Oncology and Cardiac Rehabilitation: An Underrated Relationship

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.

Cardiac rehabilitation and its essential role in the secondary prevention of cardiovascular diseases

“…Cancer patients often suffer from cardiovascular complications of treatment and increased cardiovascular risk. The most common factors are reduced CRF, muscle atrophy, hypertension, and smoking[ 182 , 183 ]. Furthermore, the adverse effects of treatment are associated with cardiac dysfunction due to cardiovascular toxicity[ 183 ].…”

“…Furthermore, the adverse effects of treatment are associated with cardiac dysfunction due to cardiovascular toxicity[ 183 ]. Prevention and mitigation of these factors are essential, and a comprehensive CR model can offer such an approach[ 182 ].…”

“…Physical activity is a significant component in cardiovascular prevention and clinical manifestations of cardiotoxicity[ 182 , 183 ]. According to the AHA[ 183 ], an individual, tailor-made exercise program is needed for oncology patients.…”

“…Recent studies showed reduced development of cancer progression as well as a reduction in cardiovascular risk following the introduction of a physical exercise[ 182 , 183 ]. Evidence suggested that cancer patients participating in an oncology rehabilitation program had experience improving psychological and physiological parameters[ 185 ].…”

“…The CR model's use provides a very suitable approach to bring rehabilitation to a larger oncology population of survivors[ 182 , 185 ]. However, ensuring routine cardio-oncological rehabilitation is likely to require modifications to current models[ 184 ].…”