Association of post-diagnosis cardiorespiratory fitness with cause-specific mortality in cancer Journal Article
| Authors: | Groarke, J. D.; Payne, D. L.; Claggett, B.; Mehra, M. R.; Gong, J.; Caron, J.; Mahmood, S. S.; Hainer, J.; Neilan, T. G.; Partridge, A. H.; Di Carli, M.; Jones, L. W.; Nohria, A. |
| Article Title: | Association of post-diagnosis cardiorespiratory fitness with cause-specific mortality in cancer |
| Abstract: | Aims The prognostic importance of post-diagnosis assessment of cardiorespiratory fitness (CRF) in cancer patients is not well established. We sought to examine the association between CRF and mortality in cancer patients. Methods and results This was a single-centre cohort analysis of 1632 patients (58% male; 64 +/- 12 years) with adult- onset cancer who were clinically referred for exercise treadmill testing a median of 7 [interquartile range (IQR): 3-12] years after primary diagnosis. Cardiorespiratory fitness was defined as peak metabolic equivalents (METs) achieved during standard Bruce protocol and categorized by tertiles. The association between CRF and all-cause and cause-specific mortality was assessed using multivariable Cox proportional hazard models adjusting for important covariates. Median follow-up was 4.6 (IQR: 2.6-7.0) years; a total of 411 deaths (229, 50, and 132 all-cause, cardiovascular (CV), and cancer related, respectively) occurred during this period. Compared with low CRF (range: 1.9-7.6 METs), the adjusted hazard ratio (HR) for all-cause mortality was 0.38 [95% confidence interval (CI): 0.28-0.52] for intermediate CRF (range: 7.7-10.6 METs) and 0.17 (95% CI: 0.11-0.27) for high CRF (range: 10.7-22.0 METs). The corresponding HRs were 0.40 (95% CI: 0.19-0.86) and 0.41 (95% CI: 0.16-1.05) for CV mortality and 0.40 (95% CI: 0.26-0.60) and 0.16 (95% CI: 0.09-0.28) for cancer mortality, respectively. The adjusted risk of all-cause, CV, and cancer mortality decreased by 26%, 14%, and 25%, respectively with each one MET increment in CRF. Conclusion Cardiorespiratory fitness is a strong, independent predictor of all-cause, CV, and cancer mortality, even after adjustment for important clinical covariates in patients with certain cancers. |
| Keywords: | mortality; exercise; cancer mortality; cardiovascular-disease; metastatic breast-cancer; american society; older-adults; health-care professionals; cause-specific mortality; cardiovascular mortality; oxygen-consumption; cardiorespiratory fitness; exercise capacity; cancer; cardio-oncology; functional-capacity; maximal; scientific statement; cardiac rehab |
| Journal Title: | European Heart Journal-Quality of Care and Clinical Outcomes |
| Volume: | 6 |
| Issue: | 4 |
| ISSN: | 2058-5225 |
| Publisher: | Oxford University Press |
| Date Published: | 2020-10-01 |
| Start Page: | 315 |
| End Page: | 322 |
| Language: | English |
| ACCESSION: | WOS:000583794300013 |
| DOI: | 10.1093/ehjqcco/qcaa015 |
| PROVIDER: | wos |
| PUBMED: | 32167560 |
| PMCID: | PMC9989596 |
| Notes: | Article -- Source: Wos |
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