- TotalCardiology Research Network, Calgary, AB, Canada; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA.
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Cardio-Oncology Rehabilitation (CORE) Exercise Prescription and Programming: A PRACTICAL GUIDE. J Cardiopulm Rehabil Prev 2021; 41:341-344. [PMID: 34461622 DOI: 10.1097/hcr.0000000000000572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with cancer almost universally report diminished health-related quality of life. Many patients experience persistent fatigue and most have below-average exercise capacities. Despite the publication of exercise guidelines for cancer survivors that encourage physical activity, few patients exercise on a regular basis. Cardiovascular disease is a major cause of death in early-stage malignancies. Exercise training has been demonstrated to decrease cardiovascular events in patients with cancer. In addition, regular exercise improves exercise capacity, reduces fatigue, and improves quality of life in cancer survivors. CLINICAL CONSIDERATIONS A 2019 American Heart Association scientific statement, endorsed by the American Cancer Society, provided a framework and rationale for partnering with existing multidimensional, interdisciplinary outpatient cardiac rehabilitation programs to provide supervised exercise training and risk factor control services for patients with cancer and cancer survivors: cardio-oncology rehabilitation. In addition, the American College of Sports Medicine has published recommendations for cancer exercise training. SUMMARY This article provides practical suggestions for incorporating patients with cancer into cardiac rehabilitation and for patient-specific exercise prescription. Illustrative patient case examples are provided.
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Finley DJ, Stevens CJ, Emond JA, Batsis JA, Fay KA, Darabos C, Sacks OA, Cook SB, Lyons KD. Potential effectiveness of a surgeon-delivered exercise prescription and an activity tracker on pre-operative exercise adherence and aerobic capacity of lung cancer patients. Surg Oncol 2021; 37:101525. [PMID: 33813267 PMCID: PMC8217197 DOI: 10.1016/j.suronc.2021.101525] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/10/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Pre-operative exercise may improve functional outcomes for lung cancer patients, but barriers associated with cost, resources, and burden make it challenging to deliver pre-operative exercise programs. The goal of this proof-of-concept study was to determine level of moderate-vigorous physical activity (MVPA) and change in aerobic capacity after participation in a home-based pre-operative exercise intervention. MATERIALS AND METHODS Eighteen patients scheduled for surgery for suspected stage I-III lung cancer received an exercise prescription from their surgeon and wore a commercially-available device that tracked their daily MVPA throughout the pre-operative period. Descriptive statistics were used to calculate adherence to the exercise prescription. A one-sample t-test was used to explore change in aerobic capacity from baseline to the day of surgery. RESULTS Participants exhibited a mean of 20.4 (sd = 46.2) minutes of MVPA per day during the pre-operative period. On average, the sample met the goal of 30 min of MVPA on 16.4% of the days during the pre-operative period. The mean distance achieved at baseline for the 6-min walk test was 456.7 m (sd = 72.9), which increased to 471.1 m (sd = 88.4) on the day of surgery. This equates to a mean improvement of 13.8 m (sd = 37.0), but this difference was not statistically different from zero (p = 0.14). Eight of the 17 participants (47%) demonstrated a clinically significant improvement of 14 m or more. CONCLUSION A surgeon-delivered exercise prescription plus an activity tracker may promote clinically significant improvement in aerobic capacity and MVPA engagement among patients with lung cancer during the pre-operative period, but may need to be augmented with more contact with and support from practitioners over time to maximize benefits. TRIAL REGISTRATION The study protocol was registered with ClinicalTrials.gov prior to initiating participant recruitment (NCT03162718).
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Affiliation(s)
- David J Finley
- Department of Surgery, Section Thoracic Surgery, Dartmouth-Hitchcock Health, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Courtney J Stevens
- Department of Psychiatry, Dartmouth-Hitchcock Health, Dartmouth Centers for Health & Aging, 46 Centerra Parkway, Lebanon, NH, 03756, USA.
| | - Jennifer A Emond
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - John A Batsis
- Department of Medicine, Dartmouth-Hitchcock Health, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Kayla A Fay
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Health, 1 Medical Center Dr., Lebanon, NH, 03756, USA.
| | - Christian Darabos
- Information, Technology and Consulting, Dartmouth College, 4 Currier Place, Hanover, NH, 03748, USA; Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Olivia A Sacks
- Department of Surgery, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, 02118, USA.
| | - Summer B Cook
- Department of Kinesiology, University of New Hampshire, 124 Main Street, Durham, NH, 03824, USA.
| | - Kathleen Doyle Lyons
- Department of Psychiatry Research, Dartmouth-Hitchcock Health, 1 Medical Center Dr., Lebanon, NH, 03756, USA.
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A Cardiac Rehabilitation Program for Breast Cancer Survivors: A Feasibility Study. JOURNAL OF ONCOLOGY 2021; 2021:9965583. [PMID: 34135964 PMCID: PMC8178006 DOI: 10.1155/2021/9965583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
Purpose The purpose of this study was to determine the feasibility and preliminary efficacy of a cardiac rehabilitation (CR) intervention in the breast cancer population. Methods This single-arm feasibility study evaluated a 14-week CR intervention program in breast cancer survivors. Feasibility was defined as completion of at least 30/36 sessions of the program without serious adverse events (SAE) in 80% of patients. Secondary endpoints included the change in VO2 max, cardiovascular disease (CVD) risk factors, Duke Activity Secondary Index (DASI), Brief Fatigue Inventory (BFI), and QLQ-C30. All outcomes were reported as mean change and compared using paired t-tests. Results A total of 25 patients were enrolled in the study. 18 patients of the 25 enrolled (72%) completed the 14 weeks program without SAE. The overall adherence to the study protocol was 60%. Of the 18 participants who did not withdraw from the program, 15 (83%) adhered to the study protocol and completed 30 or more sessions. There was a nonsignificant improvement in VO2 max (mean Δ0.5, p=0.6). The scores for DASI, BFI, and QLQ-C30 improved from baseline to posttreatment. Conclusion A CR intervention in breast cancer survivors had high adherence in those who were able to complete the 14-week program. The program significantly improved patient reported physical activity, fatigue, and quality of life (QoL), without significant improvement in CVD risk factors. Implications for cancer patients are that early implementation of a CR program should be considered by practitioners as it improves QoL and exercise tolerance in breast cancer survivors.
