Advanced-Practice Nurse Telephone Counseling Improves Rate of Cardiomyopathy Screening in At‑Risk Adult Survivors of Pediatric Cancer
In the ECHOS trial reported in the Journal of Clinical Oncology, Hudson et al found that the addition of two tailored telephone counseling sessions by an advanced-practice nurse to a mailed personalized survivorship care plan including cardiac screening recommendations resulted in a greater than twofold increase in recommended cardiomyopathy screening in high-risk adult survivors of pediatric cancer.
Although pediatric oncology survivorship guidelines recommend baseline and periodic cardiac imaging for at-risk survivors who have received cardiotoxic treatments, adherence to cardiomyopathy screening has been low. A recent study in the Childhood Cancer Survivor Study (CCSS) showed that screening within the prior 24 months was received by only 28.2% of 1,810 childhood cancer survivors considered to be at high risk due to treatment with anthracycline ≥ 300 mg/m2 or anthracycline plus chest irradiation.
Study Details
In the current trial, 425 survivors aged ≥ 25 years in the Childhood Cancer Survivor Study who had received cardiotoxic therapy and had reported no history of cardiomyopathy screening in the previous 5 years were randomly assigned to receive standard care consisting of a survivorship care plan summarizing cancer treatment and cardiac health screening recommendations (n = 234) or standard care plus two advanced-practice nurse telephone counseling sessions (n = 238). Patients had a mean age of 40 years (range = 25–59 years), and 53% were women. Completion of cardiomyopathy screening within 1 year was the primary outcome measure.
Screening Rates
At 1-year follow-up, 411 of 472 randomized survivors had completed the follow-up survey. Cardiomyopathy screening had been completed by 107 (52.2%) of 205 survivors in the advanced-practice nurse group compared with 46 (22.3%) of 206 survivors in the control group (P < .001). After adjustment for sex, age, and Children’s Oncology Group cardiomyopathy risk group, the adjusted relative risk (RR) for completing screening in the nurse group was 2.31 (95% confidence interval [CI] = 1.74–3.07; unadjusted RR = 2.34, 95% CI = 1.76–3.11). No other factors were found to modify the effect of the nurse intervention on likelihood of completing screening.
Reasons for Not Undergoing Screening
Among 224 patients who did not undergo screening, the most commonly cited reasons were lack of time (n = 62), screening not perceived to be important (n = 43), concerns about insurance coverage of testing (n = 43), inability to afford test or absence of insurance (n = 41), and lack of physician recommendation or ordering of screening (n = 35). Patients in the nurse counseling group were more likely to cite concerns over insurance coverage as a reason to not complete screening (29.4% vs 12.8%, P = .002), whereas those in the control group were more likely to cite lack of physician recommendation as a reason (19.9% vs 8.2%, P = .02).
The investigators concluded: “The addition of telephone counseling to [a survivorship care plan] with cardiac health screening recommendations increases cardiomyopathy screening in at-risk survivors.”
Melissa M. Hudson, MD, of St Jude Children’s Research Hospital, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by National Institutes of Health grants and by the American Lebanese Syrian Associated Charities. Wendy Leisenring, ScD, reported research funding from Merck.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
