Cardio-oncology rehab programs proposed for CVD risk reduction

In a scientific statement published online April 8, the American Heart Association introduced the concept of cardio-oncology rehabilitation—a spin on cardiac rehab that takes into account cancer-specific considerations.

There are more than 16.7 million cancer survivors in the U.S. today, the authors noted, which is partially attributable to improvements in early cancer detection and treatment. However, these individuals are often at increased risk of death from noncancer causes, including cardiovascular disease.

To better address their heart health, Susan C. Gilchrist, MD, MS—the chair of the statement writing committee—and co-authors presented the rationale for offering cardiac rehabilitation (CR) to cancer survivors and highlighted some special considerations required for those patients.

They also proposed an algorithm, based on treatment exposure and symptoms, that showed how patients might be funneled to different tests or consultations and ultimately to cancer rehabilitation, cardio-oncology rehabilitation (dubbed CORE) or community-based cancer programs.

“Current investigations indicate that CR models are feasible and can improve (cardiorespiratory fitness), muscular strength, and quality of life in cancer survivors,” Gilchrist, with the University of Texas MD Anderson Cancer Center, and colleagues wrote in Circulation. “Given the multisystem consequences of cancer therapy resulting in increased risk of morbidity and mortality, there is a strong rationale both to identify survivors at greatest risk and to deliver individualized interventions.”

But it’s not as simple as plugging cancer patients into a standard CR program. The authors emphasized there are cancer-specific factors that must be taken into account during patient assessments, nutritional counseling, blood pressure testing, psychosocial management, exercise training and the management of diabetes and lipid levels.

And currently, there are no reimbursement strategies in place for such rehabilitation programs. However, the authors believe their statement is the first step down that path, although “further work is needed to establish the science base for CR in the cancer population and to generate guidelines and accompanying policy metrics to shape referrals and reimbursement.”

Gilchrist et al. said progress in the following areas could bring cardio-oncology rehab programs closer to reality:

  • Developing and communicating the evidence base for CORE to patients, clinicians, health systems, payers and employers.
  • Demonstrating which patients are most likely to benefit, and tying those gains to economic outcomes through downstream healthcare utilization, the ability to return to work, etc.
  • Identifying the best delivery strategies for the programs.
  • Testing the impact of the rehab programs on cardiac-specific outcomes.
  • Defining and testing a set of quality and performance metrics, which could be used in both fee-for-service models and value-based payment arrangements.

“If realized, CORE has the potential to grow exponentially within an existing CR infrastructure, thus providing a widely accessible multimodality program to patients with cancer across the United States that is not presently available,” the authors wrote.