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20
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Dennett AM, Zappa B, Wong R, Ting SB, Williams K, Peiris CL. Bridging the gap: a pre-post feasibility study of embedding exercise therapy into a co-located cancer unit. Support Care Cancer 2021; 29:6701-6711. [PMID: 33963458 PMCID: PMC8105143 DOI: 10.1007/s00520-021-06261-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/28/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE To establish the feasibility of embedding a flexible, exercise-based rehabilitation program into a cancer treatment unit to allow cancer survivors early exercise support. METHOD A pre-post study was conducted using Bowen's Framework to describe key domains of feasibility: demand (referrals), acceptability (uptake, attendance, satisfaction), implementation (resources), practicality (adverse events, costs) and limited-efficacy (function, quality of life, self-efficacy). Participants were medically stable, adult cancer survivors receiving curative or palliative treatment for cancer at the health service. Participants completed an 8-week home or hospital-based exercise program. Data were analysed descriptively. Standardised mean differences (Hedge's g) and mean differences were calculated to determine effect size and clinical significance. RESULTS The exercise-based rehabilitation service received 155 referrals over 6 months. Of those eligible, 73/119 (61%) commenced. Participants opting for twice-weekly, hospital-based exercise attended 9/16 (56%) sessions. Participants reported high satisfaction and there were no major adverse events. The program utilised existing resources, with the predominant cost being staff. The average health service cost per participant was AUD $1,104. Participants made clinically significant gains in function (6-min walk distance; + 73 m, 95% confidence interval 49 to 96) and quality of life (EORTC QLQ-C30 Global quality of life; + 8 units, 95% confidence interval 3 to 13). CONCLUSION Implementation of exercise-based rehabilitation in a co-located cancer unit was safe and feasible. Access, patient and staff education and establishing funding streams are important implementation considerations. Implications for cancer survivors Access to exercise in a cancer unit provides opportunity for early intervention to optimise function during treatment.
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Affiliation(s)
- Amy M Dennett
- School of Allied Health, Human Services and Sport, La Trobe University and Allied Health Clinical Research Office, Eastern Health, Level 2, 5 Arnold St, Box Hill, VIC, Australia.
| | - Bernadette Zappa
- North Eastern Melbourne Cancer Services and Department of Cancer Services, Eastern Health, Box Hill, VIC, Australia
| | - Rachel Wong
- Department of Oncology, Eastern Health and Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Stephen B Ting
- Department of Clinical Haematology, Eastern Health and Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Kimberley Williams
- Department of Physiotherapy, Specialty Medicine and Ambulatory Care, Eastern Health, Box Hill, VIC, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
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21
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Ibeggazene S, Turner R, Rosario D, Bourke L. Remote interventions to improve exercise behaviour in sedentary people living with and beyond cancer: a systematic review and meta-analysis. BMC Cancer 2021; 21:308. [PMID: 33761906 PMCID: PMC7987748 DOI: 10.1186/s12885-021-07989-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has forced many cancer services to consider a transition to a remote format of delivery that is largely untested. Accordingly, we sought to perform a systematic review of the effects of remotely delivered interventions to improve exercise behaviour in sedentary adults living with and beyond cancer. METHODS Eligible studies were randomised controlled trials comparing a remotely delivered exercise intervention to a usual care comparison in sedentary people over 18 years old with a primary cancer diagnosis. Nine electronic databases were searched from inception to November 2020. RESULTS The review included three trials, totalling 186 participants. Two of the included trials incorporated prescriptions that meet current aerobic exercise recommendations, one of which also meets the guidelines for resistance exercise. No trials reported an intervention adherence of 75% or more for a set prescription that meets current exercise guidelines. CONCLUSION There is little evidence suggesting that remote exercise interventions promote exercise behaviours or improve physical function in sedentary adults living with and beyond cancer. The development and evaluation of novel remote exercise interventions is needed to establish their usefulness for clinical practice. Given the social response to the COVID-19 pandemic, further research in this area is urgently needed.
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Affiliation(s)
- Saïd Ibeggazene
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK.
| | - Rebecca Turner
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Derek Rosario
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Liam Bourke
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
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22
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Winnige P, Vysoky R, Dosbaba F, Batalik L. Cardiac rehabilitation and its essential role in the secondary prevention of cardiovascular diseases. World J Clin Cases 2021; 9:1761-1784. [PMID: 33748226 PMCID: PMC7953385 DOI: 10.12998/wjcc.v9.i8.1761] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases are the most common causes of mortality worldwide. They are frequently the reasons for patient hospitalization, their incapability for work, and disability. These diseases represent a significant socio-economic burden affecting the medical system as well as patients and their families. It has been demonstrated that the etiopathogenesis of cardiovascular diseases is significantly affected by lifestyle, and so modification of the latter is an essential component of both primary and secondary prevention. Cardiac rehabilitation (CR) represents an efficient secondary prevention model that is especially based on the positive effect of regular physical activity. This review presents an overview of basic information on CR with a focus on current trends, such as the issue of the various training modalities, utilization, and barriers to it or the use of telemedicine technologies. Appropriate attention should be devoted to these domains, as CR continues evolving as an effective and readily available intervention in the future.
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Affiliation(s)
- Petr Winnige
- Department of Public Health, Faculty of Medicine, Masaryk University, Czech Republic, Brno 62500, Jihomoravsky, Czech Republic
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Robert Vysoky
- Department of Public Health, Faculty of Medicine, Masaryk University, Czech Republic, Brno 62500, Jihomoravsky, Czech Republic
- Department of Health Promotion, Faculty of Sports Studies, Masaryk University, Brno 62500, Jihomoravsky, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
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23
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Venturini E, Gilchrist S, Corsi E, DI Lorenzo A, Cuomo G, D'Ambrosio G, Pacileo M, D'Andrea A, Canale ML, Iannuzzo G, Sarullo FM, Vigorito C, Barni S, Giallauria F. The core components of cardio-oncology rehabilitation. Panminerva Med 2021; 63:170-183. [PMID: 33528152 DOI: 10.23736/s0031-0808.21.04303-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The increased efficacy of cancer therapy has resulted in greater cancer survival and increasing number of people with cancer and cardiovascular diseases. The sharing of risk factors, the bidirectional relationship between cancer and cardiovascular diseases and the cardiotoxic effect of chemotherapy and radiotherapy, are the cause of the rapid expansion of cardio-oncology. All strategies to preserve cardiovascular health and mitigate the negative effect of cancer therapy, by reducing the cardiovascular risk, must be pursued to enable the timely and complete delivery of anticancer therapy and to achieve the longest remission of the disease. Comprehensive cardiac rehabilitation is an easy-to-use model, even in cancer care, and is the basis of Cardio-Oncology REhabilitation (CORE), an exercise-based multi-component intervention. In addition, CORE, besides using the rationale and knowledge of cardiac rehabilitation, can leverage the network of cardiac rehabilitation services to offer to cancer patients exercise programs, control of risk factors, psychological support, and nutrition counseling. The core components of CORE will be discussed, describing the beneficial effect on cardiorespiratory fitness, quality of life, psychological and physical well-being, and weight management. Furthermore, particular attention will be paid to how CORE can counterbalance the negative effect of therapies in those at heightened cardiovascular risk after a cancer diagnosis. Barriers for implementation, including personal, family, social and of the health care system barriers for a widespread diffusion of the CORE will also be discussed. Finally, there will be a call-to-action, for randomized clinical trials that can test the impact of CORE, on morbidity and mortality.
