The influence of adjuvant therapy on cardiorespiratory fitness in early-stage breast cancer seven years after diagnosis: the Cooper Center Longitudinal Study

Abstract

Background We examined cardiorespiratory fitness (CRF) levels in early-stage breast cancer patients and determined whether CRF differs as a function of adjuvant therapy regimen. Patients and methods A total of 180 early breast cancer patients representing three treatment groups (surgery only, single-modality adjuvant therapy, and multi-modality adjuvant therapy) in the Cooper Center Longitudinal Study (CCLS) were studied. A non-cancer control group (n=180) matched by sex, age, and date of the CCLS visit were included. All subjects underwent an incremental exercise tolerance test to symptom limitation to assess CRF (i.e., peak METs and time to exhaustion). Results The mean time from breast cancer diagnosis to exercise tolerance testing was 7.4 ± 6.2 years. In adjusted analyses, time to exhaustion and peak METs were incrementally impaired with the addition of surgery, single-modality, and multi-modality adjuvant therapy compared to matched controls (p=0.006 and p=0.028, respectively). CRF was lowest in the multi-modality group compared to all other groups (all p’s <0.05). Conclusions Despite being seven years post diagnosis, asymptomatic early breast cancer survivors have marked reductions in CRF. Patients treated with multi-modal adjuvant therapy have the greatest impairment in CRF.

Associations Between Physical Fitness Indices and Working Memory in Breast Cancer Survivors and Age-Matched Controls

“…** < .01, * < .05. conventional statistical between-group differences in cardiorespiratory fitness may have been related to our use of a submaximal graded exercise test, which could have overestimated peak cardiorespiratory fitness in both groups. 49 Overall, these findings suggest that while breast cancer survivors may have had similar age-predicted cardiorespiratory fitness levels, they differed in their cardiovascular recovery ability from a submaximal graded exercise test and overall physical activity levels.…”

Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study

“…There is emerging evidence that NAC may decrease physical fitness by affecting oxygen transport system components, although it is still unclear which NAC toxicity-related effects result in lowered aerobic capacity. 13 To address this point, we compared preoperative CPETderived parameters in a cohort of non-small-cell lung cancer subjects scheduled for curative lung resection and receiving or not receiving NAC. We hypothesized that subjects receiving NAC would have lower aerobic exercise capacity compared with subjects not treated with NAC.…”

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

“…Cancer therapy is associated with reduced cardiovascular reserve attributed to either the direct effects of therapy or the indirect effects of therapy-associated lifestyle changes [11,92]. Application of 'system stress' (via pharmacologic or exercise) is an established method to detect subclinical impairments in myocardial function and determination of contractile reserve is an independent predictor of prognosis beyond LVEF in patients with coronary artery disease, although these methods have received limited attention in cancer therapyrelated cardiotoxicity [54].…”