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Top Things to Know:
Cardio-Oncology Rehabilitation to Manage Cardiovascular Outcomes in Cancer Patients and Survivors

  1. There are more than 16.7 million cancer survivors in the United States today and many of these people are at increased risk of morbidity and mortality from noncancer causes, predominately cardiovascular disease (CVD).
  2. This American Heart Association scientific statement introduces the concept of cardio-oncology rehabilitation which includes providing structured exercise and other services to cancer patients and survivors.
  3. The elevated risk of CVD in cancer survivors is likely from normal age-related co-morbidities along with the direct (e.g. radiation, chemotherapy, targeted therapy, etc.) and indirect (e.g. deconditioning, weight gain etc.) effects of cancer therapy that cross multiple systems.
  4. The rationale for Cardiac Rehabilitation for Patients with Cancer: Cardiovascular toxicity in cancer survivors has focused mainly on the detection and management of cardiac dysfunction (e.g. reduced left ventricle ejection fraction - LVEF) which can cause the development of overt heart failure (HF). The direct and indirect adverse effects of anticancer therapies extend beyond the heart to affect the entire CV-skeletal muscle axis.
  5. This statement outlines how to identify patients with cancer for cardiac rehabilitation.
  6. This paper presents a targeted approach to identifying patients with cancer who are expected to derive the greatest benefit to cardiac rehabilitation (CR). Rehabilitation in this setting is described as cardio-oncology rehabilitation or CORE.
  7. The CORE Components of CORE are: patient assessment, nutrition counseling, weight management, blood pressure management, lipid/lipoprotein management, diabetes management, tobacco cessation, psychosocial management, physical activity counseling, and exercise training.
  8. A CORE algorithm for patients with cancer is discussed in detail in this statement. It includes delineating the exposure from cancer therapeutics, addresses symptoms that are related to these therapeutics, who should be consulted for developing a plan and finalizing the plan a rehabilitation intervention.
  9. In patients who are eligible for CORE, cardiopulmonary (CP) safety should be assessed using a CP safety checklist. This checklist includes areas that should be addressed prior to exercise training. Areas included in this checklist are:  normal testing requirements, persons with no baseline symptoms, identification of cancer complications and the persons knowledge associated with exercise training.
  10. This statement offers a comprehensive look at rehabilitation in the setting of cancer patients with CVD risk factors.  It outlines the multidisciplinary, organized approach helping address the multiorgan issues that occur in this setting.  CR programs across the country should develop an infrastructure to provide services that align with the unique exposures that these patients face.

Citation

Gilchrist SC, Barac A, Ades PA, Alfano C, Franklin BA, Jones LW, La Gerche A, Ligibel J, Gabriel Lopez G, Madan K, Oeffinger KC, Salamone J, Scott JM, Squires RW, Thomas RJ, Treat-Jacobson DJ, Wright JS; on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Secondary Prevention Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Council on Peripheral Vascular Disease. Cardio-oncology rehabilitation to manage cardiovascular outcomes in cancer patients and survivors: a scientific statement from the American Heart Association [published online ahead of print April 8, 2019]. Circulation. doi: 10.1161/CIR.0000000000000679.