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Affiliation(s)
- Elio Venturini
- Unit of Cardiac Rehabilitation, AUSL Toscana Nord-Ovest, Cecina Civil Hospital, Cecina, Livorno, Italy -
| | - Susan Gilchrist
- Department of Clinical Cancer Prevention, Anderson Cancer Center, the University of Texas, Houston, TX, USA.,Department of Cardiology, Anderson Cancer Center, the University of Texas, Houston, TX, USA
| | - Elisabetta Corsi
- Unit of Cardiac Rehabilitation, AUSL Toscana Nord-Ovest, Cecina Civil Hospital, Cecina, Livorno, Italy
| | - Anna DI Lorenzo
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Gianluigi Cuomo
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giuseppe D'Ambrosio
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Mario Pacileo
- Unit of Cardiology and Intensive Care, Umberto I Hospital, Nocera Inferiore, Salerno, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Care, Umberto I Hospital, Nocera Inferiore, Salerno, Italy
| | - Maria L Canale
- Department of Cardiology, AUSL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Lucca, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Filippo M Sarullo
- Unit of Cardiovascular Rehabilitation, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Carlo Vigorito
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Sandro Barni
- Department of Oncology, ASST Bergamo Ovest, Bergamo, Italy
| | - Francesco Giallauria
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Faculty of Sciences and Technology, University of New England, Armidale, Australia
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24
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Dennett AM, Sarkies M, Shields N, Peiris CL, Williams C, Taylor NF. Multidisciplinary, exercise-based oncology rehabilitation programs improve patient outcomes but their effects on healthcare service-level outcomes remain uncertain: a systematic review. J Physiother 2021; 67:12-26. [PMID: 33358544 DOI: 10.1016/j.jphys.2020.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 11/15/2020] [Accepted: 12/15/2020] [Indexed: 02/01/2023] Open
Abstract
QUESTION What is the effect of multidisciplinary, exercise-based, group oncology rehabilitation programs on healthcare service outcomes and patient-level outcomes, including quality of life and physical and psychosocial function? DESIGN Systematic review with meta-analysis of randomised controlled trials. PARTICIPANTS Adults diagnosed with cancer. INTERVENTION Multidisciplinary, group-based rehabilitation that includes exercise for cancer survivors. OUTCOME MEASURES Primary outcomes related to health service delivery, including costs, hospitalisations and healthcare service utilisation. Secondary outcomes were patient-level measures, including: the European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire, 30-second timed sit to stand and the Hospital Anxiety and Depression Scale. The evidence was evaluated using the PEDro Scale and the Grades of Research, Assessment, Development and Evaluation (GRADE) approach. RESULTS Seventeen trials (1,962 participants) were included. There was uncertainty about the effect of multidisciplinary, exercise-based rehabilitation on healthcare service outcomes, as only one trial reported length of stay and reported wide confidence intervals (MD 2.4 days, 95% CI -3.1 to 7.8). Multidisciplinary, exercise-based rehabilitation improved muscle strength (1RM chest press MD 3.6 kg, 95% CI 0.4 to 6.8; 1RM leg press MD 19.5 kg, 95% CI 12.3 to 26.8), functional strength (30-second sit to stand MD 6 repetitions, 95% CI 3 to 9) and reduced depression (MD -0.7 points, 95% CI -1.2 to -0.1) compared to usual care. There was uncertainty whether multidisciplinary rehabilitation programs are more effective when delivered early versus late or more effective than exercise alone. Adherence was typically high (mean weighted average 76% sessions attended) with no major and few minor adverse events reported. CONCLUSION Multidisciplinary, exercise-based oncology rehabilitation programs improve some patient-level outcomes compared with usual care. Further evidence from randomised trials to determine their effect at a healthcare service level are required if these programs are to become part of standard care. TRIAL REGISTRATION PROSPERO CRD42019130593.
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Affiliation(s)
- Amy M Dennett
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia.
| | - Mitchell Sarkies
- School of Public Health, Curtin University, Perth, Australia; School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Cylie Williams
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia; Department of Allied Health, Peninsula Health, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
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Abstract
Cardiovascular disease (CVD) is a major competing cause of morbidity and mortality in patients with cancer. Cancer treatment can have detrimental short- and long-term cardiovascular effects. Moreover, cancer patients may have a significant loss in cardiorespiratory fitness, a key CVD risk factor, during and after cancer treatment. Exercise training has emerged as a potential intervention to improve fitness and reduce the risk of CVD in cancer. In this review, we discuss the role of cardiorespiratory fitness to predict cancer and CVD outcomes, as well as explore the impact of exercise training to improve fitness and other key outcomes in patients with cancer. The role of cardio-oncology rehabilitation will also be highlighted.
