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Singleton AC, Redfern J, Diaz A, Koczwara B, Nicholls SJ, Negishi K, La Gerche A, Playford D, Conyers R, Cehic DA, Garvey G, Williams TD, Hunt L, Doyle K, Figtree GA, Ngo DTM, Sverdlov AL. Integrating Cardio-Oncology Across the Research Pipeline, Policy, and Practice in Australia-An Australian Cardiovascular Alliance Perspective. Heart Lung Circ 2024; 33:564-575. [PMID: 38336544 DOI: 10.1016/j.hlc.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/24/2023] [Accepted: 01/01/2024] [Indexed: 02/12/2024]
Abstract
Over 18 million people worldwide were diagnosed with cancer in 2020, including over 150,000 people in Australia. Although improved early detection and treatment have increased the survival rates, cardiotoxic treatment and inadequate management of cardiovascular risk factors have resulted in cardiovascular disease (CVD) being one of the leading causes of non-cancer-related death and disability among cancer survivors. International guidelines outline the standards of care for CVD risk surveillance and management. However, Australian cardio-oncology policies and clinical guidelines are limited. There is increasing growth of cardio-oncology research in Australia and support from leading Australian professional bodies and advocacy and research networks, including the Cardiac Society of Australia and New Zealand, the Clinical Oncology Society of Australia, the National Heart Foundation of Australia, and the Australian Cardiovascular Alliance (ACvA). Thus, opportunities to drive multidisciplinary cardio-oncology initiatives are growing, including grant funding, position statements, and novel research to inform new policies. The ACvA has a unique flagship structure that spans the translational research pipeline from drug discovery to implementation science. This article aims to highlight how multidisciplinary cardio-oncology innovations could intersect with the seven ACvA flagships, and to showcase Australian achievements in cardio-oncology thus far. We summarise eight key priority areas for future cardio-oncology research that emerged. These strategies will strengthen cardio-oncology research and care in Australia, and drive new guidelines, policies, and government initiatives to ensure equity in health outcomes for all cardio-oncology patients.
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Affiliation(s)
- Anna C Singleton
- Faculty of Medicine and Health, The University of Sydney School of Health Sciences, Sydney, NSW, Australia
| | - Julie Redfern
- Faculty of Medicine and Health, The University of Sydney School of Health Sciences, Sydney, NSW, Australia; George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Abbey Diaz
- First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Qld, Australia
| | - Bogda Koczwara
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Flinders Medical Centre, Adelaide, SA, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Clayton, Vic, Australia; Department of Medicine, Monash University, Clayton, Vic, Australia
| | - Kazuaki Negishi
- Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, Sydney, NSW, Australia
| | - Andre La Gerche
- St Vincent's Institute, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia
| | - David Playford
- The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Rachel Conyers
- Heart Disease Team, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia; Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Vic, Australia
| | | | - Gail Garvey
- First Nations Cancer and Wellbeing Research Program, School of Public Health, The University of Queensland, Qld, Australia
| | - Trent D Williams
- Newcastle Centre of Excellence in Cardio-Oncology, The University of Newcastle, Hunter Medical Research Institute, Calvary Mater Newcastle, Newcastle, NSW, Australia; College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Lee Hunt
- Cancer Voices NSW, Sydney, NSW, Australia
| | - Kerry Doyle
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia; University of Tasmania, Burnie, Tas, Australia; University of Wollongong, Wollongong, NSW, Australia
| | - Gemma A Figtree
- Faculty of Medicine and Health, The University of Sydney School of Health Sciences, Sydney, NSW, Australia; Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia
| | - Doan T M Ngo
- Newcastle Centre of Excellence in Cardio-Oncology, The University of Newcastle, Hunter Medical Research Institute, Calvary Mater Newcastle, Newcastle, NSW, Australia; College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.
| | - Aaron L Sverdlov
- Newcastle Centre of Excellence in Cardio-Oncology, The University of Newcastle, Hunter Medical Research Institute, Calvary Mater Newcastle, Newcastle, NSW, Australia; College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia.
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Foulkes SJ, Howden EJ, Pituskin E, Thompson RB, La Gerche A, Haykowsky MJ. A Review on the Role of Exercise Training to Prevent a Decline in Cardiorespiratory Fitness and Cardiac Function in Breast Cancer Survivors. J Cardiopulm Rehabil Prev 2024; 44:5-14. [PMID: 38032257 DOI: 10.1097/hcr.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
PURPOSE Improvements in diagnosis and treatment mean that the long-term health of breast cancer survivors (BCS) is increasingly dictated by cardiovascular comorbidities. This is partly a consequence of exposure to cardiotoxic therapies, which result in cardiac dysfunction and decreased cardiorespiratory fitness (CRF). Exercise training (ExT) is a key therapeutic strategy for secondary prevention and increasing CRF in adults with established cardiovascular disease. Exercise-based cardio-oncology rehabilitation (CORE) has been proposed as an emerging strategy to address CRF and cardiac impairment in BCS. This review aims to (1) provide an overview of the impact of breast cancer therapy on CRF; (2) provide an up-to-date summary of the effects of ExT on CRF and cardiac function in BCS undergoing cardiotoxic therapy; and (3) discuss how traditional ExT approaches can be adapted for BCS undergoing therapy. REVIEW METHODS A literature review was performed based on an intensive literature search for systematic reviews and meta-analyses, randomized and non-randomized controlled trials and single-arm trials investigating the impact of exercise training or cardiac rehabilitation on CRF and/or cardiac function in BCS who are undergoing or have completed cardiotoxic cancer therapy. SUMMARY Overall, current evidence suggests that ExT induces clinically meaningful benefits for CRF in BCS during and after therapy. There is also emerging evidence that ExT can improve peak exercise measures of cardiac function; however, there is a need for further research to understand how to adapt these effective ExT approaches into clinical CORE-based settings.
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Affiliation(s)
- Stephen J Foulkes
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada (Drs Foulkes, Pituskin, and Haykowsky); Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (Drs Foulkes, Howden, La Gerche, and Haykowsky); Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Australia (Drs Foulkes, Howden, and La Gerche); College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Dr Thompson); National Centre for Sports Cardiology, Fitzroy, Victoria, Australia (Dr La Gerche); and Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (Dr La Gerche)
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