Futility

Other than optimizing medical management of cardiac risk factors, and reducing radiotherapy (RT) dose to the heart, there currently exist no interventions to mitigate or reverse the adverse cardiac effects of RT. Aerobic exercise has been demonstrated to improve patient quality of life, cardiac outcomes, and cardiorespiratory fitness in patients with cancer receiving cardiotoxic systemic therapies, but the effects of aerobic exercise on patients at high risk for radiation induced heart disease (RIHD) is unknown. In addition, home-based cardiac rehabilitation has not been tested in patients with thoracic cancers.

Inclusion Criteria:

• Pathologically confirmed or radiographically diagnosed non-small cell lung cancer, small cell lung cancer, esophageal cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, sarcoma, thymoma, or left-sided breast cancer.
• Planning to receive neo-adjuvant, adjuvant, or definitive radiation therapy to the thorax with curative intent.
• Willing to participate in home-based cardiac rehabilitation program and be monitored remotely via smart phone application
• Possess a smart phone or tablet capable of supporting teleHeart application
• Willing and eligible to co-enroll in the Cardiovascular Toxicity in Cancer and Improvement in Recovery (SURVIVE) Registry Study (HRPO# 201801031).
• At least 18 years of age.
• ECOG performance status ≤ 2
• Ability to understand and willingness to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable).

Exclusion Criteria:

• Presence of distant metastatic disease (except patients with lymphoma).
• Life expectancy less than 6 months
• Patient lives in skilled nursing facility, chronic care facility, nursing home, or palliative care or hospice facility
• Unable to walk
• Presence of significant cancer disease burden that would make patient unlikely to tolerate cardiac rehabilitation (CR)
• Diagnosis of primary cervical esophageal cancer.
• Presence of unstable angina.
• Recipient of heart transplant.
• Patient on cardiac transplant list or has a ventricular assist device
• Patient's baseline weight > 300 lbs (due to weight limitations of the scale and bioelectrical impedance device)
• Pregnant and/or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 14 days of study entry.
• Other medical comorbidities that make the patient unable to participate in the CR program or other assessments involved with this study.