Nav: Home

Device may detect heart dysfunction in childhood cancer survivors treated with chemo

June 21, 2018

Bottom Line: A wireless device designed for detection of heart dysfunction in childhood cancer survivors treated with anthracycline chemotherapy was accurate and displayed a low false-negative rate as compared to cardiac magnetic resonance (CMR) imaging.

Journal in Which the Study was Published:Clinical Cancer Research, a journal of the American Association for Cancer Research.

Author: Saro Armenian, DO, MPH, director of the Childhood Cancer Survivorship Clinic, City of Hope, Duarte, California

Background: "The pediatric oncology community is becoming increasingly aware that there are new issues faced by many cancer survivors that may not manifest themselves until decades after their cancer treatment is done," said Armenian. "One of these issues is a higher burden of cardiovascular disease, which can result from exposure to anthracyclines [a class of chemotherapy] as part of their cancer treatment."

Because of known anthracycline-induced cardiotoxicity, it is recommended that childhood cancer survivors undergo screening for the detection of heart dysfunction following the completion of their treatment. Screening via echocardiography is the standard of care for monitoring heart function, yet this technique can be highly variable and has many limitations, noted Armenian. CMR imaging is an alternative screening method and is regarded as the gold standard; however, this screening approach is expensive and is not widely accessible.

Furthermore, while 90 percent of long-term cancer survivors (individuals surviving more than five years after their initial diagnosis) are actively engaged in regular medical care, less than 30 percent of this population undergo routine recommended risk-based screening, Armenian explained. "We need a method to facilitate the population-based screening that is being underperformed in these cancer survivors," he noted.

How the Study Was Conducted: Armenian and colleagues tested the accuracy of Vivio, a prototype handheld instrument which collects pulse waves and phonocardiogram data from the carotid artery. The data is then streamed wirelessly to a compatible device such as a smart phone or e-tablet. This mobile health platform negates the need for result interpretation and allows for real-time monitoring of heart health, explained Armenian. Using a specialized algorithm, Vivio measures the left ventricular ejection fraction (LVEF), which is commonly used to assess heart function and measures the percentage of blood ejected from the left ventricle of the heart. An LVEF measurement of less than 50 percent may indicate signs of abnormal heart function, explained Armenian.

The researchers compared Vivio with both echocardiography and CMR imaging in 191 patients who had been exposed to anthracycline chemotherapy. Participants were diagnosed with cancer before 22 years of age and had completed their treatment at least two years prior to the study.

Results: The average LVEF measurement from Vivio was comparable to that of CMR imaging (56.8 percent versus 56.5 percent, respectively). The average LVEF as measured by echocardiography was higher (61.7 percent), resulting in high false-negative rates. Using CMR imaging as the gold standard, Vivio displayed high sensitivity and a low false-negative rate for the identification of individuals with abnormal LVEF (85.7 and 14.3 percent, respectively).

Author's Comments: Importantly, Vivio is not currently intended to replace echocardiography or CMR imaging, noted Armenian. As both echocardiography and CMR imaging generate images of the heart, these techniques can provide a more comprehensive assessment of heart health and facilitate the diagnosis of heart problems.

"One possible implementation of Vivio could be for preliminary screening," Armenian explained. "If the patient's heart function is below a specific threshold as measured by Vivio, that patient could schedule an in-depth evaluation. This way, Vivio could keep these survivors engaged and help to reduce the burden of inconvenient tests for individuals with a normal heart function as determined by the device.

"This study is the first step in thinking about new paradigms of long-term monitoring and care delivery for cancer survivors who are at risk for severe and life-threatening health conditions," said Armenian. "It's important to think about more proactive and convenient approaches for early detection, early surveillance, and early prevention to help potentially reverse heart disease before it becomes clinically apparent in this population."

Study Limitations: Limitations include that this study was conducted at a single center. Furthermore, a small subset of individuals (3.8 percent) were excluded from the analysis due to low quality readings from Vivio.
-end-
Funding & Disclosures: This study was sponsored by the Caltech-City of Hope Biomedical Research Initiative and the Leukemia & Lymphoma Society Scholar Award for Clinical Research.

Vivio is a product of Avicena LLC, in which several authors hold equity, employment agreements, and consulting agreements. One author is an unpaid board member of Avicena, and authors in this study are involved in patents related to this research. Armenian declares no conflict of interest.

American Association for Cancer Research

Related Cancer Articles:

Radiotherapy for invasive breast cancer increases the risk of second primary lung cancer
East Asian female breast cancer patients receiving radiotherapy have a higher risk of developing second primary lung cancer.
Cancer genomics continued: Triple negative breast cancer and cancer immunotherapy
Continuing PLOS Medicine's special issue on cancer genomics, Christos Hatzis of Yale University, New Haven, Conn., USA and colleagues describe a new subtype of triple negative breast cancer that may be more amenable to treatment than other cases of this difficult-to-treat disease.
Metabolite that promotes cancer cell transformation and colorectal cancer spread identified
Osaka University researchers revealed that the metabolite D-2-hydroxyglurate (D-2HG) promotes epithelial-mesenchymal transition of colorectal cancer cells, leading them to develop features of lower adherence to neighboring cells, increased invasiveness, and greater likelihood of metastatic spread.
UH Cancer Center researcher finds new driver of an aggressive form of brain cancer
University of Hawai'i Cancer Center researchers have identified an essential driver of tumor cell invasion in glioblastoma, the most aggressive form of brain cancer that can occur at any age.
UH Cancer Center researchers develop algorithm to find precise cancer treatments
University of Hawai'i Cancer Center researchers developed a computational algorithm to analyze 'Big Data' obtained from tumor samples to better understand and treat cancer.
New analytical technology to quantify anti-cancer drugs inside cancer cells
University of Oklahoma researchers will apply a new analytical technology that could ultimately provide a powerful tool for improved treatment of cancer patients in Oklahoma and beyond.
Radiotherapy for lung cancer patients is linked to increased risk of non-cancer deaths
Researchers have found that treating patients who have early stage non-small cell lung cancer with a type of radiotherapy called stereotactic body radiation therapy is associated with a small but increased risk of death from causes other than cancer.
Cancer expert says public health and prevention measures are key to defeating cancer
Is investment in research to develop new treatments the best approach to controlling cancer?
UI Cancer Center, Governors State to address cancer disparities in south suburbs
The University of Illinois Cancer Center and Governors State University have received a joint four-year, $1.5 million grant from the National Cancer Institute to help both institutions conduct community-based research to reduce cancer-related health disparities in Chicago's south suburbs.
Leading cancer research organizations to host international cancer immunotherapy conference
The Cancer Research Institute, the Association for Cancer Immunotherapy, the European Academy of Tumor Immunology, and the American Association for Cancer Research will join forces to sponsor the first International Cancer Immunotherapy Conference at the Sheraton New York Times Square Hotel in New York, Sept.

Related Cancer Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Bias And Perception
How does bias distort our thinking, our listening, our beliefs... and even our search results? How can we fight it? This hour, TED speakers explore ideas about the unconscious biases that shape us. Guests include writer and broadcaster Yassmin Abdel-Magied, climatologist J. Marshall Shepherd, journalist Andreas Ekström, and experimental psychologist Tony Salvador.
Now Playing: Science for the People

#513 Dinosaur Tails
This week: dinosaurs! We're discussing dinosaur tails, bipedalism, paleontology public outreach, dinosaur MOOCs, and other neat dinosaur related things with Dr. Scott Persons from the University of Alberta, who is also the author of the book "Dinosaurs of the Alberta Badlands".