Peak oxygen consumption and long‐term all‐cause mortality in nonsmall cell lung cancer

Jones, Lee W.; Watson, Dorothy; Herndon, James E.; Eves, Neil D.; Haithcock, Benjamin E.; Loewen, Gregory; Kohman, Leslie J.

doi:10.1002/cncr.25396

Cited by 161 publications

(140 citation statements)

References 41 publications

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“…[28][29][30] Cardiopulmonary exercise testing has demonstrated predictive ability in advanced lung and breast cancer. 12,13 Functional capacity impairments in patients with chronic GVHD have also been shown to mediate adverse changes in post-HCT functional performance associated with symptom burden. 31 There are limited data regarding 6MW in HCT, 32 and no data that we are aware of that explore the feasibility or prognostic value of cardiopulmonary testing in patients planning to undergo HCT.…”

Section: Discussionmentioning

confidence: 99%

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Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

Wood

Deal

Reeve

et al. 2013

Bone Marrow Transplant

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Hematopoietic cell transplantation (HCT) is a life-saving treatment for patients with high-risk hematological malignancies. Prognostic measures to determine fitness for HCT are needed to inform decision-making and interventions. VO 2peak is obtained by measuring gas exchange during cycle ergometry and has not been studied as a prognostic factor in HCT. Thirty-two autologous and allogeneic HCT patients underwent VO 2peak and 6 Minute Walk (6MW) testing before HCT, and provided weekly symptom and health-related quality of life (HRQOL) assessments before HCT and concluding at Day 100. Twenty-nine patients completed pre-HCT testing. Pre-HCT VO 2peak was positively correlated with pre-HCT 6MW (r ¼ 0.65, Po0.001) and negatively correlated with number of chemotherapy regimens and months of chemotherapy. Patients with lower VO 2peak reported higher symptom burden and inferior HRQOL at baseline and during early post-HCT period. Patients with pre-HCT VO 2peak o16 mL/kg/min had higher risk of mortality post HCT (entire cohort: hazard ratio (HR) 9.1 (1.75-47.0), P ¼ 0.01; allogeneic HCT patients only: HR 6.70 (1.29-34.75), P ¼ 0.02) and more hospitalized days before Day 100 (entire cohort: median 33 vs 19, P ¼ 0.003; allogeneic HCT patients only: median 33 vs 21, P ¼ 0.004). VO 2peak pre-HCT is feasible and might predict symptom severity, HRQOL and mortality. Additional studies are warranted. Keywords: cardiopulmonary fitness; symptoms; health-related quality of life; hematopoietic SCT INTRODUCTIONFor patients with life-threatening hematological diseases, hematopoietic cell transplantation (HCT) offers the possibility of extended survival relative to standard conventional treatments. 1 The benefits of HCT are counterbalanced by the risk of treatmentrelated toxicity. Prognostic measures are needed to inform clinician and patient decision-making and to limit treatmentrelated risk. Direct cardiopulmonary fitness assessments such as VO 2peak are now available but have not yet been studied.Myeloablative allogeneic HCT has been associated with a 30-40% risk of treatment-related mortality (TRM). 2 Reduced intensity conditioning HCT is offered to older individuals and patients with comorbid illness, but this technique is still associated with a 20-30% risk of TRM. 3 Autologous HCT in older patients has been associated with a TRM risk exceeding 10%. 4 Subsets of patients after all types of transplants experience late health-related quality of life (HRQOL) deficits and functional impairment; 5 this effect is variable with other subgroups experiencing preserved patient-reported outcomes (PROs), relative to normative values. 6 Investigators and clinicians have attempted to determine who is 'fit' for transplant to inform pre-HCT counseling, selection of suitable HCT candidates and identification of vulnerable HCT recipients at risk for treatment-related complications. 7 Age remains the most commonly used surrogate variable for HCT

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Section: Discussionmentioning

confidence: 99%

“…[12][13][14] These techniques have not been studied in patients planning to undergo HCT. Studies have demonstrated the feasibility of VO 2peak measurement in survivors of allogeneic HCT, [15][16][17] and the potential benefit of exercise intervention in ameliorating functional decline.…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

Wood

Deal

Reeve

et al. 2013

Bone Marrow Transplant

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“…Recent studies also show that physical performance is an independent predictor of survival in NSCLC patients [21][22][23], currently the same goes for depression and anxiety which usually accompanies the disease [24].…”

Section: Introductionmentioning

confidence: 88%

“…The same author has subsequently shown that the reduction in exercise capacity is a strong predictor of mortality, which is regarded as the VO 2 peak [33], or the MET'S products or meters walked to the walk test [34].…”

