Key result
Breast cancer linked to ~2.5-fold higher risk of abnormal cardiopulmonary exercise response versus high-risk women.
Why the study?
The study was conducted to evaluate the prevalence of abnormal cardiopulmonary responses to exercise and the pathophysiological mechanisms underpinning exercise intolerance across the continuum of breast cancer care.
Does breast cancer and its treatment impair cardiopulmonary responses to exercise and peak oxygen consumption compared to high-risk controls?
Meta-Analysis (n=443)
Does breast cancer and its treatment impair cardiopulmonary responses to exercise and peak oxygen consumption compared to high-risk controls?
Effect estimate: OR 2.5 (95% CI 1.2-5.3)
p-value: p=0.014
Breast cancer patients across the care continuum exhibit significantly impaired peak oxygen consumption and a higher prevalence of abnormal cardiopulmonary responses to exercise compared to high-risk controls, highlighting the need for cardiovascular risk stratification.
Supports cardiopulmonary exercise testing for risk stratification in breast cancer; confirms impaired responses and reduced VO2peak versus high-risk controls.
PURPOSE: The purpose of this study is to evaluate the prevalence of abnormal cardiopulmonary responses to exercise and pathophysiological mechanism(s) underpinning exercise intolerance across the continuum of breast cancer (BC) care from diagnosis to metastatic disease. METHODS: Individual participant data from four randomized trials spanning the BC continuum ([1] prechemotherapy [n = 146], [2] immediately postchemotherapy [n = 48], [3] survivorship [n = 138], and [4] metastatic [n = 47]) were pooled and compared with women at high-risk of BC (BC risk; n = 64). Identical treadmill-based peak cardiopulmonary exercise testing protocols evaluated exercise intolerance (peak oxygen consumption; V̇O2peak) and other resting, submaximal, and peak cardiopulmonary responses. The prevalence of 12 abnormal exercise responses was evaluated. Graphical plots of exercise responses were used to identify oxygen delivery and/or uptake mechanisms contributing to exercise intolerance. Unsupervised, hierarchical cluster analysis was conducted to explore exercise response phenogroups. RESULTS: Mean V̇O2peak was 2.78 ml O2.kg-1·min-1 (95% confidence interval [CI], -3.94, -1.62 mL O2.kg-1·min-1; P < 0.001) lower in the pooled BC cohort (52 ± 11 yr) than BC risk (55 ± 10 yr). Compared with BC risk, the pooled BC cohort had a 2.5-fold increased risk of any abnormal cardiopulmonary response (odds ratio, 2.5; 95% confidence interval, 1.2, 5.3; P = 0.014). Distinct exercise responses in BC reflected impaired oxygen delivery and uptake relative to control, although considerable inter-individual heterogeneity within cohorts was observed. In unsupervised, hierarchical cluster analysis, six phenogroups were identified with marked differences in cardiopulmonary response patterns and unique clinical characteristics. CONCLUSIONS: Abnormal cardiopulmonary response to exercise is common in BC and is related to impairments in oxygen delivery and uptake. The identification of exercise response phenogroups could help improve cardiovascular risk stratification and guide investigation of targeted exercise interventions.
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Scott et al. (2023) conducted a meta-analysis in Breast cancer (n=443). Breast cancer (disease state) vs. Women at high-risk of breast cancer was evaluated on Any abnormal cardiopulmonary response to exercise (OR 2.5, 95% CI 1.2-5.3, p=0.014). Women across the breast cancer continuum had a 2.5-fold increased risk of any abnormal cardiopulmonary response to exercise compared with high-risk women (OR 2.5; 95% CI 1.2-5.3; P=0.014).
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