Cardiovascular Disease Risk and Cardio-oncology Rehabilitation (CORE) Referral in Breast Cancer Survivors

Breast cancer is the most prevalent cancer among Canadian women. Due to advancements in cancer prevention, treatment and screening, more breast cancer survivors are living longer, for whom, survivorship issues have become a significant concern. Cardiovascular disease (CVD) is recognized as the leading non-cancer cause of death in this population, and is the number one cause of death in older cancer survivors (≥65 years of age). The American Heart Association recently endorsed the use of multi-modal exercise-rehabilitation programs, similar to cardiac rehabilitation (CR), to help mitigate CVD risk in breast cancer survivors. This approach has been coined as cardio-oncology rehabilitation (CORE). Despite this, there are no clinical guidelines on who should be prioritized for CORE among people with cancer and referral of all patients would quickly overwhelm current CR programs. Against this background, we aimed to identify which early-stage breast cancer survivors should be prioritized for CORE referral until greater program capacity is available. Novel measures that were explored included, cardiac biomarkers, echocardiography derived global longitudinal strain, cardiopulmonary fitness, measures of vascular function and structure, and clinical data that is prognostic and diagnostic for CVD events in breast cancer survivors. Our research revealed that women treated with potentially cardiotoxic therapies and the presence of ≥2 CVD risk factors, vascular impairments, history of cardiotoxicity, diastolic impairment and impaired GLS (Ph.D