Adherence to cardiomyopathy screening guidelines among adolescent and young adult cancer survivors exposed to chest radiation and/or anthracyclines

Abstract

Purpose

Cancer survivors are at risk for late effects from therapeutic exposures, including cardiovascular complications. To improve outcomes among adolescents and young adults (AYA) with cancer, the National Comprehensive Cancer Network (NCCN) released guidelines for screening services (based on the Children’s Oncology Group Long-Term Follow-Up [LTFU] guidelines) for survivors of AYA cancer. To better understand survivorship care gaps, we conducted a baseline evaluation of cardiomyopathy screening among survivors of AYA cancers.

Methods

Members of Kaiser Permanente Southern California diagnosed with cancer between ages 15 and 39 from 2000 to 2010 with at least 5-year survival after diagnosis who were exposed to chest radiation and/or anthracyclines were included. We calculated the Prevention Index ([PI], proportion of person-time covered by receipt of preventive services relative to the total person-time eligible) to evaluate adherence to recommended cardiomyopathy screenings based on the LTFU through 2016. Predictors for screening were evaluated in multivariable logistic regression.

Results

Among 479 survivors recommended for cardiomyopathy screening, 28 received at least one screening, and the mean PI was 2.38% (SD = 13.05%, median = 0.00%). Compared to stage I, survivors of stage II (odds ratio [OR] = 5.56 [1.05–29.46]) and stage III/IV cancer (OR = 6.08 [1.10–33.54]) were more likely to receive cardiomyopathy screening.

Conclusions

Cardiomyopathy screening among survivors was low around the time when NCCN AYA oncology guidelines were released.

Implications for Cancer Survivors

Our study highlights significant room for improvement for adherence to cardiomyopathy screening recommendations among survivors of AYA cancer. Attention is needed to ensure that recommended cardiomyopathy screenings are met for better management of cardiomyopathy late effects.

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Acknowledgments

The authors thank the patients of Kaiser Permanente for helping us improve care through the use of information collected through our electronic health record systems.

Funding

This study was supported by the National Cancer Institute (grant # 1R21CA198042-01A1).

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Correspondence to Chun Chao.

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The authors declare that they have no conflicts of interest to disclose.

Ethical approval

Ethical approval for the study was obtained from the Kaiser Permanente Southern California Institutional Review Board, and a waiver of informed consent was granted.

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Tanenbaum, H.C., Wolfson, J., Xu, L. et al. Adherence to cardiomyopathy screening guidelines among adolescent and young adult cancer survivors exposed to chest radiation and/or anthracyclines. J Cancer Surviv (2020). https://doi.org/10.1007/s11764-020-00965-w

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Keywords

  • Survivorship
  • Cardiomyopathy
  • Adolescents and young adults
  • AYA
  • Late effects