Structured Cardio-Oncology Rehabilitation for Cardiovascular Outcomes in Cancer Survivors (CORE-CTRCD)

A Multicenter, Prospective, Parallel-Group, Superiority Randomized Controlled Trial of Structured Cardio-Oncology Rehabilitation for Improving Cardiovascular Outcomes in Patients With Cancer Therapy-Related Cardiac Dysfunction or High Cardiovascular Risk

Cancer therapy-related cardiac dysfunction (CTRCD) has become a major cause of morbidity and mortality among cancer survivors. Although cardiac rehabilitation is recommended for cardiovascular disease prevention and management, high-quality randomized controlled evidence regarding its efficacy in cardio-oncology populations remains limited.

This multicenter, prospective, parallel-group, superiority randomized controlled trial aims to evaluate whether a structured cardio-oncology rehabilitation (CORE) program combined with usual care can improve cardiovascular outcomes in patients with CTRCD or cancer survivors at high cardiovascular risk, compared with usual care alone.

A total of 800 participants will be randomized in a 1:1 ratio to receive either structured cardio-oncology rehabilitation plus usual care or usual care alone. The intervention includes individualized exercise training, nutritional management, psychosocial support, cardiovascular risk-factor optimization, and patient education. Participants will be followed for 12 months.

The primary endpoint is time to first major adverse cardiovascular event (MACE) within 12 months. Secondary endpoints include changes in cardiorespiratory fitness, cardiac function, biomarkers, quality of life, physical function, psychological status, safety outcomes, and health economic outcomes.

Study Overview

• Status: Not yet recruiting
• Conditions: Heart Failure; Cardiovascular Risk; Cancer Survivorship; Cardio-oncology; Cancer Therapy-Related Cardiac Dysfunction
• Intervention / Treatment: Behavioral: Structured Cardio-Oncology Rehabilitation; Behavioral: Usual Care

Detailed Description

With advances in anti-cancer therapies, the number of cancer survivors has increased substantially worldwide. However, cancer therapy-related cardiac dysfunction (CTRCD) has emerged as a major long-term complication associated with increased cardiovascular morbidity, mortality, reduced quality of life, and impaired survival. Current management strategies primarily focus on pharmacologic prevention and treatment, while evidence-based non-pharmacologic interventions capable of improving hard cardiovascular outcomes remain insufficient.

Cardiac rehabilitation is a Class I recommended intervention for patients with cardiovascular diseases and has demonstrated benefits in improving cardiorespiratory fitness, reducing cardiovascular events, and enhancing quality of life. Emerging studies suggest that cardio-oncology rehabilitation may improve exercise capacity and cardiac function in cancer survivors; however, most existing studies are limited by small sample size, single-center design, and lack of hard clinical endpoints.

This study is a multicenter, prospective, parallel-group, superiority randomized controlled trial designed to evaluate the efficacy and safety of a structured cardio-oncology rehabilitation (CORE) program in patients with CTRCD or cancer survivors at high cardiovascular risk.

A total of 800 participants will be enrolled and randomized in a 1:1 ratio to either:

1. Structured cardio-oncology rehabilitation plus usual care; or
2. Usual care alone.

The intervention consists of a 12-week intensive rehabilitation phase followed by long-term maintenance guidance. Core components include:

• Individualized aerobic and resistance exercise training;
• Nutritional assessment and management;
• Psychosocial and behavioral support;
• Intensive cardiovascular risk-factor management;
• Patient education and self-management support. The primary endpoint is time to first major adverse cardiovascular event (MACE) within 12 months, including cardiovascular death, myocardial infarction, ischemic stroke, hospitalization for worsening heart failure, or urgent ICD/CRT implantation due to malignant arrhythmia or heart failure.

Secondary endpoints include:

• Changes in peak oxygen uptake (VO2peak);
• Changes in left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS);
• Biomarkers including hs-cTnI and NT-proBNP;
• Quality-of-life assessments;
• Physical function measures;
• Psychological outcomes;
• Safety outcomes and health economic outcomes. Outcome assessment personnel, laboratory staff, endpoint adjudicators, and statisticians will remain blinded to treatment allocation. The study includes centralized imaging review, standardized intervention protocols, electronic data capture, and oversight by an independent Data and Safety Monitoring Board (DSMB).

The findings of this trial are expected to provide high-quality evidence supporting the implementation of standardized cardio-oncology rehabilitation strategies in cancer survivors with cardiovascular toxicity or elevated cardiovascular risk.

• Study Type: Interventional
• Enrollment (Estimated): 800
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Xiang Xie, PhD; Phone Number: +86 15099169036; Email: xiangxie999@sina.com

Study Locations

• China
  • Xinjiang
    • Ürümqi, Xinjiang, China, 830054
      • The first affiliated hospital of Xinjiang medical university
      • Contact: Xiang Xie, Ph.D.; Phone Number: +86 15099169036; Email: xiangxie999@sina.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 18 years or older, regardless of sex.
• Histologically or cytologically confirmed solid tumor or hematologic malignancy.
• Completed curative anti-cancer therapy, or receiving stable adjuvant, maintenance, or palliative anti-cancer therapy.
• Meets at least one criterion for cancer therapy-related cardiac dysfunction (CTRCD) or high cardiovascular risk, including reduced LVEF after anti-cancer therapy, high-dose anthracycline exposure, chest radiotherapy with cardiovascular risk factors, heart failure after anti-cancer therapy, or elevated cardiac injury/heart failure biomarkers.
• Estimated life expectancy of at least 24 months as assessed by the treating oncologist.
• Able to complete baseline cardiopulmonary exercise testing and has no absolute contraindication to exercise training.
• Able and willing to provide written informed consent and comply with study intervention and follow-up.

