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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References
Tai E, Buchanan N, Townsend J, Fairley T, Moore A, Richardson LC. Health status of adolescent and young adult cancer survivors. Cancer. 2012;118(19):4884–91.
Turcotte LM, Liu Q, Yasui Y, Arnold MA, Hammond S, Howell RM, et al. Temporal trends in treatment and subsequent neoplasm risk among 5-year survivors of childhood cancer, 1970-2015. JAMA. 2017;317(8):814–24.
Marjerrison S, Barr RD. Unmet survivorship care needs of adolescent and young adult cancer survivors, invited commentary. JAMA Netw Open. 2018;1(2):e180350.
Lipshultz SE, Adams MJ, Colan SD, Constine LS, Herman EH, Hsu DT, et al. Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions: a scientific statement from the American Heart Association. Circulation. 2013;128(17):1927–95.
Chao C, Xu L, Bhatia S, Cooper R, Brar S, Wong FL, et al. Cardiovascular disease risk profiles in survivors of adolescent and young adult (AYA) cancer: the Kaiser Permanente AYA Cancer Survivors Study. J Clin Oncol. 2016;34(14):1626–33.
Abosoudah I, Greenberg ML, Ness KK, Benson L, Nathan PC. Echocardiographic surveillance for asymptomatic late-onset anthracycline cardiomyopathy in childhood cancer survivors. Pediatr Blood Cancer. 2011;57(3):467–72.
Keegan TH, et al. Comparison of cancer survival trends in the United States of adolescents and young adults with those in children and older adults. Cancer. 2016;122(7):1009–16.
de Rojas T, Neven A, Terada M, et al. Access to clinical trials for adolescents and young adults with cancer: a meta-research analysis. JNCI Cancer Spectr. 2019;3(4):pkz057. https://doi.org/10.1093/jncics/pkz057.
Snyder CF, Earle CC, Herbert RJ, Neville BA, Blackford AL, Frick KD. Preventive care for colorectal cancer survivors: a 5-year longitudinal study. J Clin Oncol. 2008;26(7):1073–9.
Landier W, Bhatia S, Eshelman DA, Forte KJ, Sweeney T, Hester AL, et al. Development of risk-based guidelines for pediatric cancer survivors: the Children's Oncology Group long-term follow-up guidelines from the Children's Oncology Group Late Effects Committee and Nursing Discipline. J Clin Oncol. 2004;22(24):4979–90.
Armenian SH, Hudson MM, Mulder RL, Chen MH, Constine LS, Dwyer M, et al. Recommendations for cardiomyopathy surveillance for survivors of childhood cancer: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol. 2015;16(3):e123–36.
Landier W, Armenian SH, Lee J, Thomas O, Wong FL, Francisco L, et al. Yield of screening for long-term complications using the children's oncology group long-term follow-up guidelines. J Clin Oncol. 2012;30(35):4401–8.
Clinical practice guidelines in oncology: adolescent and young adult oncology (NCCN guidelines). National Comprehensive Care Network.
Coccia PF, Altman J, Bhatia S, Borinstein SC, Flynn J, George S, et al. Adolescent and young adult oncology. Clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2012;10(9):1112–50.
Smith AW, Seibel NL, Lewis DR, Albritton KH, Blair DF, Blanke CD, et al. Next steps for adolescent and young adult oncology workshop: an update on progress and recommendations for the future. Cancer. 2016;122(7):988–99.
Madden NA, Deng C, Fitch T, Effinger KE, Zhang C, Goyal S, et al. Adherence to Children’s Oncology Group (COG) long-term follow-up guidelines for echocardiogram screening in young adult survivors of childhood cancer. J Clin Oncol. 2018;36:e22513.
Tonorezos ES, Oeffinger KC. Research challenges in adolescent and young adult cancer survivor research. Cancer. 2011;117(10 Suppl):2295–300.
Hahn EE, Wu YL, Munoz-Plaza CE, Garcia Delgadillo J, Cooper RM, Chao CR. Use of recommended posttreatment services for adolescent and young adult survivors of Hodgkin lymphoma. Cancer. 2019;125(9):1558–67.
Vogt TM, Aickin M, Ahmed F, Schmidt M. The Prevention Index: using technology to improve quality assessment. Health Serv Res. 2004;39(3):511–30.
Vogt TM, Feldstein AC, Aickin M, Hu WR, Uchida AR. Electronic medical records and prevention quality: the prevention index. Am J Prev Med. 2007;33(4):291–6.
Marr KC, Agha M, Sutradhar R, Pole JD, Hodgson D, Guttmann A, et al. Specialized survivor clinic attendance increases adherence to cardiomyopathy screening guidelines in adult survivors of childhood cancer. J Cancer Surviv. 2017;11(5):614–23.
Reynolds K, Spavor M, Brandelli Y, Kwok C, Li Y, Disciglio M, et al. A comparison of two models of follow-up care for adult survivors of childhood cancer. J Cancer Surviv. 2019;13(4):547–57.
Grunfeld E, Earle CC. The interface between primary and oncology specialty care: treatment through survivorship. J Natl Cancer Inst Monogr. 2010;2010(40):25–30.
Sima JL, Perkins SM, Haggstrom DA. Primary care physician perceptions of adult survivors of childhood cancer. J Pediatr Hematol Oncol. 2014;36(2):118–24.
Blanch-Hartigan D, Forsythe LP, Alfano CM, Smith T, Nekhlyudov L, Ganz PA, et al. Provision and discussion of survivorship care plans among cancer survivors: results of a nationally representative survey of oncologists and primary care physicians. J Clin Oncol. 2014;32(15):1578–85.
Barthel EM, et al. Variation among follow-up survivorship guidelines for adolescent and young adults (AYA). J Clin Oncol. 2016;34(3_suppl):147.
Nathan PC, Hayes-Lattin B, Sisler JJ, Hudson MM. Critical issues in transition and survivorship for adolescents and young adults with cancers. Cancer. 2011;117(10 Suppl):2335–41.
Barakat LP, Schwartz LA, Szabo MM, Hussey HM, Bunin GR. Factors that contribute to post-treatment follow-up care for survivors of childhood cancer. J Cancer Surviv. 2012;6(2):155–62.
Bitsko MJ, Cohen D, Dillon R, Harvey J, Krull K, Klosky JL. Psychosocial late effects in pediatric cancer survivors: a report from the Children's Oncology Group. Pediatr Blood Cancer. 2016;63(2):337–43.
Nass SJ, Beaupin LK, Demark-Wahnefried W, Fasciano K, Ganz PA, Hayes-Lattin B, et al. Identifying and addressing the needs of adolescents and young adults with cancer: summary of an Institute of Medicine workshop. Oncologist. 2015;20(2):186–95.
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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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 15, 738–747 (2021). https://doi.org/10.1007/s11764-020-00965-w
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DOI: https://doi.org/10.1007/s11764-020-00965-w