Cardiopulmonary exercise testing in the evaluation of functional capacity after treatment of lymphomas in adults

Abstract

The present study assessed several parameters of cardiopulmonary function in patients, after treatment for aggressive non-Hodgkin's lymphoma and Hodgkin's disease, to determine the influence of these parameters on patient's performance status. One hundred and six patients (66 male and 40 female) aged 40 +/- 15 years were examined 1-2 years (median 14 months) after anticancer treatment. The patients were examined by means of rest and dynamic stress echocardiography and cardiopulmonary exercise. The rest and post-exercise ejection fraction (EF), Doppler parameters of left ventricular diastolic function and peak oxygen consumption (pVO2) were used as parameters of cardiopulmonary performance. The cumulative dose (CD) of doxorubicin (DOX) given was 240 +/- 70 (240 mg/m2). Thirty-seven percent of patients received mediastinal irradiation in accordance with the used treatment protocol. Sixty-four patients (60%) experienced fatigue after the treatment. Three patients (3%) demonstrated an decreased EF <50%, 34 (32%) demonstrated impaired diastolic function, 14 (13%) demonstrated decreased pVO2<20 ml/kg/min and 15 (14%) demonstrated a value of pVO2 below the reference value, respectively. None of the patients exhibited clinical signs of heart failure. Apart from three patients with a rest EF<50%, all the other patients responded to stress echocardiography with an increment of EF > 5%. The parameter pVO2 significantly correlated with stress EF (0.58, P < 0.0002). A significant relationship was found with all parameters of diastolic function: to index E/A of diastolic filling (r = 0.67, P < 0.0001), isovolumic relaxation time (r = -0.56, P < 0.0009) and to deceleration time (r = -0.54, P < 0.009), respectively. A negative relationship was found with age (r = -0.74, P < 0.0001), CD of DOX (r = -0.53, P < 0.003) and radiotherapy-involving mediastinum (r = - 0.44, P < 0.04), respectively. Using multivariate analysis, a significant relationship was found between pVO2 and parameters of diastolic filling, age, female sex and CD of DOX, respectively (r = 0.58, P < 0.0001). Diastolic dysfunction was correlated with age, CD of DOX and radiotherapy-involving mediastinum, respectively (r = 0.51, P < 0.01). The results show that diastolic dysfunction was the most affected parameter of cardiopulmonary function in cancer survivors. This parameter negatively influenced cardiopulmonary performance and was significantly correlated with the cumulative dose of doxorubicin given and radiotherapy on mediastinum. Despite a high number of patients experiencing fatigue, the study demonstrates that only a relatively small number of patients show a depressed pVO2 on a cardiopulmonary stress test and other cardiac abnormalities. The results of the tests support the introduction of regular aerobic exercise for cancer survivors to increase their cardiopulmonary performance and well-being. Hypothetically, aerobic training may also positively influence diastolic function. However, this assumption warrants a prospective follow-up.

Comparison of physiological response to cardiopulmonary exercise testing among cancer survivors and healthy controls

“…As a result, the contribution of aerobic and anaerobic metabolism for energy production in this group of cancer survivors appeared unaltered and thus produced curvilinear lactate responses during the CPET. Aerobic capacity in this group of CS is substantially greater than average values reported for other cancer survivors (35-45 vs. 10-30 ml kg -1 min -1 , respectively) (De Backer et al 2007;Elbl et al 2006;Schwartz and Winter-Stone 2009;Speck et al 2010) and similar to that reported by Schumacher et al (2008) who reported on an elite level athlete (Schumacher et al 2008). Due to calibration of all testing equipment and measured power outputs (thereby confirming the oxygen consumption values), the reliability of our VO 2 values appears robust.…”

“…CPET for cancer survivor exercise rehabilitation programs are increasingly becoming practical (De Backer et al 2007;Elbl et al 2006;Jones et al 2007Jones et al , 2008Schneider et al 2003) as the number of CS desiring to remain active and healthy during and after treatment escalates (Abrahamson et al 2006;Courneya and Mackey 2001;Doyle et al 2006;Irwin et al 2003;Jones et al 2009;McNeely et al 2006;Speck et al 2010;Velthuis et al 2010;Young-McCaughan and Arzola 2007). CPET is recommended because it is the most accurate determination of VO 2peak and can identify underlying mechanisms of limitation (American College of Sports Medicine 2000; Jones et al 2008).…”

Randomized Controlled Trial of the Effects of Aerobic Exercise on Physical Functioning and Quality of Life in Lymphoma Patients

“…The disease and its repeated treatments can produce adverse effects including physical deconditioning, body composition changes, fatigue, depression, and reduced quality of life (QoL). [3][4][5][6] Few interventions have been shown to improve these outcomes.…”

Exercise in adult and pediatric hematological cancer survivors: an intervention review

“…The physical activity levels of adult hematological cancer survivors are indeed rather low and usually below the recommended levels. [13][14][15][16][17][18][19] Low physical activity levels impact a diverse set of outcomes, including fatigue 17 (though some controversy exists 20,21 ), sleep, 20 quality of life (QOL) 16,22 and risk of cardiovascular disease and hypothyroidism. 17 In ALL survivors, low physical activity levels begin during the first two decades of life.…”