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.

Keywords: AHA Scientific Statements; cancer; cardiac rehabilitation; cardiovascular diseases.

Figure 1.. Cardio-oncology rehabilitation (CORE) algorithm for patients with cancer.

Risk factors (RFs) include hypertension, dyslipidemia, diabetes mellitus, smoking, and obesity. CABG indicates coronary artery bypass graft; CV, cardiovascular; dx, diagnosis; Hx, history; LVEF, left ventricular ejection fraction; MI, myocardial infarction; OT, occupational therapy; PCI, percutaneous coronary intervention; and PT, physical therapy. *High-dose anthracycline (eg, doxorubicin ≥250 mg/m²); high-dose radiotherapy (RT; ≥30 Gy) where the heart is in the treatment field; or lower-dose anthracycline + lower-dose RT (<30 Gy). ** Other therapies should be reviewed by treating healthcare provider to determine appropriateness for community-based program vs need for consultation or other testing.

Figure 2.

Potential benefits that exercise training may confer to patients with cancer at heightened risk for cardiovascular (CV) disease. QOL indicates quality of life.

Figure 3.

Key strategies and activities of home-based cardiac rehabilitation (CR) services.