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Affiliation(s)
- Samuel G Wittekind
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA.
| | - Susan C Gilchrist
- Department of Clinical Cancer Prevention & Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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26
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Dittus K, Toth M, Priest J, O'Brien P, Kokinda N, Ades P. Effects of an exercise-based oncology rehabilitation program and age on strength and physical function in cancer survivors. Support Care Cancer 2020; 28:3747-3754. [PMID: 31828490 PMCID: PMC8185895 DOI: 10.1007/s00520-019-05163-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/30/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Cancer therapy diminishes strength and physical function in cancer survivors. Whether oncology rehabilitation (OR) exercise training following therapy can correct these deficits, and whether its effectiveness differs by age, is not clear. We examine the utility of a clinically based, 12-week, combined aerobic and resistance training intervention on muscle strength and physical function in two age groups of cancer survivors. METHODS Strength and physical function measures were assessed in middle-aged (45 to 64 years) and older (≥ 65 years) patients following treatment for stage 0-III cancer before and after the OR training program. RESULTS Older patients had lower physical function compared to middle-aged patients across a range of subjective and objective measures at baseline, and exercise improved all indices of physical function and strength in both age groups. Compared to the middle-aged individuals, older participants tended to have less improvement leg strength and the 5 time sit to stand (5TSTS) test as a result of OR. In models predicting post-intervention measures, older age contributed to less improvement in walking distance and power as well as the 5TSTS test. CONCLUSION Prior to beginning the OR exercise program, middle-aged patients had higher physical function compared to older patients. However, a 12-week aerobic and resistance training intervention improved physical function across both age groups, although older age did limit responsiveness in some physical function measures. The physical function and strength of middle-aged and older cancer survivors improve in response to an exercise-based OR program after cancer treatment.
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Affiliation(s)
- Kim Dittus
- Department of Internal Medicine, Vermont Center on Behavior and Health, University of Vermont, Given E-214, 89 Beaumont Ave, Burlington, VT, 05405, USA.
| | - Michael Toth
- Departments of Internal Medicine and Molecular Physiology and Biophysics, College of Medicine, University of Vermont, Burlington, VT, USA
| | - Jeff Priest
- Medical Biostatistics Unit, University of Vermont, Burlington, VT, 05405, USA
| | - Patricia O'Brien
- Department of Internal Medicine, University of Vermont, Burlington, VT, USA
| | - Nathan Kokinda
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Philip Ades
- Department of Internal Medicine, Vermont Center on Behavior and Health, University of Vermont, Given E-214, 89 Beaumont Ave, Burlington, VT, 05405, USA
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27
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Morris GS, Barbe C, Miller L. Increasing the clinical utility of exercise training as a modality in the oncology setting—What we learned in 2019. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1787723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- G. Stephen Morris
- Department. of Physical Therapy, Wingate University, Wingate, NC, USA
| | - Cynthia Barbe
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Lauren Miller
- Board Certified in Oncologic Physical Therapy, University of Chicago Hospital, Chicago, IL, USA
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28
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Venturini E, Iannuzzo G, D’Andrea A, Pacileo M, Tarantini L, Canale M, Gentile M, Vitale G, Sarullo F, Vastarella R, Di Lorenzo A, Testa C, Parlato A, Vigorito C, Giallauria F. Oncology and Cardiac Rehabilitation: An Underrated Relationship. J Clin Med 2020; 9:E1810. [PMID: 32532011 PMCID: PMC7356735 DOI: 10.3390/jcm9061810] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023] Open
Abstract
Cancer and cardiovascular diseases are globally the leading causes of mortality and morbidity. These conditions are closely related, beyond that of sharing many risk factors. The term bidirectional relationship indicates that cardiovascular diseases increase the likelihood of getting cancer and vice versa. The biological and biochemical pathways underlying this close relationship will be analyzed. In this new overlapping scenario, physical activity and exercise are proven protective behaviors against both cardiovascular diseases and cancer. Many observational studies link an increase in physical activity to a reduction in either the development or progression of cancer, as well as to a reduction in risk in cardiovascular diseases, a non-negligible cause of death for long-term cancer survivors. Exercise is an effective tool for improving cardio-respiratory fitness, quality of life, psychological wellbeing, reducing fatigue, anxiety and depression. Finally, it can counteract the toxic effects of cancer therapy. The protection obtained from physical activity and exercise will be discussed in the various stages of the cancer continuum, from diagnosis, to adjuvant therapy, and from the metastatic phase to long-term effects. Particular attention will be paid to the shelter against chemotherapy, radiotherapy, cardiovascular risk factors or new onset cardiovascular diseases. Cardio-Oncology Rehabilitation is an exercise-based multi-component intervention, starting from the model of Cardiac Rehabilitation, with few modifications, to improve care and the prognosis of a patient's cancer. The network of professionals dedicated to Cardiac Rehabilitation is a ready-to-use resource, for implementing Cardio-Oncology Rehabilitation.
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Affiliation(s)
- E. Venturini
- Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Cecina Civil Hospital, 57023 LI Cecina, Italy
| | - G. Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (G.I.); (M.G.)
| | - A. D’Andrea
- Unit of Cardiology and Intensive Care, “Umberto I” Hospital, Viale San Francesco, Nocera Inferiore, 84014 SA, Italy; (A.D.); (M.P.)
| | - M. Pacileo
- Unit of Cardiology and Intensive Care, “Umberto I” Hospital, Viale San Francesco, Nocera Inferiore, 84014 SA, Italy; (A.D.); (M.P.)
| | - L. Tarantini
- Division of Cardiology, Ospedale San Martino ULSS1 Dolomiti, 32100 Belluno, Italy;
| | - M.L. Canale
- Department of Cardiology, Azienda USL Toscana Nord-Ovest, Ospedale Versilia, Lido di Camaiore, 55041 LU, Italy;
| | - M. Gentile
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (G.I.); (M.G.)
| | - G. Vitale
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy; (G.V.); (F.M.S.)
| | - F.M. Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy; (G.V.); (F.M.S.)
| | - R. Vastarella
- UOSD Scompenso Cardiaco e Cardiologia Riabilitativa, AORN Ospedale dei Colli-Monaldi, 80131 Naples, Italy;
| | - A. Di Lorenzo
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
| | - C. Testa
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
| | - A. Parlato
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
| | - C. Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
| | - F. Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (A.D.L.); (C.T.); (A.P.); (C.V.); (F.G.)
