Key result
A survey of 65 physicians revealed that while 89% regularly screen childhood cancer patients, evaluation by a cardiologist was significantly more common post-therapy (43%) than prior to or during therapy (12%).
Why the study?
To enhance the understanding of cardiovascular care delivery in childhood cancer patients and survivors.
Cross-Sectional (n=65)
Yes
Absolute Event Rate: 43% vs 12%
p-value: p=<0.01
While pediatric cancer patients are frequently screened with imaging and EKGs, cardiovascular specialists are underutilized prior to and during therapy, and post-treatment risk factor counseling is lacking.
Highlights potential gap in early cardiologist involvement for childhood cancer survivors; hypothesis-generating and requires prospective validation before practice change.
Objective To enhance the understanding of cardiovascular care delivery in childhood cancer patients and survivors. Study design A 20-question survey was created by the Pediatric Cardio-oncology Work Group of the American College of Cardiology (ACC) Cardio-oncology Section to assess the care, management, and surveillance tools utilized to manage pediatric/young adult cardio-oncology patients. The survey distribution was a collaborative effort between Cardio-oncology Section and membership of the Adult Congenital and Pediatric Cardiology Section (ACPC) of the ACC. Results Sixty-five individuals, all self-identified as physicians, responded to the survey. Most respondents ( n = 58,89%) indicated childhood cancer patients are regularly screened prior to and during cancer therapy at their centers, predominantly by electrocardiogram (75%), standard echocardiogram (58%) and advanced echocardiogram (50%) (i.e. strain, stress echo). Evaluation by a cardiologist prior to/during therapy was reported by only 8(12%) respondents, as compared to post-therapy which was reported by 28 (43%, p < 0.01). The most common indications for referral to cardiology at pediatric centers were abnormal test results ( n = 31,48%) and history of chemotherapy exposure ( n = 27,42%). Of note, during post-treatment counseling, common cardiovascular risk-factors like blood pressure (31,48%), lipid control (22,34%), obesity & smoking (30,46%) and diet/exercise/weight loss (30,46%) were addressed by fewer respondents than was LV function (72%). Conclusions The survey data demonstrates that pediatric cancer patients are being screened by EKG and/or imaging prior to/during therapy at most centers. Our data, however, highlight the potential for greater involvement of a cardiovascular specialist for pre-treatment evaluation process, and for more systematic cardiac risk factor counseling in posttreatment cancer survivors.
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Ryan et al. (2019) conducted a cross-sectional in Pediatric cancer (cardiovascular care delivery) (n=65). Cardiovascular care delivery and screening practices was evaluated on Evaluation by a cardiologist post-therapy compared to prior to/during therapy (p=<0.01). A survey of 65 physicians revealed that while 89% regularly screen childhood cancer patients, evaluation by a cardiologist was significantly more common post-therapy (43%) than prior to or during therapy (12%).
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