Cardio-Oncology Rehabilitation to Manage Cardiovascular Outcomes in Cancer Patients and Survivors: A Scientific Statement From the American Heart Association

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.

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

“…The following sections give information on specific clinical conditions. All 'general' core components presented in Table 1 25,26 maintain validity in each clinical condition, if not modulated and re-adapted in specific tables.…”

“…153 Moreover, cancer survivors have an increased risk of relapses, second cancers, cardiovascular diseases, fatigue, bone loss and psychosocial distress, all conditions in which structured exercise training has documented beneficial effects. 154 For these reasons, active cancer patients and cancer survivors referred to cardiac rehabilitation programmes (independently from the cardiovascular diagnosis for referral) should receive appropriate exercise programmes in a multidisciplinary approach (see Gilchrist et al 25 for detailed prescription, which is outside the scope of the present position paper). As a form of general advice, endurance training can sometimes be difficult to sustain for frail and debilitated cancer patients.…”

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors

“…Hopefully, appropriate and safe increases in physical activity will decrease survivors' cardiovascular risk [129,140]. A recent Scientific Statement from the American Heart Association promotes the use of cardiac rehabilitation to provide structured exercise to cancer patients and survivors [141]. This AHA Scientific Statement also discusses the need for research to fully develop and implement a multimodal model of the cardio-oncology rehabilitation.…”

Strategies to Prevent Cardiovascular Toxicity in Breast Cancer: Is It Ready for Primetime?

“…Furthermore, there is data suggesting those who start physical activity after a diagnosis of breast cancer have a lower risk of death in general (HR 0.33 (95% CI 0.15-0.73; p = 0.046)) [68]. Thus, the findings of these studies have prompted the American Heart Association (AHA) to recommend physical activity as an individualized cardiac rehabilitation intervention for those most at risk of developing cardiotoxicity [69] and the European Society for Medical Oncology (ESMO) to recommend exercise for all cancer survivors [27]. However, further large-scale inquiry is warranted to determine specific exercise recommendations based on population and risk stratification.…”