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Cuthbertson CC, Pearce EE, Valle CG, Evenson KR. Cardiac Rehabilitation Programs for Cancer Survivors: A Scoping Review. CURR EPIDEMIOL REP 2020; 7:89-103. [PMID: 32577336 PMCID: PMC7311091 DOI: 10.1007/s40471-020-00235-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Participation in cardiac rehabilitation is associated with improved quality of life and physical functioning and may be an effective strategy to assist in the recovery from cancer. We conducted a scoping review to identify studies that enrolled cancer survivors into cardiac rehabilitation programs. RECENT FINDINGS We identified nine studies that included 662 cancer survivors. Five studies integrated cancer survivors and cardiac patients into the same sessions, three studies developed cancer-only rehabilitation sessions, and one study did not report details on the rehabilitation sessions. On average, more than 60% of enrolled cancer survivors completed the rehabilitation programs and many health and psychosocial outcomes improved after rehabilitation. SUMMARY Cardiac rehabilitation appears to be acceptable and favorably impacts many health and psychosocial outcomes among cancer survivors. Future research should consider randomized controlled trial study designs, enrolling diverse survivor populations, and using a set of core physical function and psychosocial outcomes.
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Affiliation(s)
- Carmen C Cuthbertson
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill, NC
| | - Emily E Pearce
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill, NC
| | - Carmina G Valle
- Department of Nutrition Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill, NC
- Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill Chapel Hill, NC
| | - Kelly R Evenson
- Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill, NC
- Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill Chapel Hill, NC
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Dennett AM, Harding KE, Reed MS. The challenge of timing: a qualitative study on clinician and patient perspectives about implementing exercise-based rehabilitation in an acute cancer treatment setting. Support Care Cancer 2020; 28:6035-6043. [PMID: 32291598 DOI: 10.1007/s00520-020-05436-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/27/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Assess the barriers and facilitators to implementing an exercise-based rehabilitation program in an acute setting for cancer survivors receiving treatment. METHODS A qualitative study using individual semi-structured interviews and focus groups was completed with 25 clinicians working in oncology and 9 patients receiving cancer treatment who were purposively sampled at a tertiary hospital. Interviews were audio-recorded and transcribed verbatim with coding completed independently by two reviewers and confirmed by a third reviewer, followed by thematic analysis. RESULTS The main theme was finding the 'right time' for rehabilitation. Exercise-based rehabilitation was seen as important to deliver in the acute cancer treatment setting but challenging due to patient factors such as feeling overwhelmed and health service constraints. Barriers and facilitators to acute exercise-based rehabilitation were raised under four sub-themes: attitudes, knowledge, convenience and resources. There was agreement among both patients and clinicians around the main themes. CONCLUSION Implementing exercise-based rehabilitation in the acute cancer treatment setting is viewed as necessary but challenging to implement. Positive attitudes towards exercise-based cancer rehabilitation services from staff and patients in this study are at odds with current levels of service delivery. This study provides evidence for why this might be the case, and can be used to inform the design of future models of rehabilitation in the acute treatment setting to meet the needs of this patient group.
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Affiliation(s)
- Amy M Dennett
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
- Eastern Health Allied Health Clinical Research Office, Level 2, 5 Arnold St, Box Hill, VIC, Australia.
| | - Katherine E Harding
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Eastern Health Allied Health Clinical Research Office, Level 2, 5 Arnold St, Box Hill, VIC, Australia
| | - Melissa S Reed
- Eastern Health Allied Health Clinical Research Office, Level 2, 5 Arnold St, Box Hill, VIC, Australia
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Frankinouille R, Vanhoutte G, Stassijns G, De Coster C, Roelant E, Rasschaert M, Gielen J, Altintas S, Peeters M. EVALUATION OF A SUPERVISED PHYSICAL ACTIVITY PROGRAMME FOR CANCER SURVIVORS: FROM TREATMENT TO TRIATHLON. ACTA ACUST UNITED AC 2020; 3:1000030. [PMID: 33884132 PMCID: PMC8008719 DOI: 10.2340/20030711-1000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 11/16/2022]
Abstract
Objective It is recommended that cancer survivors incorporate physical activity into their daily lives after in-hospital rehabilitation. However, there is a lack of training programmes focusing on the specific needs of cancer survivors. TriaGO! - an 8-month intervention study of aerobic endurance training for cancer survivors - was therefore examined. The training programme aims to meet the participants' physical needs and provide socio-emotional support, in the form of an exercise programme that challenges participants to aim to compete in an Olympic- distance triathlon (1,000 m swimming, 45 km cycling, 10 km running) after 8 months' of training. Methods The TriaGO! training programme was provided to in-hospital rehabilitated cancer survivors (n = 12). Each patient invited a healthy friend or family member to train with them (a so called buddy (n = 12)). The 8-month programme involves supervised training sessions, combining cycling, swimming and running, which progress in frequency, duration and intensity. Physical health was measured at the start, 4 and 8 months, using objective parameters of aerobic fitness, muscular fitness and body composition. Results A total of 22 out of 24 participants successfully completed the training programme and the triathlon. Both the cancer survivors and their buddies showed significant improvements in physical health. Cancer survivors showed improvements in aerobic fitness, as increases in VO2max and VO2peak of 5.5 ml.kg-1.min-1 and 0.26 ml.min-1 respectively (p <0.0001). Buddies underwent similar significant increases; 5.39 ml.kg-1.min-1 and 0.18 ml.min-1, respectively. Conclusion The TriaGO! training programme introduces the concept of supervised endurance training for cancer survivors. Through measurement of ob-jective parameters, this study demonstrated that significant physical reconditioning is possible in cancer survivors. A supervised programme would be recommended for all cancer patients after in-hospital treatment, in order to facilitate the transition to incorporation of physical activity into daily life.
