Main Session
Sep
28
PQA 04 - Breast Cancer, Patient Reported Outcomes/QoL/Survivorship, Functional Radiation Medicine, Hematologic Malignancies, Palliative Care, and International/Global Oncology
Presenter(s)
Kevin Chen, MD, MSCI - Washington University in St. Louis, St. Louis, MO
K. Chen1, S. Hutton2, K. M. S. Moore2, C. G. Robinson1, P. Samson1, G. R. Vlacich1, I. Zoberi1, L. R. Peterson2, J. Mitchell2, C. Bergom1, and S. N. Badiyan3; 1WashU Medicine, Department of Radiation Oncology, St. Louis, MO, 2WashU Medicine, Department of Medicine, Cardiovascular Division, St. Louis, MO, 3University of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX
Purpose/Objective(s):
Cardiovascular disease is the leading cause of noncancer-related morbidity and mortality among patients with cancer receiving radiation therapy (RT) to the thorax. Consequently, the management of cardiac risk factors has a substantial impact on this population, especially during survivorship. Beyond optimizing medical therapy, there currently exists no post hoc interventions to mitigate the adverse cardiac effects of RT. We seek to evaluate the feasibility and safety of home-based cardiac rehabilitation (CR) among patients receiving thoracic RT.Materials/Methods:
A prospective, single-arm study was performed among patients undergoing curative-intent thoracic RT (between 2022 and 2024) and expected to receive incidental radiation dose to the heart. Patients were evaluated pre-RT by a cardiologist and exercise physiologist, then prescribed home-based CR via a remote platform (Phas3 LLC). CR, initiated within 6 weeks of completing cancer therapy, consisted of aerobic exercise-based sessions and health education over 12 weeks. Among participants who started CR, feasibility was defined as =75% of participants completing =75% of CR exercises. Exploratory analysis included assessment of cardiorespiratory fitness using a six-minute walk test (6MWT) at pre- and post-intervention. Adverse events (AE) related to CR were recorded.Results:
We enrolled 22 patients with one of the following malignancies: left-sided breast (n = 13), esophageal (n = 4), locally advanced non-small cell lung (n = 3), limited stage small cell lung (n = 1), or thymoma (n = 1). There were 13 patients (59%) who initiated CR and 9 who did not start CR. Within the participating group, 6 (46%) completed =75% of prescribed exercises (CR-adherent: mean 93% completion, SD 8%), while the remaining 7 (54%) did not meet this pre-specified threshold (CR-non-adherent: mean 47% completion, SD 25%). Nonetheless, 10 of 13 patients participated in at least 1 CR session weekly for =75% of the total CR regimen (mean 10.8 weeks, SD 1.0), and the majority completed all educational content (median 100% completion). Mean heart doses received by CR-adherent patients (mean 9.0 Gy) versus CR-non-adherent patients (mean 10.6 Gy) were comparable. On average, CR-adherent patients had a minimal change in 6MWT after CR (-0.24 meters), while non-CR-adherent patients had a more modest decrease (-8.7 meters). Only 2 of 13 (15%) patients who started CR experienced a grade 2 AE related to lightheadedness; no patients required hospitalization.Conclusion:
While the trial did not meet pre-specified feasibility, the majority of patients who started home-based CR demonstrated longitudinal adherence over a 12-week period with an excellent safety profile. Exploratory analysis suggests the potential of CR to help stabilize cardiopulmonary fitness. Larger prospective controlled trials will be important for appropriate patient selection and evaluation of clinical efficacy.