Exercise and Cardio-Oncology Programs Address Heart and Cognitive Risks in Cancer Treatment
New research shows home-based exercise reduces cognitive impairment during chemotherapy, while cardio-oncology programs monitor and minimize heart complications from cancer treatments that pose cardiovascular risks to survivors.
A six-week home-based individually tailored exercise intervention may reduce cancer-related cognitive impairment and mental fatigue for patients scheduled to start chemotherapy, according to a study published online March 12 in the Journal of the National Comprehensive Cancer Network. The study examined the effects of the Exercise for Cancer Patients (EXCAP) program on cognitive impairment and mental fatigue in 687 patients diagnosed with any cancer type and scheduled to start chemotherapy.
Participants were randomly assigned to EXCAP or usual care (354 and 333 individuals, respectively). Cognitive impairment and mental fatigue were assessed using the Functional Assessment of Cancer Therapy-Cognitive Function and the Multidimensional Fatigue Symptom Inventory.
EXCAP participants undergoing chemotherapy on two-week cycles reported less overall cognitive impairment, less perceived cognitive impairment, fewer comments from others identifying cognitive impairment, and less mental fatigue compared with participants receiving usual care (mean differences, 7.0, 4.1, 0.6, and −1.6, respectively). Regardless of chemotherapy cycle duration, all EXCAP participants reported less mental fatigue than those receiving usual care (−0.7). In participants receiving chemotherapy, there was an association seen for suppressed inflammatory responses with cancer-related cognitive impairment.
Cancer care providers should consider incorporating structured, home-based exercise prescriptions, such as walking and resistance band exercises, into routine chemotherapy care, researchers stated.
Cardiovascular disease is the second leading cause of death among cancer survivors, second only to cancer itself. The same treatments that can save patients from cancer may also raise the risk of heart complications. Cardio-oncology programs monitor and minimize patients' risk of heart complications before, during and after cancer treatment.
Specialists are available from the time of diagnosis onward to respond to any increased risk for complications. Patients do not need to have an existing heart condition to be referred to cardio-oncologic care.
Certain cancer treatments can increase the risk of complications such as heart failure, high blood pressure and arrhythmia, or abnormal heartbeats. The likelihood of heart issues depends on the type of treatment and individual patient factors. A few of the medications that can lead to cardiac complications include:
- Anthracyclines: May weaken the heart muscle over time.
- Tyrosine kinase inhibitors: Can cause high blood pressure and increase heart strain.
- Immune checkpoint inhibitors: May trigger myocarditis, or inflammation of the heart, in rare cases. This can be life-threatening if untreated.
- Hormone blocking therapy for breast and prostate cancer can accelerate metabolic changes (weight gain, elevate blood sugar, blood pressure and cholesterol).
- Certain chemotherapy drugs can cause fluid retention and swelling, leading to shortness of breath or heart strain.
The cardio-oncology program utilizes heart screening to catch any of the effects early, such as electrocardiograms, or EKGs. Depending on the medication, management methods such as beta blockers, blood pressure medications, steroids or immunosuppressive therapy, and diuretics can reduce the risk of complications.
Cardio-oncologists help patients adopt lifestyle changes to improve their heart health during and after treatment. These changes may include exercising, implementing a heart-healthy diet and managing blood pressure.
Cancer and heart disease have common risk factors. Smoking is a prime example. It increases the risk of lung and other cancers and coronary artery disease, heart attacks and peripheral artery disease. In addition to not smoking, reducing risk of cancer and heart disease can be achieved by achieving a healthy weight; avoiding or moderating alcohol use; controlling cholesterol (some cancer treatments can worsen cholesterol levels); getting enough sleep; and adopting a healthy diet with fruit and vegetables.
Physical activity is another important factor. It has been shown to reduce heart damage risk during cancer treatment, help prevent cancer recurrence and improve cardiovascular outcomes.
Cancer itself can impact the cardiovascular system apart from cancer therapies, and vice versa. Patients with heart failure or other cardiovascular diseases have a higher risk of cancer.
Which treatments are given and how can affect the risk of heart damage. The medical team may use treatments that minimize harm to healthy tissue, such as targeted therapies or proton beam therapy; stagger certain chemotherapy drugs to give the heart a chance to heal between treatments; use medications that protect the heart during chemotherapy; or use techniques to shield healthy tissue during radiation therapy, such as body positioning and breath-holding to provide greater separation between the tumor and the heart.
Research has found that applying AI to an electrocardiogram, a test that measures the heart's electrical activity, may help detect a decline in heart function. Research is also underway on developing simulations to show how different therapies would affect a given patient.
Some patients remain at risk of heart disease for a lifetime after cancer treatment, but it's impractical to do echocardiograms to look at the heart for the rest of their lives. Wearables to alert cancer survivors and their care teams to cardiac abnormalities are another promising area of research.