Exercise Therapy and Cardiovascular Toxicity in Cancer
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The authors discuss the tolerability and efficacy of exercise for adult patients with cancer treatment–induced cardiac dysfunction, which predisposes to increased cardiovascular mortality at a young age. Although evidence is limited in cancer patients, there is evidence supporting the efficacy of exercise in other clinical populations.
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Further research is needed to facilitate personalized risk assessment and to allow the development of targeted exercise prescriptions to effectively prevent or manage cardiotoxicity in this population.
abstract
This abstract is available on the publisher's site.
Access this abstract nowCardio-oncology is an emerging discipline focused predominantly on the detection and management of cancer treatment-induced cardiac dysfunction (cardiotoxicity), which predisposes to development of overt heart failure or coronary artery disease. The direct adverse consequences, as well as those secondary to anticancer therapeutics, extend beyond the heart, however, to affect the entire cardiovascular-skeletal muscle axis (ie, whole-organism cardiovascular toxicity). The global nature of impairment creates a strong rationale for treatment strategies that augment or preserve global cardiovascular reserve capacity. In noncancer clinical populations, exercise training is an established therapy to improve cardiovascular reserve capacity, leading to concomitant reductions in cardiovascular morbidity and its attendant symptoms. Here, we overview the tolerability and efficacy of exercise on cardiovascular toxicity in adult patients with cancer. We also propose a conceptual research framework to facilitate personalized risk assessment and the development of targeted exercise prescriptions to optimally prevent or manage cardiovascular toxicity after a cancer diagnosis.
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Exercise Therapy and Cardiovascular Toxicity in Cancer
Circulation 2018 Mar 13;137(11)1176-1191, JM Scott, TS Nilsen, D Gupta, LW JonesFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Cancer and your heart
The diagnosis of cancer is already hard enough, and the ensuing chemotherapy and/or radiation take a significant toll on the body. Thankfully, the survival rates are improving; but, as our patients live longer, they now have to face the wrath of cardiovascular disease.
Back in 1968, it was already known that anthracycline-containing chemotherapies could cause arrhythmias, heart failure, and sudden cardiac death in adults with leukemia. But at that time the main concern was saving the patient and the cardiovascular system was of secondary concern.
Over the years, there have been studies on the effects of cancer therapies on cardiorespiratory fitness (CRF). Normal people lose approximately 10% CRF every 10 years. Reduction in CRF has been associated with an increase in mortality. Chemotherapy has been shown to reduce CRF by as much as 26%. This means that cancer patients have a very rapid loss in CRF.
This makes sense because cancer therapies are designed to kill cells, so healthy cells also get hit hard. The anthracycline-containing chemotherapy causes an increase in cellular senescence markers, which basically means that the cells are aging rapidly. But the concerning thing is that these markers stayed elevated for up to 12 months after the breast cancer treatments stopped. This is equivalent to 14 years of aging.
The problem is that we do not have very good studies to figure out how to combat this aging. What types of exercise should these patients do? What types of medications should we be using after the chemotherapy? What can we give before the chemotherapy to protect the heart and other tissues? These are the types of questions that need to be answered so that we can look after the millions of post–cancer care patients.
The authors did suggest some algorithms as to how to screen and how to tailor an exercise and preventative plan for our patients. But nothing is based on solid research yet, so this is an area that needs much more research.
I guess the good news is that, at least in the war against cancer, we are winning because we now have so many survivors who live long enough that we now need deal with their cardiovascular complications. So, if cancer did not get them, then we better make sure that their heart will not get them either. Let us all pay more attention to the innocent bystander in cancer therapy – the cardiovascular system.