Section: Functional Assessmentmentioning

confidence: 99%

Pulmonary Rehabilitation in lung cancer

Pasqua

Geraneo

Nardi

et al. 2015

Monaldi Arch Chest Dis

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Non-small-cell lung cancer (NSCLC) represents a very severe disease, being its incidence increasingly reported and, nowadays, successfully treatable only when surgery is deemed to be feasible. Furthermore, the disease and the clinical effects related to the complementary therapies (radio and/or chemotherapy) may strongly affect, frequently with dramatic clinical side effects, the patient’s ability to endure physical exercise. In such context, the PR(PR), which has already been proved to be useful and effective in other diseases such as COPD, could play a pivotal role. The aim of this review article is, therefore, to analyze the pertinent data recently reported in English literature in order to highlight the role of rehabilitation as complementary therapy in the management of patients with NSCLC. The evidence currently available suggests that, when surgery is indicated, PR is a safe and feasible option, both during pre-operative and post-operative timing.The safety and feasibility of rehabilitation are proven even in inoperable patients, although to date, little evidence has been reported on its role in the overall management of such complex diseases.

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“…Thus, tools with the ability to evaluate integrated crosstalk between cardiovascular organ components, like VO 2peak , may provide a more comprehensive measure of therapy-related global cardiovascular effects in the setting of cancer [54]. As a measure of global cardiovascular function and reserve capacity, VO 2peak is also inversely correlated with cardiovascular and all-cause mortality in a broad range of adult populations, including lung cancer [102][103][104][105]. In breast cancer, Jones et al [106] found that despite preserved resting LVEF ≥50%, 130 patients, on average 3 years following the completion of adjuvant therapy, had VO 2peak that was 22% below that of sedentary age-matched women without a history of breast cancer.…”

Section: Stress-related Functional Testingmentioning

confidence: 99%

Current and Emerging Modalities for Detection of Cardiotoxicity in cardio-oncology

et al. 2015

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Advancements in diagnostic tools and curative-intent therapies have improved cancerspecific survival. With prolonged survival, patients are now subject to increased aging and development of cardiovascular risk factors such that further improvements in cancerspecific mortality are at risk of being offset by increased cardiovascular mortality. Moreover, established and novel adjuvant therapies used in cancer treatment are associated with unique and varying degrees of direct as well as indirect myocardial and cardiovascular injury (i.e., cardiotoxicity). Current approaches for evaluating anticancer therapy-induced injury have limitations, particularly lack of sensitivity for early detection of subclinical cardiac and cardiovascular dysfunction. With emerging evidence suggesting early prevention and treatment can mitigate the degree of cardiotoxicity and limit interruption of life-saving cancer therapy, the importance of early detection is increasingly paramount. Newer imaging modalities, functional capacity testing and blood biomarkers have the potential to improve early detection of cardiotoxicity and reduce cardiovascular morbidity and mortality. KeywordsMortality rates from cancer have declined over the past 30 years as more effective methods of early detection, pharmacologic treatments and surgical approaches have resulted in significant cancerrelated survival gains [1][2][3]. Long-term survivors with cancer are expected to increase by approximately 30% in the next decade to an estimated 18 million by 2022 in the USA alone [4]. With prolonged survival, cancer patients are now subject to the effects of aging and to the development of other risk factors that determine the long-term risk of cardiovascular disease (CVD) [5][6][7]. In this setting, CVD may limit the survival gains of oncology and is already the predominant cause of mortality in breast cancer patients over 50 years of age [5,6,8] and a more common contributor than cancer to mortality among older survivors [9,10].The cardiovascular effects of a prolonged survival are also compounded by those of standard modern cancer therapy. Current anticancer therapies are associated with unique and varying degrees of direct (e.g., myocardial toxicity, ischemia, hypertension, arrhythmias) [11][12][13][14] as well as indirect (e.g., unfavorable lifestyle changes) sequential and progressive cardiovascular insults [11]. The most well known direct cardiotoxic effects of cancer therapy historically occur with anthracyclinecontaining regimens (i.e., doxorubicin, epirubicin). Anthracyclines are still widely used in solid tumors (i.e., breast cancer, osteosarcoma etc.) and hematologic malignancies (Hodgkin's/nonHodgkin's lymphoma, acute lymphoblastic leukemia etc.) and are well recognized to trigger dosedependent, cumulative, progressive cardiac dysfunction [15,16] manifest as decreased left ventricular ejection fraction (LVEF) [17][18][19], and ultimately, symptomatic heart failure (HF) in up to 5% of patients [20]. Newer, targeted agents have dramatically improved the a...

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Peak oxygen consumption and long‐term all‐cause mortality in nonsmall cell lung cancer

Cited by 161 publications

References 41 publications

Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

Pulmonary Rehabilitation in lung cancer

Current and Emerging Modalities for Detection of Cardiotoxicity in cardio-oncology

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