TOPLINE:

A randomized clinical trial of 347 adult survivors of childhood cancer found that survivorship care plan-based counseling did not significantly reduce cardiovascular disease (CVD) risk factor undertreatment compared to screening results alone. After 1 year, 26% of intervention participants and 30.2% of control participants showed improved risk factor control.

METHODOLOGY:

• CVD is a leading contributor to morbidity and mortality in cancer survivors, particularly affecting childhood cancer survivors. More than 80% of adult survivors of childhood cancer are followed by primary care clinicians (PCCs), yet most younger adult-aged survivors at high risk do not receive recommended CVD screening tests. The study aimed to determine whether a survivorship care plan coupled with brief, remotely delivered counseling sessions could improve control of conventional CVD risk factors among high-risk adult survivors of childhood cancer.
• Researchers conducted the Communicating Health Information and Improving Coordination With Primary Care Study, a randomized clinical trial enrolling 347 adult survivors of childhood cancer exposed to cardiotoxic therapies in nine US metropolitan areas between August 2017 and April 2020.
• Participants with undertreated CVD risk factors (hypertension, dyslipidemia, and glucose intolerance) were randomized 1:1 to receive either a survivorship care plan with two remote counseling sessions or an enhanced care control, which involved receiving screening results and written encouragement to follow-up with their PCC.
• Analysis included blood pressure measurements, lipid profiles, glucose and A1c levels collected at baseline and 1-year follow-up, with undertreatment defined by standard guidelines.
• PCCs received all materials sent to participants, with follow-up completed by July 2022.

TAKEAWAY:

• Among intervention participants, greater engagement with the action plan was associated with less undertreatment at 1 year (odds ratio [OR], 0.31; 95% CI, 0.18-0.72).
• The intervention group showed an improved documentation of CVD risk in primary care records compared to control group after 1 year (improvement, 14.8% vs 0.9%; P = .002).
• Both groups demonstrated significantly lower diastolic blood pressure (-2.3 mm Hg for intervention and -1.9 mm Hg for control) and low-density lipoprotein cholesterol (-18.0 mg/dL for intervention and -20.1 mg/dL for control) values after 1 year.
• The intervention did not reduce overall risk for undertreatment compared to control after adjusting for covariates (OR, 1.31; 95% CI, 0.84-2.05).

IN PRACTICE:

“In this randomized clinical trial of long-term survivors of childhood cancer, the addition of survivorship-based self-management counseling did not reduce undertreatment beyond simply providing CVD risk assessments to survivors and PCCs. Additional strategies to mitigate CVD risk in high-risk survivors should be examined in the future,” the authors of the study wrote.

SOURCE:

This study was led by Eric J. Chow, MD, MPH, Fred Hutchinson Cancer Center in Seattle. It was published online on February 5 in JAMA Network Open.

LIMITATIONS:

According to the authors, while the trial did not meet its prespecified accrual goal, the degree of improvement seen in the control group suggests that even a fully accrued trial would not have had sufficient power to detect a significant difference. The study population was primarily drawn from a long-standing cohort that may not fully reflect the more racially and ethnically diverse contemporary pediatric cancer patient population. Additionally, trial eligibility was limited to English speakers, which excluded more vulnerable populations from minority racial and ethnic groups. The study was also geographically limited to participants living near selected metropolitan areas, potentially affecting generalizability to survivors with less access to primary care or those living in more rural areas.

DISCLOSURES:

This study received support through grants CA204378 and CA55727 from the National Institutes of Health and the Unravel Pediatric Cancer Foundation. Additional support was provided to the Fred Hutchinson Cancer Center through grant CA15704 and to St. Jude Children’s Research Hospital through grant CA21765 and the American Lebanese-Syrian Associated Charities. Claire Snyder, PhD, reported receiving grant support from Pfizer Inc, Genentech, personal fees from Shionogi and Movember, and travel costs from Shionogi and Executive Insight Healthcare Consultants outside the submitted work. Karen L. Syrjala, PhD, disclosed receiving personal fees for coauthoring chapters for UpToDate and having a patent with royalties paid. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.