Kanserli Olgularda Kardiyak Rehabilitasyon Perspektifi

Öz

Kanser, vücuttaki hücrelerin kontrolsüz şekilde bölünmesi ve çoğalmasıyla karakterize ülkemizde ve dünyada insidansı ve prevelansı gün geçtikçe artan önemli ve kompleks bir sağlık sorunudur. Hastalığın görülme sıklığına paralel olarak yeni tedavi yöntemleri geliştirilmiştir. En yaygın olarak uygulanan tedavi yöntemleri; kemoterapi, radyoterapi ve cerrahi yöntemlerdir, bunların yanında biyolojik tedaviler de kullanılmaktadır. Yapılan çalışmalara göre, kemoterapi ve radyoterapi ajanlarının uzun süreli kullanımı kanser hastalarının ve kanserden sağ kalan bireylerin kardiyovasküler sistemi üzerinde kardiyotoksisite adı verilen toksik etkilere neden olmaktadır. Kardiyotoksisite sonucunda hastaların ventriküler fonksiyonları, kardiyorespiratuar uygunlukları ve fiziksel kapasitelerinde önemli ölçüde azalma ile birlikte kalp yetmezliği riskinde artış meydana gelmektedir. Bu negatif etkilerin önlenmesi veya hafifletilmesi için hastalara bütüncül bir yaklaşım olan kardiyak rehabilitasyon programları önerilmektedir. Kardiyak rehabilitasyon programları egzersiz desteği, nutrisyonel destek, psikolojik destek, sigarayı bırakma desteği ve yaşam tarzı modifikasyonlarının önerilmesi şeklinde alt gruplara sahiptir. Bu derlemede kardiyak rehabilitasyonun egzersiz bölümüne odaklanılmıştır. Amerikan Spor Hekimliği Koleji tarafından yayınlanan kılavuzda, egzersizin kardiyorespiratuar uygunluğu ve fiziksel kapasiteyi iyileştirdiği belirtilmektedir. Bunun yanında kalp yetmezliği hastalarında oluşabilecek sarkopeni durumlarında kas kuvvetinde ve yaşam kalitesinde meydana gelebilecek azalmaların hafifletilmesinde hastalara sıklıkla dirençli egzersizler, aerobik egzersizler ve bu iki egzersiz çeşidinin kombinasyonu önerilmektedir. Literatürdeki çalışmalar incelendiğinde, kanser hastalarına veya kanserden sağ kurtulan bireylere uygulanan kardiyak rehabilitasyon yaklaşımlarının hastaların kardiyorespiratuar uygunluklarını iyileştirdiği, metabolik sendrom geliştirme riskinin önüne geçtiği, kanser hastalarında sıklıkla meydana gelen yorgunluk ve kas kütlesi kaybı gibi fiziksel performans parametreleri üzerinde olumlu etkileri olduğu görülmektedir. Bu derleme, kanser hastalığı sonucunda bireylerde meydana gelen kardiyovasküler değişimleri, bu bireylerin değerlendirilmesi ve rehabilitasyonunu içermektedir.

Anahtar Kelimeler

• Fizyoterapi ve rehabilitasyon
• kanser
• kardiyak rehabilitasyon

Cardiac Rehabilitation Perspective on Cancer Patients

Öz

Cancer is an important and complex health problem, the incidence and prevalence of which are increasing day by day in our country and the world, characterized by the uncontrolled division and proliferation of cells in the body. In parallel with the incidence of the disease, new treatment methods have been developed. The most commonly applied treatment methods are; chemotherapy, radiotherapy, and surgical methods, as well as biological treatments, are used. Studies have shown that long-term use of chemotherapy and radiotherapy agents can cause toxic effects, called cardiotoxicity, on the cardiovascular system of cancer patients and cancer survivors. As a result of cardiotoxicity, there is a significant decrease in the ventricular functions, cardiorespiratory fitness, and physical capacity of the patients, and an increase in the risk of heart failure occurs. To prevent or alleviate these negative effects, cardiac rehabilitation programs, which are a holistic approach, are recommended. Cardiac rehabilitation programs have divisions such as exercise support, nutritional support, psychological support, smoking cessation support, and lifestyle modifications. This review focuses on the exercise part of cardiac rehabilitation. According to American College of Sports Medicine guideline, exercise improves cardiorespiratory fitness and physical capacity. In addition, resistance exercises, aerobic exercises, and combined exercises are often recommended to patients to alleviate the decrease in muscle strength and quality of life in sarcopenia that may occur in patients with heart failure. Previous studies have shown that cardiac rehabilitation improves cardiorespiratory fitness, prevents the risk of metabolic syndrome development, and decreases muscle mass loss and perceived fatigue in cancer patients. This review includes cardiovascular changes in individuals as a result of cancer disease, evaluation, and rehabilitation of these individuals.

