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Telephone counseling increased cardiomyopathy screenings in childhood cancer survivors

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The addition of telephone counseling to a printed survivorship care plan increased the frequency with which survivors of childhood cancer at risk for cardiovascular disease underwent cardiomyopathy screening, according to results of a randomized, controlled trial.

The trial included 472 participants in the Childhood Cancer Survivor Study (CCSS), a multicenter, retrospective cohort study that followed more than 12,000 childhood cancer survivors diagnosed between 1970 and 1986. All participants were aged at least 25 years; underwent treatment with anthracyclines and/or chest-directed radiation therapy involving cardiac structures; had not undergone cardiomyopathy screening within the previous 5 years; and had not participated in any follow-up program that included risk-based screening.

Melissa M. Hudson

Melissa M. Hudson, MD, of the department of oncology at St. Jude Children’s Research Hospital, and colleagues randomly assigned patients to receive standard survivorship care plans only (n=234) or survivorship care plans plus telephone counseling from advanced-practice nurses (n=238).

Following baseline examination, patients in the standard-care group received via email a customized survivorship care plan that summarized their individual cancer treatments and health risks, and offered personalized recommendations for cardiomyopathy screening based on Children’s Oncology Group (COG) guidelines.

Participants in the other group received the same materials, as well as two telephone counseling sessions with an advanced-practice nurse 1 week and 3 weeks after receipt of their survivorship care plan. The counseling sessions addressed potential patient barriers to cardiomyopathy screening, including health knowledge deficits, perceptions and health care access. After each counseling session, participants in this group also received a personalized follow-up letter.

The two study arms were comparable with regard to participants’ demographics and clinical characteristics.

Completion of cardiomyopathy screening within 12 months served as the primary outcome measure.

More patients assigned telephone counseling underwent screening at 1 year (52.2% vs. 22.3%; P<.001). After adjustments for gender, age and Children’s Oncology Group-recommended screening frequency, researchers determined participants assigned telephone counseling were more than twice as likely to undergo cardiomyopathy screening (RR=2.31; 95% CI, 1.74-3.07).

“This method of intervention provides pediatric cancer follow-up centers with a long reach to their survivor population that can be adapted to support other types of health-protective screening in other at-risk survivor populations,” Hudson and colleagues wrote. “Future efforts will assess the value of interventions that take advantage of electronic and mobile health applications, which may similarly facilitate survivors’ interaction with the appropriate health care providers.”

In an accompanying editorial, Saro H. Armenian, MD, of City of Hope in Duarte, Calif., praised the researchers for evaluating screening adherence outcomes in an important patient population.

“By selecting an older population of survivors who are not in active follow-up, they have demonstrated efficacy in a subset of survivors who may derive the most benefit from such interventions,” Armenian wrote. “Importantly, by designing a brief distance-delivered intervention, the study goes a long way to support the feasibility of implementing such interventions across a variety of clinical settings.

“The growing population of survivors at risk for treatment-related complications such as heart failure makes it imperative that strategies be developed not only to facilitate early screening, but also to identify efficacious options for risk reduction once subclinical disease has been identified,” Armenian added. “Multidisciplinary collaborations between oncologists, cardiologists, primary care, and other health care providers will be integral to the success of such initiatives.”

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Disclosure: One researcher reports research funding from Merck. Armenian reports no relevant financial disclosures.