BACKGROUND: Poor cardiorespiratory fitness (CRF) is associated with a higher symptom burden and an increased prevalence of long-term treatment-related cardiovascular disease risk factors in cancer survivors. However, the magnitude of systemic therapy-related CRF impairment remains unclear. OBJECTIVES: The aim of this study was to evaluate the effects of systemic anticancer treatment on CRF and identify physiological determinants underpinning CRF impairment. METHODS: A systematic literature search was performed in PubMed, Embase, CINAHL, SPORTDiscus, and the Cochrane Library. The primary endpoint was the change in CRF, measured by peak oxygen consumption (Vo RESULTS: A total of 44 studies were included, comprising 27 prospective trials (61%
n = 1,234 cancer survivors, median age 52.4 years) and 17 cross-sectional studies (39%
n = 1,372 cancer survivors, median age 54.0 years
n = 1,923 noncancer control subjects, median age 56.0 years). Systemic anticancer treatment was associated with a significant decrease in Vo CONCLUSIONS: Systemic anticancer treatment leads to substantial and sustained impairments in CRF.