Anahtar Kelimeler

• Cancer
• cardiac rehabilitation
• physiotherapy and rehabilitation

Kaynakça

1. 1. Kocamaz D, Düger T. Meme kanserli kadınlarda farkli tedaviler ile birlikte verilen kalistenik egzersizlerin fiziksel aktivite düzeyi ve depresyona etkisi. Türk Fiz ve Rehabil Derg. 2017;28(3):93-99. doi: 10.21653/tfrd.340716.
2. 2. Kurt S, Ünsar S, Erol Ö. Kanserli hastalara bakım verenlerin yaşam kalitesinin değerlendirilmesi. SDÜ Sağlık Bilim Derg. 2020;11(1):43-48. doi: 10.22312/sdusbed.614872.
3. 3. Sung H, Ferlay J, Siegel R, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. A Cancer J Clin. 2021;71(3):209-249. doi: 10.3322/caac.21660.
4. 4. Baykara O. Current modalities in treatment of cancer. Balıkesır Heal Sci J. 2016;5(3):154-165. doi: 10.5505/bsbd.2016.93823.
5. 5. Padegimas A, Clasen S, Ky B. Cardioprotective strategies to prevent breast cancer therapyInduced cardiotoxicity. Trends Cardiovasc Med. 2020;30(1):22-28. doi: 10.1016/j.tcm.2019.01.006.Cardioprotective.
6. 6. Beyer AM, Bonini MG, Moslehi J. Cancer therapy-induced cardiovascular toxicity: Old/new problems and old drugs. Am J Physiol Hear Circ Physiol. 2019;317(1):164-167. doi: 10.1152/ajpheart.00277.2019.-Cardio-oncology.
7. 7. Chyu C, Halnon N. Exercise training in cancer survivors. Curr Oncol Rep. 2016;18(6):1-9. doi: 10.1007/s11912-016-0520-2.
8. 8. Sase K, Kida K, Furukawa Y. Cardio-Oncology rehabilitation- challenges and opportunities to improve cardiovascular outcomes in cancer patients and survivors. J Cardiol. 2020;76(6):559-567. doi: 10.1016/j.jjcc.2020.07.014.

