The cardio-oncology field has become an increasing focus among the management of cancer survivors. Despite the survival rate of most cancers increasing, cancer survivors experience an increased rate of cardiovascular diseases (CVD) such as ischaemic heart disease, heart failure and stroke compared with the general population. This is generally attributed to treatments such as chest radiotherapy, anthracyclines and methotrexate causing short and long term-effects. With known potential cardiovascular risks from treatment, an important clinical focus is to prevent the development of CVD after treatment. Supportive care such as increasing physical activity are becoming increasingly supported in oncology clinics, with the Clinical Oncology Society of Australia recently releasing their first statement supporting exercise. Despite this increasing support, receiving individualised physical activity advice and assessing cardiorespiratory fitness are not standard-of-care in Australian cancer hospitals.
Having higher physical activity and cardiorespiratory fitness levels has been shown to reduce the risk of CVD in the general population, as well as improving many physical and psychological factors impaired by cancer treatment. There are multiple methods of assessing cardiovascular fitness, a modifiable CVD risk factor. The gold standard, Cardiopulmonary Exercise Test, requires maximal patient exertion, trained staff, a calibrated gas analysis system and a cycle ergometer or treadmill. Cardiorespiratory fitness can also be estimated, which reduces sensitivity but becomes more practical when large patients volumes are seen and resources are limited. Patients can be objectively monitored over time using submaximal exercise assessments including the 6-minute walk test, 3-minute step test and a submaximal cycle test. Further, patients can generally accurately self-perceive if they have high or low fitness. This information should be used to identify patients with low fitness, to motivate them (and refer if necessary) to become more physically active and thus decrease their CVD risk.