French institutional cardio-onco-rehabilitation program: a successful co-creation since 2015 for patients with breast cancer, colorectal cancer, prostate cancer and lymphoma

Objective The recent position papers (1,2,3) encourage the implementation of the Cardio-Oncological Rehabilitation (CORe) program in Cardiovascular rehabilitation centers (CVRC), but no team has ever published all of its results, and funding is not always supported. Our goal is to promote CORe, and show that it is possible to set up such a program in CVRC. The medical objectives of CORe are to improve quality of life (reduction of cancer-related fatigue, anxiety, depression), to reduce cancer recurrences or the emergence of cardiovascular (CV) diseases after cancer. Patients with cancer have a high CV risk, particularly after breast cancer and malignant hematological disease. Their prognosis is worsened by CV toxicity and CV mortality. Method In 2015, in a city ( on the French Atlantic west coast) a team of motivated caregivers from a CV rehabilitation clinic voluntarily set up a feasibility study of CORe after breast cancer. The program is named the "Gaïa program". Patients are referred by their oncologist immediately after their oncological care without CV disease. In two years, 90 patients were trained, and a significant improvement in physical fitness and physical and mental EQ5D/SF36 score was observed before/after the three-month program. The regional health agency decided to institutionalize the program in daily hospitalization of the clinic and the French NHS finances it. Since 2018, 600 patients have been rehabilitated after breast cancer, colorectal cancer, prostate cancer and lymphoma. The physical fitness and QoL of patients improve significantly. In the medico-economic impact thesis carried out for the population of non metastatic breast cancer patients, the results are encouraging, and the average progression of physical capacity is 13 Watts, the SF36 physical and mental score increasing for 20 points (p<0,001). This thesis obtained the 2022 thesis' prize of the faculty of Rennes. In 2018, the same care team decided to create an association allowing empowerment in the pursuit of a serene and sustainable physical activity coupled with the sustainability of the management of CV risk factors (nutrition/stress management, emotions). This program was created like a "heart and cancer" club, to improve the autonomy of the patients in changing their lifestyle. Currently 100 patients are members and participate in physical activities (endurance, resistance activities, Aquagym, dance therapy, badminton), nutrition workshops, mental coaching and art therapy workshops. Conclusion The promotion of CORe is a public health issue and must be part of the oncologist's therapeutic arsenal. The caregivers of a private clinic in La Rochelle have chosen to promote comprehensive care for patients during and after cancer in institutional and voluntary forms, in co-creation with the hospital's oncologists. This gives meaning to their care work and can inspire other professionals to get involved.