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Affiliation(s)
| | - Greetje Vanhoutte
- Multidisciplinary Oncological Center of Antwerp (MOCA), Antwerp, Belgium
| | - Gaëtane Stassijns
- Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Edegem, Belgium
| | - Carmen De Coster
- Multidisciplinary Oncological Center of Antwerp (MOCA), Antwerp, Belgium
| | - Ella Roelant
- StatUA Core Facility, Antwerp University, Antwerp, Belgium
| | - Marika Rasschaert
- Department S.P.O.R.T.S., Antwerp University Hospital, Edegem, Belgium
| | - Jan Gielen
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | | | - Marc Peeters
- Multidisciplinary Oncological Center of Antwerp (MOCA), Antwerp, Belgium.,Department of Oncology, Edegem, Belgium
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Gilchrist SC, Barac A, Ades PA, Alfano CM, Franklin BA, Jones LW, La Gerche A, Ligibel JA, Lopez G, Madan K, Oeffinger KC, Salamone J, Scott JM, Squires RW, Thomas RJ, Treat-Jacobson DJ, Wright JS. Cardio-Oncology Rehabilitation to Manage Cardiovascular Outcomes in Cancer Patients and Survivors: A Scientific Statement From the American Heart Association. Circulation 2020; 139:e997-e1012. [PMID: 30955352 DOI: 10.1161/cir.0000000000000679] [Citation(s) in RCA: 285] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cardiovascular disease is a competing cause of death in patients with cancer with early-stage disease. This elevated cardiovascular disease risk is thought to derive from both the direct effects of cancer therapies and the accumulation of risk factors such as hypertension, weight gain, cigarette smoking, and loss of cardiorespiratory fitness. Effective and viable strategies are needed to mitigate cardiovascular disease risk in this population; a multimodal model such as cardiac rehabilitation may be a potential solution. This statement from the American Heart Association provides an overview of the existing knowledge and rationale for the use of cardiac rehabilitation to provide structured exercise and ancillary services to cancer patients and survivors. This document introduces the concept of cardio-oncology rehabilitation, which includes identification of patients with cancer at high risk for cardiac dysfunction and a description of the cardiac rehabilitation infrastructure needed to address the unique exposures and complications related to cancer care. In this statement, we also discuss the need for future research to fully implement a multimodal model of cardiac rehabilitation for patients with cancer and to determine whether reimbursement of these services is clinically warranted.
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Coletta AM, Campbell A, Morris GS, Schmitz KH. Synergy Between Licensed Rehabilitation Professionals and Clinical Exercise Physiologists: Optimizing Patient Care for Cancer Rehabilitation. Semin Oncol Nurs 2020; 36:150975. [PMID: 32007288 DOI: 10.1016/j.soncn.2019.150975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To differentiate between rehabilitation and exercise training and propose how rehabilitation professionals and exercise physiologists can collaborate to optimize cancer survivor care. DATA SOURCE Professional organizations and peer-reviewed manuscripts. CONCLUSION Both professions offer complementary skillsets that, when integrated, optimize the ability of the cancer care team to implement more effective survivorship care plans. Future models of care must incorporate efficient communications between the cancer rehabilitation program and oncology team, include various reimbursement/payment/funding options, and continuously assess program efficacy. IMPLICATIONS FOR NURSING PRACTICE Nurses must be cognizant of physical needs (ie, functional and conditioning status) and cancer-related comorbidities when referring cancer survivors for exercise reconditioning.
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Affiliation(s)
- Adriana M Coletta
- University of Utah, Department of Health, Kinesiology and Recreation, Salt Lake City, UT; Huntsman Cancer Institute at the University of Utah, Cancer Control and Population Sciences Program, Salt Lake City, UT
| | - Anna Campbell
- Edinburgh Napier University, Sport, Exercise and Health, School of Applied Science, Edinburgh, Scotland, UK
| | | | - Kathryn H Schmitz
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA; Penn State Cancer Institute, Hershey, PA.
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Pituskin E, Kirkham AA, Cox-Kennett N, Dimitry R, Dimitry J, Paterson I, Gyenes GT. Rehabilitation Needs in Cancer Treatment-Related Cardiotoxicity. Semin Oncol Nurs 2020; 36:150986. [PMID: 31983487 DOI: 10.1016/j.soncn.2020.150986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine and summarize current international guidelines regarding cardiovascular risk reduction before and during cancer therapy, and to discuss the emerging role of cardio-oncology as a subspecialty in cancer care and the role of cardio-oncology rehabilitation. DATA SOURCES Published articles and guidelines. CONCLUSION With improvements in cancer detection and the use of novel adjuvant therapies, an increasing number of individuals now survive a cancer diagnosis. However, for some the cost is high - many survivors are now at higher risk of death from cardiovascular disease than from recurrent cancer. Cardiovascular morbidity and mortality are common and associated with common cancer therapies serially administered in adult oncology care. IMPLICATIONS FOR NURSING PRACTICE Timely risk-reduction interventions hold promise in reducing cardiovascular morbidity and mortality. Oncology nurses are the key providers to identify baseline risks, perform necessary referrals, provide individualized teaching, and support the patient within the family and community.
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Affiliation(s)
- Edith Pituskin
- Faculty of Nursing, Edmonton Clinic Health Academy (ECHA), Edmonton, AB, Canada.
| | - Amy A Kirkham
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | | | - Rebecca Dimitry
- Medical Oncology, Alberta Health Services, Edmonton, AB, Canada
| | - John Dimitry
- Medical Oncology, Alberta Health Services, Edmonton, AB, Canada
| | - Ian Paterson
- Division of Cardiology, University of Alberta, Edmonton, AB, Canada
| | - Gabor T Gyenes
- Cardiac Rehabilitation, Division of Cardiology, University of Alberta, Edmonton, AB, Canada
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35
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Brown SA. Preventive Cardio-Oncology: The Time Has Come. Front Cardiovasc Med 2020; 6:187. [PMID: 31998754 PMCID: PMC6965025 DOI: 10.3389/fcvm.2019.00187] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/10/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Sherry-Ann Brown
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
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36
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Winser SJ, Chan HTF, Ho L, Chung LS, Ching LT, Felix TKL, Kannan P. Dosage for cost-effective exercise-based falls prevention programs for older people: A systematic review of economic evaluations. Ann Phys Rehabil Med 2020; 63:69-80. [DOI: 10.1016/j.rehab.2019.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 01/23/2023]
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Outcomes of a text message, Fitbit, and coaching intervention on physical activity maintenance among cancer survivors: a randomized control pilot trial. J Cancer Surviv 2019; 14:80-88. [PMID: 31776849 DOI: 10.1007/s11764-019-00831-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/26/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE We aimed to determine the effect of a health coach, text message, and Fitbit intervention on moderate-to-vigorous physical activity (MVPA) maintenance in cancer survivors following a supervised exercise program compared to provision of a Fitbit alone. METHODS Participants were recruited during the last month of an exercise-based oncology rehabilitation program and randomly assigned to the full intervention (n = 34) or Fitbit-only control groups (n = 32). In total, 59 cancer survivors completed the program (81% female; mean age 61.4 ± 9.0). Group by time differences in accelerometer-measured MVPA was assessed using linear mixed models. Additionally, we examined mean weekly Fitbit-derived MVPA levels. RESULTS Intervention participants maintained weekly MVPA from pre- (295.7 ± 139.6) to post-intervention (322.0 ± 199.4; p = 0.37), whereas those in the Fitbit-only group had a significant decrease in MVPA (305.5 ± 181.1 pre vs 250.7 ± 166.5 post; p = 0.03, effect size 0.57). The intervention participants maintained recommended levels of MPVA for health benefits during the 8-week intervention, whereas the Fitbit-only control group did not. CONCLUSIONS The findings demonstrate that a remote intervention delivered through health coaching, text messages, and Fitbit can promote maintenance of MVPA after a structured program for cancer survivors. However, use of a Fitbit alone was not sufficient to prevent expected decline in MVPA. Additional research is warranted to examine long-term impacts and efficacy in a more diverse population of cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Use of a wearable tracker alone may not be sufficient for exercise maintenance among cancer survivors after transition to an independent program. Additional planning for relapse prevention is recommended.
