HOW TO PUT CARDIO-ONCOLOGY REHABILITATION (CORE) IN DAILY CLINICAL PRACTICE. BENEFITS, INDICATIONS, BARRIERS AND POSSIBLE SOLUTIONS

Abstract

Background The rehabilitation programs are a cornerstone in the approach to both patients with cardiovascular disease and those with cancer. There are some common points and some differences in the two approaches: cardiovascular rehabilitation (CVR) and cancer rehabilitation (CaR). Cancer itself and cancer treatments may cause adverse cardiac side-effects. Recently, an integrated approach to patients with both cancer history and cardiovascular diseases has been proposed: the so-called cardio-oncology rehabilitation (CORE). Material and methods We reviewed the literature concerning methods and results of CVR, CaR and CORE, including the prehabilitation programs. Results The positive effects of any rehabilitation program may be evaluated from different points of view: physical, psychological, and symptomatic, or on the basis of the quality of life in general. In most studies, measurable parameters to evaluate the results (such as cardiac ejection fraction, peak oxygen uptake, blood exams) are lacking, the level of evidence is low, and only a part of the goals are achieved. In general, the most frequent effect is an improvement of symptoms such as fatigue, depression, sleep disorders, and of quality of life. There are many different programs (aerobic, resistance training, or a combination of both), with different schedules and different approaches (medically supervised, in a hospital or in a rehabilitation centre or home- based). Most of the studies include selected groups of patients with different diseases (prostate cancer, breast cancer, head/neck cancer) and in different points of their cancer trajectory (during or shortly after chemotherapy, radiotherapy, surgery or years apart in the long-term survivors). There are several barriers limiting participation in a rehabilitation program. Conclusions Different patients require different approaches, according to their cancer, comorbidities, and antineoplastic treatments. A multidisciplinary team is necessary to evaluate each patient and plan a tailored program. Finally, the challenge is to improve the long term adherence to the rehabilitation programs.

Keywords

• cardio-oncology
• rehabilitation
• cardiotoxicity
• cardiac rehabili- tation
• cancer rehabilitation