Cardio-Oncology Rehabilitation and Telehealth: Rationale for Future Integration in Supportive Care of Cancer Survivors

Abstract

The direct toxicity of cancer treatment threatens patients and survivors with an increased risk of cardiovascular disease or adverse functional changes with subsequent progression of cardiovascular complications. An accumulation of cardiovascular risk factors combined with an unhealthy lifestyle has recently become more common in cancer patients and survivors. It has been recommended to integrate a comprehensive cardiac rehabilitation model called cardio-oncology rehabilitation to mitigate cardiovascular risk. Nevertheless, cardiac rehabilitation interventions limit barriers in low utilization, further exacerbated by the restrictions associated with the COVID-19 pandemic. Therefore, it is essential to integrate alternative interventions such as telehealth, which can overcome several barriers. This literature review was designed as a framework for developing and evaluating telehealth interventions and mobile applications for comprehensive cardio-oncology rehabilitation. We identify knowledge gaps and propose strategies to facilitate the development and integration of cardio-oncology rehabilitation telehealth as an alternative approach to the standard of care for cancer patients and survivors. Despite the limited evidence, the pilot results from included studies support the feasibility and acceptability of telehealth and mobile technologies in cardio-oncology rehabilitation. This new area suggests that telehealth interventions are feasible and induce physiological and psychological benefits for cancer patients and survivors. There is an assumption that telehealth interventions and exercise may be an effective future alternative approach in supportive cancer care.

The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: a systematic review

“…This would make the telehealth approach suitable for integration among other subgroups of patients with CVD or other chronic diseases in which the health benefit of providing physical exercise was found. 74 - 76 Given the recent calls for comprehensive integration of the essential preventive components of CR, this should support the expected preventive health outcomes. 77 , 78 …”

Adherence, safety, and satisfaction of a cardio-oncology rehabilitation program framework versus community exercise training for cancer survivors: findings from the CORE trial

“…Given the paramount role of these programs in terms of morbidity and quality of life in CVD in general, and the expanding interest in oncologic settings, current data from these analyses could be highly informative in helping improve future trial designs (namely in comparison to other modalities), to enhance overall access and allow for optimization of tailoring to the needs of different patient groups [18,27,43,44]. In addition, and given the lack of data on this topic, the findings derived from this contemporary pragmatic study could also be of value by providing novel insights into this complex field.…”

Adherence, safety and satisfaction of a cardio-oncology rehabilitation program framework versus community exercise training for cancer survivors: findings from the CORE trial

“…This contrasts with 51.3% of patients in CBET, suggesting that patients prefer an intervention that takes place in a clinical setting with a multidisciplinary outlook. Given the major role of these programs in terms of morbidity and quality of life in CVD in general, and the expanding interest in oncologic setting, current data from these analyses could be highly informative in helping improve future trial designs (namely in comparison to other modalities, such as those incorporating telemedicine), to enhance overall access and allow for optimization of tailoring to the needs of different patient groups [18,27,43,44]. Limitations Some limitations should be considered when analyzing the present data.…”