Telephone counseling leads more adult childhood cancer survivors to get heart screenings

November 03, 2014

(MEMPHIS, Tenn. - November 3, 2014) Supplementing written heart screening guidelines with telephone counseling from specially trained nurses more than doubled the likelihood that adult survivors of childhood cancer received recommended heart checks, according to results from the Childhood Cancer Survivor Study (CCSS). St. Jude Children's Research Hospital investigators led the research, whose findings appear in the current issue of the Journal of Clinical Oncology.

The research focused on adults whose childhood cancer treatment put them at risk for a variety of heart problems, including heart muscle weakness known as cardiomyopathy, which can lead to heart failure and other health problems. This study was designed to understand and address why more survivors do not get the periodic heart screenings that are recommended to detect cardiomyopathy early when interventions may slow disease progression and prevent heart failure.

In this study, cardiomyopathy screening by at-risk survivors rose from 22.3 percent to 52.2 percent when the written recommendations survivors received were followed by telephone counseling from nurse practitioners. The two brief counseling sessions focused on helping survivors identify and overcome barriers to receiving the recommended diagnostic testing.

Of the 153 survivors who got the recommended screening, 52.2 percent were found to have heart abnormalities that required continued medical monitoring. Cardiomyopathy was detected in 10 percent of the survivors who were screened.

"This intervention offers a model for how to motivate other cancer survivors, including survivors of adult cancers, to be more proactive about their health," said the study's first and corresponding author Melissa Hudson, M.D., a member of the St. Jude Department of Oncology. "This study shows that by understanding and addressing the concerns and obstacles survivors face to acting on screening recommendations, medical providers can increase the number of survivors who get this potentially life-saving test."

The U.S. is home to at least 328,000 residents who were age 20 or younger when their cancer was discovered. With overall childhood cancer survival rates in the U.S. now approaching 80 percent, the ranks of childhood cancer survivors will continue to increase.

Thanks to efforts like the CCSS and St. Jude long-term survivorship studies, there is a growing understanding of the health risks and challenges that survivors face. That knowledge has led to new approaches to help survivors and current cancer patients better manage or reduce such threats.

The strategies include screening guidelines for survivors treated with chest irradiation or chemotherapy drugs called anthracyclines, alone or in combination. Both therapies predispose survivors to cardiomyopathy before middle age. The risk increases with the cumulative dose of either therapy alone or in combination. Based on treatment histories, the Children's Oncology Group (COG) recommends at-risk survivors undergo cardiomyopathy screening annually or at two- or five-year intervals. COG is an international consortium of pediatric cancer researchers and institutions.

The 472 at-risk survivors in this study had gone at least five years without cardiomyopathy screening. On average, they were 40 years old, but ranged in age from 25 to 59 years old.

All were enrolled in the CCSS, an ongoing federally funded project designed to improve understanding and management of the health risks and challenges facing childhood cancer survivors as they age. The CCSS includes more than 12,000 adults who were age 20 or younger when their cancer was discovered between 1970 and 1986. The survivors were treated at 26 medical centers in the U.S. or Canada. CCSS participants are surveyed periodically about their health, health behaviors and use of health care services. None of the survivors in this study was enrolled in long-term follow-up programs that provide survivor health monitoring based on treatment-related risk.

After a baseline health assessment, survivors in this study received a personalized survivorship care plan in the mail that included a summary of their cancer treatments, health risks and cardiomyopathy screening recommendations. The recommendations were based on COG guidelines. The mailing included a laminated card summarizing the information and screening recommendations for survivors to share with their primary-care providers.

A week after receiving the care plan, nurses called 205 participants to discuss the survivors' concerns and barriers to completing the recommended screening. The nurses called again two weeks later. Survivors also received letters summarizing each counseling session.

A year later, 22.3 percent of survivors who received the written recommendations through the postal service had been checked for cardiomyopathy compared to the 52.2 percent of those who were also counseled by a nurse by telephone.

When researchers queried survivors about why they did not get screened, those in the counseling group were more likely to cite concerns about insurance coverage. Those who received the written information only were more likely to link lack of screening to the failure of their current health care provider to recommend the test. Hudson said the findings underscored the need for better communication among survivors, primary care providers and pediatric oncologists.

Meanwhile, researchers are working on ways to implement the intervention detailed in this study more widely, possibly by developing an online approach.
-end-
The other authors are Wendy Leisenring and Kayla Stratton, both of Fred Hutchinson Cancer Research Center, Seattle; Nina Tinner, Brenda Steen, Susan Ogg, Linda Barnes, Leslie Robison and Cheryl Cox, all of St. Jude; and Kevin Oeffinger, of Memorial Sloan Kettering Cancer Center, New York.

The research was funded in part by grants (NR011322, CA55727, CA21765) by the National Institutes of Health; and ALSAC.

St. Jude Media Relations Contacts

Summer Freeman
desk (901) 595-3061
cell (901) 297-9861
summer.freeman@stjude.org

Carrie Strehlau
desk (901) 595-2295
cell (901) 297-9875
carrie.strehlau@stjude.org

St. Jude Children's Research Hospital

St. Jude Children's Research Hospital is leading the way the world understands, treats and cures childhood cancer and other life-threatening diseases. It is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children. Treatments developed at St. Jude have helped push the overall childhood cancer survival rate from 20 percent to 80 percent since the hospital opened more than 50 years ago. St. Jude is working to increase the overall survival rate for childhood cancer to 90 percent in the next decade. St. Jude freely shares the breakthroughs it makes, and every child saved at St. Jude means doctors and scientists worldwide can use that knowledge to save thousands more children. Families never receive a bill from St. Jude for treatment, travel, housing and food--because all a family should worry about is helping their child live. To learn more, visit stjude.org or follow St. Jude at @stjuderesearch.

St. Jude Children's Research Hospital

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.