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Cardio-Oncology Rehabilitation
I had to figure out my own cardio-oncology rehabilitation program. My diagnosis of a blood cancer called multiple myeloma in early 1994 led to the standard-of-care, FDA approved, safe and effective, treatment plan for newly diagnosed myeloma patients in 1995.
Specifically-
- Induction therapy-
- High-dose cytoxan/cyclophophomide therapy-
- An Autologous stem cell transplant-
I had a baseline echocardiogram before my ASCT but the cardiologist gave the “all clear.” I developed chemotherapy-induced cardiomyopathy in December of 2010. I experienced a couple of bouts with atrial fibrillation in the years preceding my diagnosis of chemo-induced cardiomyopathy but what I experienced in December of 2010 was chronic Afib aka Afib 24/7.
All to say that there was no formal cardio-oncology rehabilitation of any kind in my experience as a cancer survivor from my diagnosis in 1994 through my diagnosis of chemo-induced cardiomyopathy in 2010.
The article linked and excerpted below states what current cancer patients should do if-
- they undergo any number of cardiotoxic chemotherapy regimens-
- they have pre-existing heart issues aka heart damage is a co-morbility-
What is the current meaning of cardio-oncology rehabilitation?
Cardio-oncology rehabilitation is a specialized branch of rehabilitation medicine that focuses on the cardiovascular health of individuals who have undergone or are undergoing cancer treatment. Cancer treatments, such as chemotherapy and radiation therapy, can have significant effects on the cardiovascular system, leading to various cardiac issues. Cardio-oncology rehabilitation aims to address these issues and improve the overall cardiovascular well-being of cancer survivors.
Key components of cardio-oncology rehabilitation may include:
- Assessment: A thorough assessment of the patient’s cardiovascular health, taking into account their medical history, cancer treatment details, and any pre-existing cardiovascular conditions.
- Exercise Programs: Tailored exercise programs designed to improve cardiovascular fitness and function. These programs may include aerobic exercises, strength training, and flexibility exercises. The intensity and type of exercise will depend on the individual’s overall health and specific cardiovascular concerns.
- Monitoring: Continuous monitoring of cardiovascular health during and after cancer treatment to detect any signs of cardiotoxicity or other cardiovascular issues. This may involve regular screenings, imaging studies, and other diagnostic tests.
- Education: Providing patients with information and education about the potential cardiovascular risks associated with cancer treatments, as well as strategies to mitigate these risks. This can include lifestyle modifications, dietary recommendations, and guidance on managing stress.
- Collaboration with Oncology Teams: Close collaboration between cardio-oncology rehabilitation specialists and oncology teams to ensure comprehensive care for cancer patients. This may involve regular communication to coordinate treatment plans and address any emerging cardiovascular concerns.
- Psychosocial Support: Recognizing and addressing the psychological and emotional aspects of cancer survivorship. Coping with cancer and its treatments can be challenging, and providing support for mental health is an essential aspect of comprehensive care.
As you might be able to hear from my introduction at the beginning of this post, I am a bit cynical about conventional oncology’s efforts at cardio-oncology rehabilitation.
I would add a few evidence-based, non-conventional therapies to the cancer patient who wants to protect his/her heart.
- Moderate daily exercise before, during and after cancer therapy
- Heart-healthy nutrition before, during and after cancer therapy
- Heart-healthy supplementation before, during and after therapy
Please don’t misunderstand me. I think it is a good thing that conventional oncology has developed this program. Chemo-induced heart damage is a serious problems for cancer survivors.
My point is two fold. First and foremost, the FDA and conventional oncology is a lousy job of managing cancer patient’s heart function throughout history.
Secondly, that conventional oncology refuses to acknowledge any therapy that is not FDA approved (nutrition, supplementation, lifestyle, etc.). So I am adding my research and experience to the practice of cardio-oncology rehabilitation.
Have you been diagnosed with cancer? Do you have heart issues currently? Are you about to undergo cardio-toxic chemotherapy regimens?
Let me know- David.PeopleBeatingCancer@gmail.com
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Introduction to Cardio-Oncology
“Cardio-oncology is neither the science nor the practice of treating heart tumors, rather an emerging multidisciplinary field that focuses on the cardiovascular management (prevention, diagnosis and treatment) of patients with cancer.
The core objective of the cardio-oncology discipline is to ensure that “the cancer patient of today does not become the heart patient of tomorrow…”
Treating Cancer Survivors at Increased Cardiovascular Risk
“The results of the CORE trial, a prospective, randomized clinical trial, showed that a cardio-oncology rehabilitation model for cancer survivors at high cardiovascular risk (or those who received cardiotoxic cancer treatments) led to greater improvements in peak oxygen consumption (peak VO2) in comparison with usual care that encompassed an exercise intervention in a community setting. Clinical rehabilitation also showed superior results in exercise compliance, cardiovascular risk factor control, quality of life, and health literacy…
In 2019, the American Heart Association recommended that cardio-oncology rehabilitation programs for cancer survivors be based on structured physical activity and on adopting healthy lifestyle habits…
CORE Trial Methodology
The objective of the CORE trial was to assess whether a center-based cardiac rehabilitation (CBCR), in comparison with usual care that encompassed community-based exercise training (CBET), was superior for cardiorespiratory fitness improvement and cardiovascular risk factor control among cancer survivors at high cardiovascular risk…
The powered primary efficacy measure was change in peak VO2 at 2 months. Secondary outcomes included
- hand grip maximal strength,
- functional performance,
- blood pressure (BP),
- body composition,
- body mass index (BMI),
- lipid profile,
- plasma biomarker level,
- physical activity (PA) level,
- psychological distress,
- quality of life, and
- health literacy…”
Implications for Practice
According to the authors, “It is important to note that exercise adherence seems to have influenced the differences in peak VO2 and the lipid profile…
The trial also corroborates an already well-established paradigm in medicine: that behavioral changes made with the support of a specialized multidisciplinary team are essential to the long-term follow-up of patients with complex diseases such as cardiovascular diseases and cancer…”