Exclusion Criteria:

• Active progressive malignancy requiring urgent anti-cancer therapy, or estimated life expectancy less than 24 months.
• Severe structural heart disease, including severe valvular disease, congenital heart disease, end-stage heart failure, or waiting for heart transplantation or left ventricular assist device implantation.
• Absolute contraindications to exercise training, including uncontrolled malignant arrhythmia, acute myocarditis or pericarditis, acute coronary syndrome within 2 weeks, severe anemia, severe thrombocytopenia or neutropenia, uncontrolled hypertension, active infection, or severe musculoskeletal disease preventing exercise training.
• Participation in a structured cardiac rehabilitation program within the previous 12 months, or regular moderate-to-vigorous aerobic or resistance training for at least 3 months before enrollment.
• Implanted ICD or CRT, except pacemakers with exercise mode.
• Severe psychiatric disease or cognitive impairment preventing participation.
• Concurrent participation in another interventional clinical trial, or planned participation in another interventional clinical trial during the study period.
• Any other condition that, in the investigator's judgment, makes the participant unsuitable for the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Structured Cardio-Oncology Rehabilitation; Participants will receive a structured cardio-oncology rehabilitation program combined with usual care. The intervention includes individualized aerobic and resistance exercise training, nutritional management, psychosocial support, cardiovascular risk-factor optimization, and patient education for 12 weeks, followed by maintenance rehabilitation guidance through 12 months.	Behavioral: Structured Cardio-Oncology Rehabilitation; A structured cardio-oncology rehabilitation program including individualized aerobic and resistance exercise training, nutritional management, psychosocial support, cardiovascular risk-factor optimization, and patient education. The intervention consists of a 12-week intensive rehabilitation phase followed by maintenance rehabilitation guidance through 12 months.
Active Comparator: Usual Care; Participants will receive usual cardio-oncology care, including routine oncology and cardiovascular follow-up and general health advice, without structured cardio-oncology rehabilitation.	Behavioral: Usual Care; Participants receive routine oncology and cardiovascular follow-up and general health advice without structured cardio-oncology rehabilitation or supervised exercise training.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to First Major Adverse Cardiovascular Event (MACE)	Time from randomization to the first occurrence of a major adverse cardiovascular event (MACE), including cardiovascular death, myocardial infarction, ischemic stroke, hospitalization for worsening heart failure, or urgent ICD/CRT implantation due to malignant arrhythmia or heart failure.	From randomization to 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Peak Oxygen Uptake	Change in peak oxygen uptake (VO2peak) measured by cardiopulmonary exercise testing.	From baseline to 12 months
Change in HADS Depression Score	The Hospital Anxiety and Depression Scale (HADS) Depression subscale ranges from 0 to 21, with higher scores indicating greater depressive symptoms.	From baseline to 12 months
Change in Left Ventricular Ejection Fraction	Change in left ventricular ejection fraction (LVEF) measured by three-dimensional echocardiography.	From baseline to 12 months
Change in Global Longitudinal Strain	Change in global longitudinal strain (GLS) measured by echocardiography.	From baseline to 12 months
Change in NT-proBNP	Change in N-terminal pro-B-type natriuretic peptide level.	From baseline to 12 months
Exercise-Related Adverse Events	Incidence of adverse events related to the rehabilitation intervention or exercise training.	From randomization to 12 months
Change in High-Sensitivity Cardiac Troponin I	Change in high-sensitivity cardiac troponin I level.	From baseline to 12 months
Change in 6-Minute Walk Distance	Change in 6-minute walk distance measured by the 6-minute walk test.	From baseline to 12 months
Change in SF-36 Score	Change in the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) score. Scores range from 0 to 100, with higher scores indicating better health-related quality of life.	From baseline to 12 months
Change in EORTC QLQ-C30 Global Health Status Score	Change in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status score. Scores range from 0 to 100, with higher scores indicating better quality of life.	From baseline to 12 months
Change in Hospital Anxiety and Depression Scale (HADS) Anxiety subscale score.	The Hospital Anxiety and Depression Scale (HADS) Anxiety subscale ranges from 0 to 21, with higher scores indicating greater anxiety symptoms.	From baseline to 12 months
Anti-Cancer Treatment Interruption	Incidence of interruption of anti-cancer treatment during the study period.	From randomization to 12 months

Collaborators and Investigators

• Sponsor: Xinjiang Medical University

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): September 30, 2029
• Study Completion (Estimated): September 30, 2029

Study Registration Dates

• First Submitted: May 15, 2026
• First Submitted That Met QC Criteria: June 2, 2026
• First Posted (Actual): June 3, 2026

Study Record Updates

• Last Update Posted (Actual): June 3, 2026
• Last Update Submitted That Met QC Criteria: June 2, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Exercise Training; Cardiac Rehabilitation; Major Adverse Cardiovascular Events; Cancer Survivors; Cardiorespiratory Fitness; CTRCD; Structured Cardio-Oncology Rehabilitation
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Heart Diseases; Heart Failure
• Other Study ID Numbers: CORE-CTRCD-RCT-2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data underlying the results reported in publications arising from this study will be shared, including demographic data, baseline characteristics, outcome measures, adverse events, and follow-up data.
• IPD Sharing Time Frame: Beginning 12 months after publication of the primary study results and ending 5 years after publication.
• IPD Sharing Access Criteria: Qualified researchers who provide a methodologically sound proposal may gain access to de-identified individual participant data and supporting documents. Requests will be reviewed by the study investigators and sponsoring institution. Data will be shared after approval of a data access agreement and will be provided through a secure data-sharing platform or institutional repository.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No