Duke Cardio-Oncology. Physical Ac7vity for Cancer Survivors. Bridget Koontz MD Associate Professor Radia7on Oncology

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1 Duke Cardio-Oncology Physical Ac7vity for Cancer Survivors Bridget Koontz MD Associate Professor Radia7on Oncology

2 PA and the Cancer Con7nuum Diagnosis Treatment Surveillance PHYSICAL ACTIVITY / EXERCISE Preven7on Symptom Mgmt Tumor Biology Symptom Mgmt Preven4on

3 Cancer Cardiovascular Disease Diagnosis Treatment Surveillance Pre-Exis7ng CV Disease Cancer Risk Ability to Diagnosis Treatment Toxicity Dosing Toxicity Tolerance Late CV Effects Tx-Related Morbidity QOL CV Mortality

4 Duke Cancer Ins7tute Established in 1973 as a NCI designated Comprehensive Cancer Center More than 100 hundred physicians, 500 specialized staff new pa7ent visits each year

5 Duke Center for Living Duke Health and Fitness Center 30,000 sq ^ facility exercise physiologists, personal trainers, fitness specialists, die77ans, and massage therapists

6 Duke Cancer Ins7tute Cardio-Oncology Program Collabora7ons between Cardiology and Oncology Interac7on between cancer and cardiac disease Developing research data pla`orm Exper7se in heart failure, coronary disease, an7coagula7on, oncology, survivorship, and health outcomes data Contact: Chiara Melloni MD Michael Khouri MD

7 Duke Cancer Network Currently associated with 12 community hospitals / cancer prac7ces Best prac7ce research and clinical program support Strong interest in research, including QOL and survivorship care Contact: Linda Sucon MD Melanie Watson RN MSN ANP-C

8 Duke Primary Care Research Consor7um Includes 32 clinics and nearly 500 clinicians across NC family medicine, internal medicine, pediatrics Part of the North Carolina Network Consor7um (Duke, UNC-CH, ECU, CarolinasHC) Goals: clinical research to improve health care delivery and outcomes through evidencebased medicine Contact: Rowena Dolor MD

9 Interven7onal Approach Clinical: improving health / symptoms Preclinical: symptom preven7on, tumor biology Can we increase ac7vity in cancer survivors and ac7ve treatment pa7ents? What are most effec7ve strategies to do so? What does ac7vity do to tumor/treatment biology?

10 Previous Work - Highlights RENEW Morey and Demark-Wahnefried Workbook, telephone counseling Sta7s7cal improvement in minutes per week of exercise and dietary changes Improvement in mee7ng goals Strength exercise: 28% vs 11% (<.001) Endurance exercise: 15% v 11 % (.07) Saturated fat: 49% vs 38% (.001) JAMA :1883.

11 - develop mobile health technology to advance the delivery of health care through improved pa7ent-provider communica7on and collabora7ve health care management Mission is to design, test, and disseminate effec7ve digital health interven7ons in medically vulnerable popula7ons. Director: Gary Bennec PhD Programs Director: Erica Levine MPH

12 ICan STEP Increasing physical ac4vity in Cancer Survivors through a Text-messaging Exercise mo4va4on Program PI: Koontz Physical ac7vity promo7on pilot for cancer pa7ents & early survivors Fitbit Flex & daily text messaging program sends par7cipants 1 text/day with tailored informa7on about distance walked (measured in steps by Fitbit), feedback on progress, and 7ps Funded by Radia7on Oncology Now open and enrolling

13 Move2Health (PI Porter/Pollak) Couple-based counseling interven7on to promote physical ac7vity among pa7ents and their partners Technology: Skype (60min interven7on) x 4 Outcome: Feasibility/Acceptability Increased minutes ac7vity

14 Previous Work - Highlights 50 men a^er RP randomized to aerobic training or usual care Improvement in brachial FMD / VO2peak No effect on return of potency Eur Urol :852.

15 Cardiopulmonary Training Successful applica7on for ac7ve cancer pa7ents with LUNG PROSTATE BREAST Developing lab for Immuno-Exercise-Oncology research

16 EXTEND (PI Harrison)

17 Previous Work - Highlights PRECLINICAL Modula7on of murine breast tumor vascularity, hypoxia and chemotherapeu7c response by exercise (Betof/Dewhirst) JNCI PMID:

18 Exercise and Tumor Biology Palta observa7onal study of CPET tes7ng in GI cancers undergoing chemort/surgery Collec7on of serum/urine biomarkers Bartlec / Kraus developing exercise immunology lab

19 New Direc7ons Moving fitness into ac7ve cancer treatment Evalua7ng late effects of treatment on CV health Use of technology Community access