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The Cardiac Rehabilitation Model Improves Fitness, Quality of Life, and Depression in Breast Cancer Survivors. J Cardiopulm Rehabil Prev 2019; 38:246-252. [PMID: 28525464 DOI: 10.1097/hcr.0000000000000256] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Exercise is a demonstrated, therapeutic strategy for cancer survivors to minimize many treatment-induced side effects and may decrease risk of recurrence. Nonetheless, structured programs that combine exercise and education are not yet standardized within cancer care. The Health, Exercise, Active Living, Therapeutic lifestyle (HEALTh) program is a clinical exercise program based on the established cardiac rehabilitation model, but customized for female breast cancer survivors. This study assessed the effects of a cardiac rehabilitation program on cardiorespiratory fitness, quality of life, and depressive symptoms in breast cancer survivors. METHODS Charts were reviewed to evaluate the cardiac rehabilitation model. The program consisted of 1 weekly supervised session for 22 group sessions. Each patient was provided with personalized aerobic and resistance exercises plus 12 group educational sessions to encourage behavioral adoption to a healthy lifestyle. Cardiorespiratory fitness (direct (Equation is included in full-text article.)O2peak), quality of life (Short Form-36 Health Status [SF-36] and Functional Assessment of Cancer Therapy-Breast [FACT-B]), and depression (Centre of Epidemiological Studies Depression [CES-D]) were assessed at baseline and after program completion. RESULTS Two hundred seventy-four files were accessed with 152 eligible files analyzed. Baseline cardiorespiratory fitness and quality-of-life values were below population norms. Program adherence was 66.6%. Cardiorespiratory fitness improved by 14% (21 ± 6 to 24 ± 7 mL/kg/min, P < .001), with significant improvements in quality of life (P < .001) and depression scores (P = .019). Bodily pain was the only domain not significantly affected (P = .311). CONCLUSION The cardiac rehabilitation model improved physical and mental health in breast cancer survivors. These results provide support for the collaborative effort between cardiology and oncology to improve patient care across the cancer care continuum.
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ReActivate—A Goal-Orientated Rehabilitation Program for Adolescent and Young Adult Cancer Survivors. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Female cancer survivor perspectives on remote intervention components to support physical activity maintenance. Support Care Cancer 2019; 28:2185-2194. [PMID: 31422476 DOI: 10.1007/s00520-019-05038-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/08/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE Physical activity minimizes the side effects of cancer; yet, participation rates among cancer survivors are low. Technological innovations are promoted as efficient means for communication and remote monitoring, but little is known about acceptability among female cancer survivors. The purpose of this study was to examine female cancer survivor perspectives on remote monitoring and communication to support independent, physical activity maintenance after completing a structured, facility-based program. METHODS Participants were 19 female cancer survivors (mean age 56.3) recruited after completing a 12-week exercise-based oncology rehabilitation program. Semi-structured interviews were conducted with participants following a 4-week pilot trial of a tailored text message, FitBit®, and health coach intervention to support independent physical activity maintenance. All interviews were audio-recorded and transcribed. Transcripts from the interviews were iteratively coded by two team members using a thematic analysis. RESULTS Participants reported acceptance and satisfaction with remote monitoring and communication. Emergent themes related to technology-based support for physical activity maintenance included the following: (1) accountability to a remote partner; (2) plan Bs, planning for barriers; (3) the habit cycle; (4) convenience through technology; and (5) reclaiming health ownership following a cancer diagnosis. CONCLUSIONS Participants attributed physical activity maintenance to accountability enabled by technology. Communication based on remote monitoring was perceived as encouraging and not intrusive, during the transition to a home program. IMPLICATIONS FOR CANCER SURVIVORS This study highlights the importance of accountability and support for physical activity adherence and the positive role that technology can provide for female cancer survivors to regain control of health management.
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Tsai E, Mouhayar E, Lenihan D, Song J, Durand JB, Fadol A, Massey M, Harrison C, Basen-Engquist K. Feasibility and Outcomes of an Exercise Intervention for Chemotherapy-Induced Heart Failure. J Cardiopulm Rehabil Prev 2019; 39:199-203. [PMID: 31022003 PMCID: PMC6492623 DOI: 10.1097/hcr.0000000000000388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE Cancer treatment-related heart failure (HF) is an emerging health concern, as the number of survivors is increasing rapidly, and cardiac health issues are a leading cause of mortality in this population. While there is general evidence for the efficacy of exercise rehabilitation interventions, more research is needed on exercise rehabilitation interventions for patients specifically with treatment-induced HF and whether such interventions are safe and well-accepted. This study provides feasibility and health outcomes of a pilot exercise intervention for cancer survivors with chemotherapy-induced HF. METHODS Twenty-five participants were randomized to a clinic-based exercise intervention or a wait-list control group or, alternatively, allowed to enroll in a home-based exercise intervention if they declined the randomized study. For purposes of analysis, both types of exercise programs were combined into a single intervention group. Repeated-measures analysis of variance was conducted to assess for significant time and treatment group main effects separately and time × treatment group interaction effects. RESULTS Significant improvements in maximum oxygen uptake ((Equation is included in full-text article.)O2max) were observed in the intervention group. Intervention satisfaction and adherence were high for both clinic- and home-based interventions, with no reported serious adverse events. Enrollment was initially low for the clinic-based intervention, necessitating the addition of the home-based program as an intervention alternative. CONCLUSIONS Results suggest that exercise rehabilitation interventions are feasible in terms of safety, retention, and satisfaction and have the potential to improve (Equation is included in full-text article.)O2max. To maximize adherence and benefits while minimizing participant burden, an ideal intervention may incorporate elements of both clinic-based supervised exercise sessions and a home-based program.
