Evaluation of exercise capacity by means of cardiopulmonary exercise testing (CPET) in older adult cancer patients undergoing antineoplastic treatments

Background and aims. Functional capacity measured with cardiopulmonary exercise testing (CPET) is extensively studied in patients with cardiovascular diseases. In the current prospective study, we aim at exploring the role of CPET in oncologic patients and at evaluating exercise capacity and its variation with the administration of oncologic treatments. Material and methods. We analyzed 77 maximal CPETs from older adult cancer patients and assessed exercise capacity. CPETs were performed before starting (t0), during (t1) and at the end of (t2) oncologic treatments. The main outcome was death for all causes. Results. CPETs performed at t0 and t1 showed a reduced percent predicted peak V-O2, compared to CPETs performed at t2. In addition, at t2 we observed higher peak achieved workload and longer exercise time compared to t0 and t1. Intriguingly, achieved workload and oxygen uptake at Anaerobic Threshold were lowest in CPETs performed at t1, while Respiratory Exchange Ratio (RER) was higher in t1. Predicted V-o2/HR and oxygen pulse (V-o2/HR), were higher after therapy and lower during oncologic treatments. These abnormalities were even more evident in CPETs of patients who underwent anthracyclines-based treatments, and when comparing patients who then died later during follow-up (G1) vs patients who survived (G2). Conclusions. CPET can be useful to evaluate exercise capacity and muscular metabolic alterations in older adult cancer patients. The effectiveness of this technology in predicting survival or the increased incidence of cardiovascular events in cancer patients is not fully understood; further studies are needed to define the role of CPET in assessing the benefits of aerobic exercise and its potential "therapeutic" prescription in cancer patients.