A new whitepaper from the International Cardio-Oncology Society (ICOS) CORE working group outlines a critical roadmap for advancing the cardiovascular care of cancer survivors. Published in the European Heart Journal, the paper reviews the current evidence for cardio-oncology rehabilitation and exercise (CORE) programmes and sets new standards for future research to address significant knowledge gaps.¹

With a growing population of cancer survivors facing an increased long-term risk of cardiovascular disease (CVD), there is an urgent need for effective preventative strategies. CORE programmes adapt the established, multi-component cardiac rehabilitation model specifically for cancer survivors. This approach integrates prescriptive exercise, nutritional counselling, CVD risk factor management, and psychosocial support to mitigate the adverse cardiovascular effects of cancer therapies.

This consensus paper, developed by a multidisciplinary team of international experts, highlights that while the CORE model is promising, its widespread adoption as a standard of care is hindered by a lack of robust evidence. The authors reviewed the existing literature, distinguishing between comprehensive ‘CORE research’ and more limited ‘CORE-relevant research’. They found that most studies to date have not been specifically designed to test a multi-modal CORE intervention in high-risk cancer patients with primary cardiovascular endpoints.

While recent trials like ONCORE and the CORE study have shown these programmes are safe and can improve cardiorespiratory fitness and quality of life, the evidence for their impact on hard outcomes such as cancer therapy-related cardiac dysfunction (CTRCD) and mortality remains limited. The working group notes that the heterogeneity and variable quality of current research make it difficult to synthesise data and draw firm conclusions.

In practice, the paper serves as a call to action for the clinical and research communities. The authors state that CORE is an “attractive model that is potentially scalable to improve the cardiovascular health of cancer survivors as it leverages many of the existing frameworks developed through decades of delivery of cardiac rehabilitation.”¹ However, they stress that generating high-quality evidence is a critical antecedent to achieving key goals, including securing third-party reimbursement and integrating CORE into routine cancer care. This approach has been previously endorsed in a scientific statement from the American Heart Association.²

To guide future efforts, the ICOS-CORE working group has proposed a detailed set of research priorities and standards. These include recommendations for trial design, rigorous intervention reporting, and consistent outcome assessment to improve the quality of evidence. By standardising research practices, the group aims to accelerate the discovery and translation of effective CORE strategies to improve long-term outcomes for cancer survivors.

References

1. Adams SC, Rivera-Theurel F, Scott JM, et al. Cardio-oncology rehabilitation and exercise: evidence, priorities, and research standards from the ICOS-CORE working group. Eur Heart J. 2025;46(29):2847–2865. https://doi.org/10.1093/eurheartj/ehaf100

2. Gilchrist SC, Barac A, Ades PA, et al. Cardio-Oncology rehabilitation to manage cardiovascular outcomes in cancer patients and survivors: a scientific statement from the American Heart Association. Circulation. 2019;139:e997–1012. https://doi.org/10.1161/CIR.0000000000000679

Disclaimer

The information presented in this article is for educational purposes only. Any quotes included reflect the opinions of the individual quoted, and do not necessarily reflect the views of the publisher. The publisher does not guarantee the accuracy or completeness of the content and accepts no responsibility for any errors, or any consequences arising from its use.