Cardio-Oncology: Cancer Treatment and Exercise

What Increases Your Risk?

Cancer Treatments

Before starting to exercise, the types of cancer treatments — whether you had surgery and what type of therapy you may have had — also should be considered.

If you received surgery:

❱❱ How long ago did you have surgery? If less than 3 or 4 months ago, it may not be safe for you to begin all types or intensities of exercise. Ask your surgeon or oncologist if it is safe for you to start reintroducing exercise into your life.

❱❱ Did you have major or minor surgery? More invasive surgeries take longer to heal than less invasive ones. Check with your surgeon to make sure it is safe for you to start to exercise again.

❱❱ Did you have lymph nodes removed? If so, and if the nodes were in or near the arms (shoulders) or legs (pelvis), you may be at higher risk for swelling of the arms or legs (lymphedema). Although lymphedema can be prevented and treated, it can’t be cured. If you had any lymph nodes removed as part of your cancer treatment talk with your surgeon or health care provider before starting to exercise.

❱❱ Do you have other surgery-related considerations? Patients in the process of, or who recently completed, reconstructive procedures need to be careful not to irritate the affected area to avoid infections. If you are in having, or recently had, a reconstructive procedure, check with your surgeon before starting to exercise.

❱❱ Have you had an ostomy? The major concerns around exercising with an ostomy include infection and herniation risks. An ostomy is a surgical procedure done to help the body remove waste when your digestive system is not working properly. An ostomy bag worn outside the body collects the waste. If you are living with an ostomy, you should avoid contact sports and water sports. However, you may be able to do other exercises safely, for example brisk walking and cycling. You also should avoid exercises that cause high levels of abdominal strain and obtain medical clearance before doing resistance exercise.

If you received chemotherapy, hormone therapy, or a targeted therapy:

❱❱ Is the treatment linked to higher risk of cardiotoxicity? If so, ask your provider whether it is safe to begin exercise. Make sure there is a plan to monitor your heart health during and after treatment. If you had more than one such treatment, be sure to ask about possible combined risks for the treatments you are receiving or received.

❱❱ How much of the medication did you receive, and how long were you taking it? In many cases, cardiotoxicity risk adds up over time. The more medication you receive, or the longer you are taking the medication, the greater the risk. If you are concerned about your risks, talk to your oncologist to learn more about your treatment options.

If you received radiation therapy:

❱❱ What area of the body was affected? Radiation may hurt your heart, lungs, blood vessels, nerves, and bones. Speak with your radiation oncologist to learn more about your radiotherapy-related risks.

❱❱ How much radiation therapy did you receive? The amount of radiation therapy you receive or received also influences your cardiotoxicity and exercise risks. Again, speak with your radiation oncologist to learn more. Are your blood counts stable?

❱❱ Some treatments can affect components of your blood, such as red blood cells, white blood cells, platelets, or plasma volume. These levels can influence your safety and ability to exercise. If you are on — or recently completed — treatment, it’s a good idea to check with your oncologist to see if your blood counts are in a safe range before exercising.

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Published: September 2018
Authors: Scott C. Adams, PhD; Lee W. Jones, PhD; Jessica M. Scott, PhD
Medical Reviewers: Peggy Anthony; Jennifer Klemp; Bonnie Ky, MD, MSCE, FACC

These modules were developed in collaboration with the Eastern Cooperative Group—American College of Radiology Imaging Network (ECOG-ACRIN) Cardiotoxicity Working Group and Patient Advocacy Group.

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