Key result
Cardiac rehabilitation improves cardiorespiratory fitness and reduces fatigue in cancer survivors.
Why the study?
Cardiac rehabilitation is endorsed to improve cardiovascular outcomes in cancer survivors, but the quality of cardiac rehabilitation-based research in oncology had not been assessed.
Does cardiac rehabilitation improve cardiorespiratory fitness and fatigue in adult cancer survivors?
Meta-Analysis (n=741)
Does cardiac rehabilitation improve cardiorespiratory fitness and fatigue in adult cancer survivors?
Standardized Mean Difference: 0.42 (95% CI 0.27–0.57)
p-value: p=<0.001
While participation in cardiac rehabilitation is associated with improved cardiorespiratory fitness and reduced fatigue in cancer survivors, the extremely low quality and high risk of bias of the current literature limit broad clinical implementation until more rigorous RCTs are conducted.
Background: Cardiac rehabilitation (CR) is endorsed to improve cardiovascular outcomes in cancer survivors. The quality of CR-based research in oncology has not been assessed. Objectives: The aim of this study was to evaluate the quality of reporting and evidence from CR-based intervention studies in oncology and to explore associations between intervention participation and outcomes. Methods: Systematic searches of 5 databases were conducted (January 2020) and updated (September 2021). Randomized and nonrandomized studies evaluating CR-based interventions in adult cancer survivors during and after treatment were eligible. Independent reviewers extracted data using 2 reporting guidelines (Template for Intervention Description and Replication and Consolidated Standards for Reporting Trials Harms extension), risk of bias (ROB) assessment tools (Cochrane ROB 2.0 and Cochrane Risk of Bias in Non-Randomized Studies of Interventions), and a combined inventory (Tool for the Assessment of Study Quality and reporting in Exercise). A meta-analysis was used to explore pre-intervention/post-intervention differences for commonly assessed outcomes. Results: Ten studies involving data from 685 survivors were included. The mean quality scores for intervention reporting (Template for Intervention Description and Replication) and harms (Consolidated Standards for Reporting Trials Harms extension) were 62% and 17%, respectively. There was moderate-to-high ROB across nonrandomized (Cochrane Risk of Bias in Non-Randomized Studies of Interventions score: 25%) and randomized (ROB 2.0 score: 50%) studies. The mean standardized cardiorespiratory fitness was higher (0.42; 95% CI: 0.27-0.57), fatigue was lower (-0.45; 95% CI: -0.55 to -0.34), and percent body fat (0.07; 95% CI: -0.23 to 0.38) was not different in survivors completing CR compared with those not completing CR. Conclusions: CR-based studies in oncology have low-to-moderate reporting quality and moderate-to-high ROB limiting interpretation, reproducibility, and translation of this evidence into practice.
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Fakhraei et al. (2022) conducted a meta-analysis in Cancer survivors (n=741). Cardiac rehabilitation vs. Pre-intervention baseline or non-completers was evaluated on Cardiorespiratory fitness (SMD 0.42, 95% CI 0.27-0.57, p=<0.001). Cardiac rehabilitation improved cardiorespiratory fitness (SMD 0.42) and reduced fatigue in cancer survivors, though the underlying studies had low reporting quality and moderate-to-high risk of bias.
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