Purpose Cardiac dysfunction is a serious adverse effect of certain cancer-directed therapies that can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers. Methods Recommendations were developed by an expert panel with multidisciplinary representation using a systematic review (1996 to 2016) of meta-analyses, randomized clinical trials, observational studies, and clinical experience. Study quality was assessed using established methods, per study design. The guideline recommendations were crafted in part using the Guidelines Into Decision Support methodology. Results A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations. The strength of the recommendations in these guidelines is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. Recommendations It is important for health care providers to initiate the discussion regarding the potential for cardiac dysfunction in individuals in whom the risk is sufficiently high before beginning therapy. Certain higher risk populations of survivors of cancer may benefit from prevention and screening strategies implemented during cancer-directed therapies. Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy. For certain higher risk survivors of cancer, routine surveillance with cardiac imaging may be warranted after completion of cancer-directed therapy, so that appropriate interventions can be initiated to halt or even reverse the progression of cardiac dysfunction.

Resistance exercise reduces fatigue and improves quality of life and muscular fitness in men with prostate cancer receiving androgen deprivation therapy. This form of exercise can be an important component of supportive care for these patients.

Exercise training had beneficial effects on cardiopulmonary function and QOL in postmenopausal breast cancer survivors.

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We conducted a randomized controlled trial to determine the effects of a home-based exercise intervention on change in quality of life (QOL) in recently resected colorectal cancer survivors, most of whom were receiving adjuvant therapy. Participants were randomly assigned in a 2:1 ratio to either an exercise (n = 69) or control (n = 33) group. The exercise group was asked to perform moderate intensity exercise 3-5 times per week for 20-30 min each time. The primary outcome was change in QOL as measured by the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale. Adherence in the exercise group was good (75.8%) but contamination in the control group was problematic (51.6%). Intention-to-treat analysis revealed no significant differences between groups for change in the FACT-C (mean difference, -1.3; 95% CI, -7.8 to 5.1; P = 0.679). In an 'on-treatment' ancillary analysis, we compared participants who decreased versus increased their cardiovascular fitness over the course of the intervention. This analysis revealed significant differences in favour of the increased fitness group for the FACT-C (mean difference, 6.5; 95% CI, 0.4-12.6; P = 0.038). These data suggest that increased cardiovascular fitness is associated with improvements in QOL in colorectal cancer survivors but better controlled trials are needed.

A B S T R A C T PurposeTo evaluate cardiopulmonary function (as measured by peak oxygen consumption [VO 2peak ]) across the breast cancer continuum and its prognostic significance in women with metastatic disease. Patients and MethodsPatients with breast cancer representing four cross-sectional cohorts-that is, (1) before, (2) during, and (3) after adjuvant therapy for nonmetastatic disease, and (4) during therapy in metastatic disease-were studied. A cardiopulmonary exercise test (CPET) with expired gas analysis was used to assess VO 2peak . A Cox proportional hazards model was used to estimate the risk of death according to VO 2peak category (Ͻ 15.4 v Ն 15.4 mL ⅐ kg Ϫ1 ⅐ min Ϫ1 ) with adjustment for clinical factors. ResultsA total of 248 women (age, 55 Ϯ 8 years) completed a CPET. Mean VO 2peak was 17.8 Ϯ a standard deviation of 4.3 mL ⅐ kg Ϫ1 ⅐ min Ϫ1 , the equivalent of 27% Ϯ 17% below age-matched healthy sedentary women. For the entire cohort, 32% had a VO 2peak less than 15.4 mL ⅐ kg Ϫ1 ⅐ min Ϫ1 -the VO 2peak required for functional independence. VO 2peak was significantly different across breast cancer cohorts for relative (mL ⅐ kg Ϫ1 ⅐ min Ϫ1 ) and absolute (L ⅐ min Ϫ1 ) VO 2peak (P ϭ .017 and P Ͻ .001, respectively); VO 2peak was lowest in women with metastatic disease. In patients with metastatic disease (n ϭ 52), compared with patients achieving a VO 2peak Յ 1.09 L ⅐ min Ϫ1 , the adjusted hazard ratio for death was 0.32 (95% CI, 0.16 to 0.67, P ϭ .002) for a VO 2peak more than 1.09 L ⅐ min Ϫ1 . ConclusionPatients with breast cancer have marked impairment in VO 2peak across the entire survivorship continuum. VO 2peak may be an independent predictor of survival in metastatic disease.

The results of this study indicate that cancer survivors have unique and varied exercise counseling and programming preferences. Fifty-six percent of cancer survivors preferred to exercise at moderate intensity rather than at high intensity. Moderate-intensity exercise has been shown previously to be relatively safe even for cancer survivors who are advanced in age. The key to success for inactive cancer survivors may be to provide reassurance that exercise is a safe and beneficial modality for cancer survivors and to prescribe an exercise program that builds their confidence by slowly increasing the level of exercise intensity.