KEY TAKEAWAYS
- The CHIIP trial aimed to describe healthcare utilization patterns related to CVD screening and survivorship care in adult childhood cancer survivors.
- Medical records from PCPs over 2 years were used to assess cardiac testing and other factors in childhood cancer survivors, with multivariate logistic regression to identify predictors of cardiac testing.
- The study found childhood cancer survivors at high risk of heart disease are rarely screened, and their medical records often lack information about their risk.
Half a million childhood cancer survivors in the US are at high risk of heart disease, the leading non-cancer cause of death in this group. Primary care providers are largely responsible for their care but don’t know much about how often they are screened for heart disease and other late effects.
Researchers aimed to describe healthcare utilization patterns related to cardiovascular disease (CVD) screening and survivorship care in adult childhood cancer survivors.
The study examined medical records from the patient’s(pt’s) primary care physicians (PCPs) for the two years leading up to their enrollment in the trial. Information was recorded on the frequency of PCP and specialist visits, the presence of CVD conditions (hypertension, dyslipidemia, diabetes), and the completion or scheduling of screenings such as blood pressure, lipid, diabetes testing, and cardiac testing (i.e., blood pressure, lipid, diabetes testing, and cardiac testing [ECG, echocardiogram, or other imaging completed or planned]). The study documented whether there was an acknowledgment of the pt’s cancer history, exposure to cardiotoxic treatments, or the presence of a survivorship care plan (SCP). Using multivariable logistic regression, they analyzed the characteristics associated with undergoing cardiac testing while keeping covariates associated with P< 0.10 in univariate testing.
Of 347 enrolled patients(pts), 293 (84%) had evaluable data (median age 40y, range 22–65; 49% female; 87% non-Hispanic White; mean 31y since childhood cancer). In the prior 2 years, 81% of pts had a documented PCP office visit (median 3 visits [IQR 2–5]), 22% had a subspecialty visit (4% saw cardiology), and 16% had no visits. The prevalence of blood pressure, lipid, and diabetes screening was 82%, 57%, and 63%, respectively; 29% had cardiac testing done or planned, including 22% with echocardiography. Only 68% of pts had records referencing a history of cancer. PCP documentation of prior cardiotoxic exposures was low compared with known exposures to radiotherapy (35% vs 69%; P< 0.001), anthracycline chemotherapy (9% vs 76%; P= 0.017); only 12% had any documentation noting an increased risk for CVD. Few pts’ records referenced a need for cancer-related late effects surveillance (38%), and even fewer referenced an SCP (5%). In multivariable analysis, independent predictors of cardiac testing included documentation of increased CVD risk (OR 11.61, 95% CI 3.31–40.67), presence of a late effects surveillance plan (OR 3.71, 95% CI 1.62–8.48), and existing CVD conditions (modeled as 0, 1, or 2+ conditions; OR 2.21, 95% CI 1.41–3.47, for each additional level).
The study found childhood cancer survivors at high risk of heart disease are rarely screened, and their medical records often lack information about their risk.
Source: https://ascopubs.org/doi/abs/10.1200/JCO.2023.41.16_suppl.e22020
Clinical Trial: https://clinicaltrials.gov/study/NCT03104543
Timothy James Daeeun Ohlsen, Yan Chen, Laura-Mae Baldwin, Melissa M. Hudson, Paul C. Nathan, Claire Frances Snyder, Karen L Syrjala, Emily S. Tonorezos, Yutaka Yasui, Gregory T. Armstrong, Kevin C. Oeffinger, and Eric Jessen Chow. DOI: 10.1200/JCO.2023.41.16_suppl.e22020 Journal of Clinical Oncology 41, no. 16_suppl (June 01, 2023) e22020-e22020.
