1. The CORE study showed that a cardio-oncology rehabilitation program showed clinically meaningful improvements in peak oxygen consumption in cancer survivors at significant cardiovascular risk compared with community-based exercise training (CBET).
2. The centre-based cardiac rehabilitation (CBCR) framework group also demonstrated superior improvements in quality of life (QOL), exercise adherence, health literacy, and cardiovascular risk factor (CVRF) control.
Level of Evidence Rating: 1 (Excellent)
Summary of the Study: Cancer survivors face increased risk for non-cancer-related health problems, especially cardiovascular disease, due to factors such as aging, cancer treatments, and cardiovascular side effects. It is important to address cardiorespiratory fitness and control CVRFs in this population. Exercise training is recommended for patients with cardiovascular diseases (CVD), and a new multidimensional model based on cardiac rehabilitation has been proposed for cancer patients. While physical exercise is a known strategy to improve cardiorespiratory fitness in cancer survivors, the effects of a comprehensive rehabilitation approach on individuals with pre-existing cardiovascular disease or those exposed to potentially cardiotoxic cancer treatments remain unclear. Therefore, the CORE study, a randomized clinical trial, was designed to evaluate the effect of a center-based cardiac rehabilitation program (CBCR) compared with usual care that included community-based exercise for high cardiovascular risk cancer survivors. This study found that cancer survivors at high cardiovascular risk experienced greater improvements in peak oxygen consumption (VO2).2) while participating in a cardio-oncology rehabilitation model compared with individuals receiving standard care that included a community-based exercise intervention. A limitation of this study is the small sample size, which reduces the strength of the findings and their applicability to a broader population. Overall, the results highlight that combining a cardio-oncology program with cardiac rehabilitation infrastructure can optimize the benefits of exercise and lifestyle improvements for patients with complex health needs and underscore the importance of policy makers and healthcare providers to consider the inclusion of standard care with adequate coverage. .
Click to read the study in JAMA Cardiology
Click to read the editorial in JAMA Cardiology
Related Reading: Cardiovascular Risk Factors Are Associated with Future Cancer
in depth [randomized controlled trial]: This study was a prospective, single-center, randomized clinical trial (CORE study) conducted between March 1, 2022 and March 31, 2022, with a total of 75 adult participants exposed to cardiotoxic cancer therapy and/or cancer survivors. or previous cardiovascular disease. The study had a parallel 2-arm cohort design to investigate whether a two-month medically supervised cardio-oncology rehabilitation program would lead to improved cardiorespiratory fitness, better control of cardiovascular risk factors, improved quality of life, and increased health literacy in patients at high cardiovascular risk. Comparison of cancer survivors with standard care including CBET. Cancer survivors in the CBCR group received comprehensive outpatient cardiac rehabilitation as part of their standard care regimen, including exercise sessions led by physical therapists, dynamic resistance exercises, nutritional guidance, psychological support, and health education focused on cardiovascular risk factor management. Within the CBET group, participants received nutritional and psychosocial support based on their physician’s assessment and standard of care, as well as two weekly exercise sessions conducted by a certified exercise physiologist at a community-based facility with training intensity matching that of the CBCR group. The primary outcome was cardiorespiratory fitness measured by change in peak VO.2 Secondary measures such as muscle strength, cardiovascular risk factors, inflammatory markers, quality of life, and health literacy were all assessed over two days at the beginning and end of the 8-week intervention in hospital facilities using cardiopulmonary exercise testing from baseline to 8 weeks. non-consecutive days.
Peak VO in the CBCR group2 increased by mean (SD) 2.1 (2.8) mL/kg/min (P. < 0.01), whereas in the CBET group the increase was 0.8 (2.5) mL/kg/min (P. = 0.07), resulting in 1.3 mL/kg/min (95% CI, 0.1-2.6 mL/kg/min; P. = 0.03) between the two groups. There was also greater improvement in CVRF control with the CBCR group. Compared with the CBET group, participants in the CBCR group had greater systolic (average) [SD] changes, −12.3 [11.8] mmHg vs. −1.9 [12.9] mmHg; P. < 0.001) and diastolic (average [SD] change, −5.0 [5.7] mmHg vs. −0.5 [7.0] mmHg; P. = 0.003) blood pressure, heart rate, body composition (weight, BMI) [mean (SD) change, −1.2 (0.9) vs. 0.2 (0.7); P < 0.001), lean and fat body mass, waist and hip circumference, daily physical activity (mean [SD] increase, 1035.2 [735.7] metabolic equivalents [METs]/min/week etc. 34.1 [424.4] MET/min/week; P. < 0.001) and total cholesterol, triglyceride and low-density lipoprotein cholesterol levels. Superior results were also obtained in quality of life, health literacy and exercise compliance.
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