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Adherence to Children’s Oncology Group (COG) long-term follow-up guidelines for echocardiogram screening in young adult survivors of childhood cancer.
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2018
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Family MedicineHeart FailureCardiometabolic RiskPrognosisEpidemiology Of CancerPopulation Health SciencesPreventive CardiologyCog GuidelinesCancer EducationLogistic AnalysisPublic HealthCancer ResearchCancer LiteracyCardiovascular EpidemiologyMedicineYoung Adult SurvivorsRiskOutcomes ResearchCardiac CareEpidemiologyPrognostic EvaluationCancer EpidemiologyCardiovascular DiseaseCancer ScreeningPediatricsE22513 BackgroundPediatric OncologyOncologyChildhood CancerEchocardiogram Screening
e22513 Background: Late morbidity is of increasing importance with improved survival from childhood cancer. The COG Long-term Follow-up Guidelines recommend echocardiogram screening in patients who received cardiotoxic treatments, with high risk patients receiving more frequent echos. We assessed adherence to screening guidelines and cardiotoxicity rates in a young adult (YA) survivor cohort. Methods: We reviewed survivors of childhood cancer seen in our YA clinic from 2005-14 who received cardiotoxic treatment. Ever smokers were those who currently or previously smoked. COG high-risk patients were those with recommended annual screening. Cardiomyopathy was defined as an EF < 50%, symptomatic heart failure, or requiring medications. Echo screening adherence was defined as the COG recommended interval +/- 6 months. One-way ANOVA test and Kruskal-Wallis test were performed for numerical covariates. χ2was used for categorial covariates. A multivariable logistic regression was fit by a backward variable selection method with an a = 0.2 removal criteria. Results: 94 consecutive survivors (median age 28, range 24-51, time off therapy 13.1 years, time in YA survivor clinic 4.3 years) were identified. Patients were mostly white (77%); employed (70%); and insured at last follow up (87%). 9 had a lapse in insurance. 87 received anthracyclines (median dose 210 mg/m2); 46 received radiation involving the heart. 69.6% of patients were adherent to echo screening guidelines. Insured patients were more likely to adhere to screening (OR 5.67 (1.15-28.02)), while longer follow up in survivorship clinic was associated with non-adherence (OR 0.77 (0.63-0.94)). Cardiomyopathy was found in 17 patients (18.1%). Ever smokers (p = 0.012, OR 5.56 (1.46-21.13)) and COG high risk patients (p = 0.016, OR 4.28 (1.31-13.99)) were at higher risk for cardiomyopathy. Conclusions: Participants in our program had high adherence to COG guidelines. Insurance lapses and longer follow up were associated with not receiving recommended screening. Ever smokers and COG high risk patients were at highest risk of cardiomyopathy and should be targeted for adherence initiatives.