9. 9. Squires RW, Shultz AM, Herrmann J. Exercise training and cardiovascular health in cancer patients. Curr Oncol Rep. 2018;20(3). doi: 10.1007/s11912-018-0681-2.
10. 10. Maddocks M. Physical activity and exercise training in cancer patients. Clin Nutr ESPEN. 2020;40:1-6. doi: 10.1016/j.clnesp.2020.09.027.
11. 11. Eskimez Z, Tosunöz Köse İ, Öztunç G, Yeşil Demirci P, Paydaş S, Kumaş G. Kemoterapi alan meme kanserli hastalara bakım veren yakınlarının yaşam kalitesi. Sağlık Bilim Derg. 2021;30(1):21-30.
12. 12. Agmon Nardi I, Iakobishvili Z. Cardiovascular risk in cancer survivors. Curr Treat Options Cardiovasc Med. 2018;20(6):1-11. doi: 10.1007/s11936-018-0645-8.
13. 13. Bullard T, Ji M, An R, Trinh L, Mackenzie M, Mullen SP. A systematic review and meta-analysis of adherence to physical activity interventions among three chronic conditions: cancer, cardiovascular disease, and diabetes. BMC Public Health. 2019;19:636-647. doi: 10.1186/s12889-019-6877-z.
14. 14. Hiraoui M, Al-Haddabi B, Gmada N, Doutrellot PL, Mezlini A, Ahmaidi S. Effects of combined supervised intermittent aerobic, muscle strength and home-based walking training programs on cardiorespiratory responses in women with breast cancer. Bull Cancer. 2019;106(6):527-537. doi: 10.1016/j.bulcan.2019.03.014.
15. 15. Bolam KA, Mijwel S, Rundqvist H, Wengström Y, Se KB. Two-year follow-up of the OptiTrain randomised controlled exercise trial. Breast Cancer Res Treat. 2019;175:637-648. doi: 10.1007/s10549-019-05204-0.
16. 16. Spence RR, Heesch KC, Eakin EG, Brown WJ. Randomised controlled trial of a supervised exercise rehabilitation program for colorectal cancer survivors immediately after chemotherapy: Study protocol. BMC Cancer. 2007;7(154). doi: 10.1186/1471-2407-7-154.
17. 17. Jensen W, Oechsle K, Baumann HJ, et al. Effects of exercise training programs on physical performance and quality of life in patients with metastatic lung cancer undergoing palliative chemotherapy-A study protocol. Contemp Clin Trials. 2014;37(1):120-128. doi: 10.1016/j.cct.2013.11.013.
18. 18. Lee K, Tripathy D, Demark-Wahnefried W, et al. Effect of aerobic and resistance exercise intervention on cardiovascular disease risk in women with early-stage breast cancer A randomized clinical trial supplemental content. JAMA Oncol. 2019;5(5):710-714. doi: 10.1001/jamaoncol.2019.0038.
19. 19. Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, et al. Effects of aerobic and resistance exercise on metabolic syndrome, sarcopenic obesity, and circulating biomarkers in overweight or obese survivors of breast cancer: A randomized controlled trial. J Clin Oncol. 2018;36(9):875-883. doi: 10.1200/JCO.2017.75.7526.
20. 20. Ansund J, Mijwel S, Bolam KA, et al. High intensity exercise during breast cancer chemotherapy - effects on long-term myocardial damage and physical capacity - data from the OptiTrain RCT. Cardio-Oncology. 2021;7(7). doi: 10.1186/s40959-021-00091-1.
21. 21. Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: Consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375-2390. doi: 10.1249/MSS.0000000000002116.
22. 22. Scott JM, Nilsen TS, Gupta D, Jones LW. Exercise therapy and cardiovascular toxicity in cancer. Circulation. 2018;137(11):1176-1191.
23. 23. Caron J, Nohria A. Cardiac Toxicity from breast cancer treatment: Can we avoid this? Curr Oncol Rep. 2018;20(8):61. doi: 10.1007/s11912-018-0710-1.
24. 24. Hwang CL, Yu CJ, Shih JY, Yang PC, Wu YT. Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy. Support Care Cancer. 2012;20:3169-3177. doi: 10.1007/s00520-012-1452-5.
25. 25. Dittus KL, Lakoski SG, Savage PD, et al. Exercise-based oncology rehabilitation: Leveraging the cardiac rehabilitation model. J Cardiopulm Rehabil Prev. 2015;35(2):130-139. doi: 10.1097/HCR.0000000000000091.
26. 26. Anderson L, Oldridge N, Thompson DR, et al. Exercise-based cardiac rehabilitation for coronary heart disease cochrane systematic review and meta-analysis. J Am Coll Cardiol. 2016;67(1):1-12. doi: 10.1016/j.jacc.2015.10.044.
27. 27. Granger CL. Physiotherapy of management of lung cancer. J Physiother. 2016;62(2):60-67. doi: 10.1016/j.jphys.2016.02.010.
28. 28. Gilchrist SC, Barac A, Ades PA, et al. Cardio-oncology rehabilitation to manage cardiovascular outcomes in cancer patients and survivors: A scientific statement from the American heart association. Circulation. 2019;139(21):E997-E1012. doi: 10.1161/CIR.0000000000000679.
29. 29. Teske AJ, Linschoten M, Kamphuis JAM, et al. Cardio-oncology: An overview on outpatient management and future developments. Netherlands Hear J. 2018;26(11):521-532. doi: 10.1007/s12471-018-1148-7.
30. 30. Kirkham AA, Eves ND, Shave RE, et al. The effect of an aerobic exercise bout 24 h prior to each doxorubicin treatment for breast cancer on markers of cardiotoxicity and treatment symptoms: A. Breast Cancer Res Treat. 2018;167(3):719-729. doi: 10.1007/s10549-017-4554-4.
31. 31. Adams SC, Delorey DS, Davenport MH, et al. Effects of high-intensity aerobic interval training on cardiovascular disease risk in testicular cancer survivors: A phase 2 randomized controlled trial. Cancer. 2017;123(20):4057-4065. doi: 10.1002/cncr.30859.
32. 32. Wittekind SG, Gilchrist SC. Exercise testing and cardiac rehabilitation in patients treated for cancer. J Thromb Thrombolysis. 2020;(0123456789). doi: 10.1007/s11239-020-02265-7.
33. 33. Marchese VG, Chiarello LA, Lange BJ. Effects of physical therapy Intervention for children with acute lymphoblastic leukemia. Pediatr Blood Cancer. 2004;42(2):127-133. doi: 10.1002/pbc.10481.
34. 34. Tanir MK, Kuguoglu S. Impact of exercise on lower activity levels in children with acute lymphoblastic leukemia: A randomized controlled trial from Turkey. Rehabil Nurs. 2013;38(1):48-59. doi: 10.1002/rnj.58.
35. 35. Yeh CH, Man Wai JP, Lin US, Chiang YC. A pilot study to examine the feasibility and effects of a home-based aerobic program on reducing fatigue in children with acute lymphoblastic leukemia. Cancer Nurs. 2011;34(1):3-12. doi: 10.1097/NCC.0b013e3181e4553c.
36. 36. Ceseiko R, Eglitis J, Srebnijs A, et al. The impact of maximal strength training on quality of life among women with breast cancer undergoing treatment. Exp Oncol. 2019;41(2):166-172.
37. 37. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood E. The New England Journal of Medicine Exercise Capacity and Mortality Amog Men Referred for Exercise Testing. Vol 346.; 2002. Accessed June 24, 2021. www.nejm.org.
38. 38. Vainshelboim B, Chen Z, Lima RM, Myers J. Cardiorespiratory fitness, smoking status, and risk of incidence and mortality from cancer: Findings from the veterans exercise testing study. J Phys Act Health. 2019;16(12):1098-1104. doi: 10.1123/jpah.2019-0245.
39. 39. Lakoski SG, Willis BL, Barlow CE, et al. Midlife cardiorespiratory fitness, incident cancer, and survival after cancer in men: The Cooper Center Longitudinal Study. JAMA Oncol. 2015;1(2):231-237. doi: 10.1001/jamaoncol.2015.0226.