Cardiac Rehabilitation For Cancer Survivors With Heart Failure: A Case Study: 1362

Cardiac toxicity is a troubling effect of cancer treatment, affecting quality of life of survivors and limiting use of life saving therapy. Exercise interventions have been helpful in heart failure patients as well as cancer survivors without heart failure. However, lifestyle interventions have not been tested in cancer survivors with heart failure due to chemotherapy induced cardiac toxicity. PURPOSE: Our long term goal is to conduct a randomized control trial of an exercise and diet intervention for cancer survivors with chemotherapy-related heart failure. Here we present the results from our first pilot phase participant. METHODS: Our participant was a 56-year old Hodgkin's lymphoma survivor who developed heart failure as a result of anthracycline-based chemotherapy. We conducted a 16-week program involving exercise and sodium intake counseling. To develop the exercise prescription, we used the heart rate reserve (HRR) method coupled with rating of perceived exertion (Borg RPE) with the goal to increase exercise duration to 30 minutes of continuous exercise at a level of at least 50% HRR. RESULTS: The participant completed 1155 minutes of exercise in 55 sessions, of which 65% were supervised. Exercise tolerance improved from 11 minutes at 35% of HRR to 30 minutes at 60% HRR. Although ejection fraction remained the same (35-40%), BNP and troponin blood levels improved from abnormally high levels to within normal limits, (124 to 56 pg/ml; 0.04 to < 0.03 ng/ml, respectively). VO2 peak improved from 13.87 to14.30 mlO2/kg/min with ventilatory threshold improving from 80% to 95 % of VO2 peak. Quality of life as assessed by the SF-36 Physical Component Scale (PCS) improved from 17.79 to 25.31 with Mental Component Scale (MCS) improving from 43.84 to 56.65. Heart failure symptoms decreased as assessed by the M. D. Anderson Symptoms Inventory for Heart Failure (MDASI-HF) from 6 to 2, (0= "no symptoms", 10= "as bad as can be imagined"). CONCLUSIONS: To our knowledge there have been no published reports of cardiac rehabilitation specifically for cancer survivors with heart failure. This case study indicates that this is an important area for future research to improve functioning and quality of life for this population of survivors. Supported by NIH Grants: R01 CA109919; K01 CA 1034550