TITAN Trial: A Randomized Controlled Trial of a Cardiac Rehabilitation Care Model in Breast Cancer.
LVEF
cardio-oncology
cardiotoxicity
dietary counselling
exercise
lipid profiles
Journal
JACC. Advances
ISSN: 2772-963X
Titre abrégé: JACC Adv
Pays: United States
ID NLM: 9918419284106676
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
16
01
2023
revised:
10
05
2023
accepted:
18
05
2023
medline:
28
6
2024
pubmed:
28
6
2024
entrez:
28
6
2024
Statut:
epublish
Résumé
Cardiac rehabilitation (CR) modeled care is recommended for patients with breast cancer to mitigate risk of cardiotoxicity. However, the cardiovascular impact of CR-modeled interventions has not been studied. The purpose of this study was to evaluate if a multidisciplinary model of CR reduces cardiotoxicity and improves cardiovascular risk in patients undergoing breast cancer treatment. We randomly assigned patients with stage I to III breast cancer scheduled to receive anthracycline and/or trastuzumab-based chemotherapy to the CR intervention (n = 37) or usual care (n = 37). The intervention included guideline-directed management of cardiovascular risk factors, dietary counselling, and supervised exercise for 52 weeks. Cardiac magnetic resonance imaging, cardiopulmonary exercise testing, dual-energy x-ray absorptiometry, and serum biomarkers were acquired at baseline and 52 weeks. There was no difference in the primary outcome, left ventricular ejection fraction (LVEF), between groups at 52 weeks (61% ± 6%). Other markers of cardiotoxicity, including high-sensitivity troponin I and brain natriuretic peptide, were similar between groups. However, total cholesterol (5.2 ± 0.8 mmol/L to 4.7 ± 0.8 mmol/L, The CR-modeled intervention had no effect on LVEF or biomarkers of cardiotoxicity. Future lifestyle intervention trials in patients with breast cancer should consider targeting other risk factors associated with incident cardiovascular disease. (Multidisciplinary Team IntervenTion in CArdio-ONcology [TITAN Study] [TITAN]; NCT01621659).
Sections du résumé
Background
UNASSIGNED
Cardiac rehabilitation (CR) modeled care is recommended for patients with breast cancer to mitigate risk of cardiotoxicity. However, the cardiovascular impact of CR-modeled interventions has not been studied.
Objectives
UNASSIGNED
The purpose of this study was to evaluate if a multidisciplinary model of CR reduces cardiotoxicity and improves cardiovascular risk in patients undergoing breast cancer treatment.
Methods
UNASSIGNED
We randomly assigned patients with stage I to III breast cancer scheduled to receive anthracycline and/or trastuzumab-based chemotherapy to the CR intervention (n = 37) or usual care (n = 37). The intervention included guideline-directed management of cardiovascular risk factors, dietary counselling, and supervised exercise for 52 weeks. Cardiac magnetic resonance imaging, cardiopulmonary exercise testing, dual-energy x-ray absorptiometry, and serum biomarkers were acquired at baseline and 52 weeks.
Results
UNASSIGNED
There was no difference in the primary outcome, left ventricular ejection fraction (LVEF), between groups at 52 weeks (61% ± 6%). Other markers of cardiotoxicity, including high-sensitivity troponin I and brain natriuretic peptide, were similar between groups. However, total cholesterol (5.2 ± 0.8 mmol/L to 4.7 ± 0.8 mmol/L,
Conclusions
UNASSIGNED
The CR-modeled intervention had no effect on LVEF or biomarkers of cardiotoxicity. Future lifestyle intervention trials in patients with breast cancer should consider targeting other risk factors associated with incident cardiovascular disease. (Multidisciplinary Team IntervenTion in CArdio-ONcology [TITAN Study] [TITAN]; NCT01621659).
Identifiants
pubmed: 38939428
doi: 10.1016/j.jacadv.2023.100424
pii: S2772-963X(23)00283-1
pmc: PMC11198667
doi:
Banques de données
ClinicalTrials.gov
['NCT01621659']
Types de publication
Journal Article
Langues
eng
Pagination
100424Informations de copyright
© 2023 The Authors.
Déclaration de conflit d'intérêts
This trial was supported by the 10.13039/501100018911University Hospital Foundation, Edmonton, Alberta. During the study, Dr Kirkham was supported by Postdoctoral Fellowships from Susan G. Komen Foundation (PDF17483149) and the 10.13039/501100000024Canadian Institutes of Health Research. Dr Haykowsky is supported by the Faculty of Nursing Research Chair in Aging and Quality of Life at the 10.13039/501100000190University of Alberta. Dr Oudit has received study funding from 10.13039/100002429Amgen. Drs Oudit and Paterson are supported by the 10.13039/501100000024Canadian Institutes of Health Research and/or the 10.13039/100004411Heart and Stroke Foundation of Canada. Drs Dyck and Pituskin are each supported by 10.13039/501100001804Canada Research Chairs. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.