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Affiliation(s)
- Edward Tsai
- Department of Health Promotion & Behavioral Science, The University of Texas School of Public Health, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elie Mouhayar
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel Lenihan
- Cardiovascular Division, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Jaejoon Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Bernard Durand
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anecita Fadol
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mona Massey
- Clinical Research Support Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carol Harrison
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Breast Cancer and Cardiovascular Disease: Defining the Role of Physical Therapists. REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Mortality from colorectal cancer has been declining over the past 20 years due to improvements in screening and treatment. Physical activity improves patient quality of life, slows functional decline, and reduces all-cause mortality. Although some patients may have difficulty participating in physical activity, clinicians should always try to incorporate exercise into a management plan for patients who have survived colorectal cancer.
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Berkman AM, Gilchrist SC. Behavioral Change Strategies to Improve Physical Activity After Cancer Treatment. REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Does Cardiac Rehabilitation Have a Role in Providing Comprehensive Oncology Rehabilitation? Yes, But... REHABILITATION ONCOLOGY 2018. [DOI: 10.1097/01.reo.0000000000000133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Foley MP, Hasson SM, Kendall E. Effects of a Translational Community-Based Multimodal Exercise Program on Quality of Life and the Influence of Start Delay on Physical Function and Quality of Life in Breast Cancer Survivors: A Pilot Study. Integr Cancer Ther 2018; 17:337-349. [PMID: 28929821 PMCID: PMC6041921 DOI: 10.1177/1534735417731514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/06/2017] [Accepted: 08/12/2017] [Indexed: 12/20/2022] Open
Abstract
The purpose of this investigation was 2-fold: (1) to investigate the effects of a translational 12-week community-based multimodal exercise program on quality of life (QoL) in breast cancer survivors (BCS) and (2) to examine the influence of a start delay on physical function and QoL in BCS. Fifty-two female BCS completed a 12-week program consisting of 90-minute supervised exercise sessions at a frequency of 2 supervised sessions per week. Exercise sessions consisted of three 30-minute components: (1) aerobic conditioning, (2) resistance exercise training, and (3) balance and flexibility training. Significant ( P < .05) improvements in QoL were identified post-program completion. Cohort stratification comparison between the early start (<1 year since completion of oncologic treatment) and late start (>1 year since completion of oncologic treatment) revealed no significant ( P > .05) differences between the early start and late start groups on improvements in physical function. Regarding the influence of start delay on QoL, the early start group showed significant ( P < .05) improvement in emotional well-being. No other significant differences in improvement in QoL were detected between the early start and late start groups. Regardless of start delay, meaningful improvements in physical function and QoL were found after completing the community-based multimodal exercise program. Early participation in community-based exercise programming may benefit BCS' emotional well-being compared to later participation.
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Wirtz P, Baumann FT. Physical Activity, Exercise and Breast Cancer - What Is the Evidence for Rehabilitation, Aftercare, and Survival? A Review. Breast Care (Basel) 2018; 13:93-101. [PMID: 29887785 DOI: 10.1159/000488717] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The current scientific field of exercise interventions in breast cancer is very large. Rehabilitation focuses on restoring or improving quality of life and thus on independence and participation in life. Hence, it is important to investigate exercise interventions in the setting of rehabilitation and aftercare. It is also necessary to determine the influence of physical activity or exercise therapy on the prevention of recurrence and mortality as well as on certain side effects of the disease and its medical treatment in rehabilitation. Physical activity in rehabilitation and aftercare is feasible and safe and can be used for various purposes. Against the background of reduced fatigue, chemotherapy-induced peripheral neuropathy, cancer-related cognitive impairment, arthralgia, lymphedema, recurrence, and mortality, as well as improved quality of life, different methodological approaches and evidence can be seen. Although the overall data availability has increased, there are gaps in study documentation as well as inadequate verification of scientific approaches in rehabilitation clinics and in everyday life.
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Affiliation(s)
- Petra Wirtz
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany.,German Sport University Cologne, Cologne, Germany
| | - Freerk T Baumann
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
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48
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The role of physical activity in breast and gynecologic cancer survivorship. Gynecol Oncol 2018; 149:198-204. [DOI: 10.1016/j.ygyno.2018.01.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 12/14/2022]
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49
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Dittus KL, Gramling RE, Ades PA. Exercise interventions for individuals with advanced cancer: A systematic review. Prev Med 2017; 104:124-132. [PMID: 28716654 DOI: 10.1016/j.ypmed.2017.07.015] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 07/11/2017] [Accepted: 07/13/2017] [Indexed: 01/24/2023]
Abstract
Despite improvements in therapy a large proportion of individuals with cancer will have a shortened life expectancy because of advanced or metastatic disease. Advances in therapy have however, extended life in those with advanced cancer thus heightening the importance of living well and preventing decline. The burdens of disease and cancer therapy impair aerobic fitness, strength, physical function and quality of life (QOL). Fatigue, the most common side effect of cancer and cancer therapy can further deteriorate QOL. Exercise has the potential to improve aerobic fitness, physical function, control fatigue and enhance QOL. However, exercise interventions are not routinely provided to those with advanced cancer. We present a systematic literature review of outcomes from interventions that include exercise for patients with advanced cancer. Studies were reviewed if they included an advanced cancer population and an intervention with a component of exercise. Overall, exercise containing interventions resulted in improvements in measures of aerobic capacity (14 of 19 studies) strength (11 of 12 studies), and components of physical function (9 of 9 studies). Fatigue and QOL were identified to improve in slightly over half of all evaluated studies (11 of 19 studies and 10 of 19 studies for fatigue and QOL respectively). The numbers of total participants reporting improvements in QOL (60%) were greater than fatigue (45%). Exercise provided to individuals with advanced cancer maintains or improves fitness and physical function and may diminish fatigue and enhance QOL and should be considered as an intervention to prevent further health complications.
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Affiliation(s)
- Kim L Dittus
- Department of Internal Medicine, Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, United States.
| | - Robert E Gramling
- Palliative Medicine, University of Vermont Larner College of Medicine, United States
| | - Philip A Ades
- Department of Internal Medicine, Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, United States
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Integrating Rehabilitation Into the Cancer Care Continuum. PM R 2017; 9:S291-S296. [DOI: 10.1016/j.pmrj.2017.07.075] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 11/22/2022]
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