Merging sports cardiology and oncology: an approach of outpatient cardio-oncological management

Background Guidelines of cardio-oncology recommend implementation of maintained exercise intervention in outpatient treatment. Although awareness of cancer therapy-related cardiac dysfunction (CTRCD), coronary artery disease (CAD), and heart failure (HF) is growing with the advent of new oncological treatment regimens, the value of exercise to prevent adverse cardiac events and improve outcomes remains underrated. Purpose To propose an outpatient setting for sports intervention in cardio-oncological patients to reduce the burden of cardiovascular disease. Methods We report the setting at our institution to facilitate the early diagnosis and treatment of adverse cardiac events in cancer patients. Patients are referred to our department from the cooperating cancer treating centers before, during and after cancer therapy. Following assessment of cardiac biomarkers and echocardiography, patients undergo cardiopulmonary exercise testing with blood gas analysis to determine cardiorespiratory fitness and identify cardiac, pulmonary, circulatory, and peripheral limitations. Basic resistance tests are added to assess muscle strength. The results are used to provide individualized exercise prescriptions. Similar to high-performance athletes, sports cardiologists and sports scientists re-assess performance at the end of each training (chemo-) cycle. Results are discussed with the treating oncologists. Prior to inclusion, patients can attend sports medical consultation hours, where a concise overview of training offers is provided. Reference to this consultation is provided by the treating oncologists. Stable patients without relevant comorbidities are integrated into cooperating outpatient physiotherapeutic care or cancer sports groups. Exercise training consists of resistance, endurance as well as balance training. In cooperation with the departments of gynaecology and obstetrics as well as gastroenterology small training groups are being established to exercise with patients with more severe impairments. After initial on site- training with a sports scientist, patients receive access to our online video exercise program, where the aim of each specific activity is demonstrated and explained by a sports scientist. Thus, patients can maintain their efforts by home-based training. Within clinical trials we also provide video-supported home-based exercise training in cancer patients, which is also performed during chemotherapy to facilitate response to treatment and counteract treatment associated side-effects. Conclusions Our approach implements sports cardio-oncology and sports science into oncological treatment as a means for pre- and rehabilitation, maintenance therapy and as an adjunct to chemotherapy. This concept should serve to mitigate the burden of CTRCD, CAD and HF.