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- Title
Primary Care Utilization and Cardiovascular Screening in Adult Survivors of Childhood Cancer.
- Authors
Ohlsen, Timothy J. D.; Chen, Yan; Baldwin, Laura-Mae; Hudson, Melissa M.; Nathan, Paul C.; Snyder, Claire; Syrjala, Karen L.; Tonorezos, Emily S.; Yasui, Yutaka; Armstrong, Gregory T.; Oeffinger, Kevin C.; Chow, Eric J.
- Abstract
Key Points: Question: How do adult survivors of childhood cancer use health care and cardiovascular screening with their primary care practitioners (PCPs)? Findings: In this cross-sectional study including 293 survivors of childhood cancer at high risk for cardiovascular complications, participants' PCP records had infrequent documentation referencing a cancer history (67.6%) or a need for late-effects surveillance (32.4%), and only 21.5% of participants records had a completed or planned echocardiogram in the prior 2 years. Factors associated with up-to-date cardiac screening included documentation of increased cardiovascular risks or a late-effects surveillance plan. Meaning: These findings suggest that increasing participant and PCP awareness of risks and surveillance recommendations may improve adherence to screening. This cross-sectional study examines screening and health care utilization rates among survivors of childhood cancer at high risk for cardiovascular complications. Importance: Cardiovascular disease is the leading noncancer cause of premature death among survivors of childhood cancer. Adult survivors of childhood cancer are largely managed by primary care practitioners (PCPs), and health care utilization patterns related to cardiovascular screening are not well described. Objective: To examine screening and health care utilization among survivors of childhood cancer at high risk for cardiovascular complications. Design, Setting, and Participants: This multicenter cross-sectional study included participants enrolled in a randomized clinical trial from 2017 to 2021. Abstracted documentation of participants' cancer history, cardiotoxic treatment exposures, and survivorship care plans were obtained from participants' PCPs spanning 2 years preceding trial enrollment. Participants were members of the Childhood Cancer Survivor Study cohort at elevated risk for ischemic heart disease or heart failure, enrolled in a randomized trial focused on improving cardiovascular risk factor control. Data were analyzed from November 2022 to July 2023. Main Outcomes and Measures: Outcomes of interest were numbers of PCP and specialist visits, cardiovascular risk factors (hypertension, dyslipidemia, and diabetes), risk factor screening, and cardiac testing. Multivariable logistic regression assessed characteristics associated with up-to-date cardiac testing at enrollment. Results: Of 347 enrolled participants, 293 (84.4%) had evaluable medical records (median [range] age, 39.9 [21.5-65.0] years; 149 [50.9%] male) and were included in analyses. At baseline, 238 participants (81.2%) had a documented PCP encounter; 241 participants (82.3%) had undergone blood pressure screening, 179 participants (61.1%) had undergone lipid testing, and 193 participants (65.9%) had undergone diabetes screening. A total of 63 participants (21.5%) had echocardiography completed or planned. Only 198 participants (67.6%) had records referencing a cancer history. PCP documentation of prior cardiotoxic exposures was low compared with known exposures, including radiation therapy (103 participants [35.2%] vs 203 participants [69.3%]; P <.001) and anthracycline chemotherapy (27 participants [9.2%] vs 222 participants [75.8%]; P =.008). Few records referenced a need for cancer-related late effects surveillance (95 records [32.4%]). Independent factors associated with cardiac screening included documentation of increased cardiovascular disease risk (odds ratio [OR], 11.94; 95% CI, 3.37-42.31), a late-effects surveillance plan (OR, 3.92; 95% CI, 1.69-9.11), and existing cardiovascular risk factors (OR per each additional factor, 2.09; 95% CI, 1.32-3.31). Conclusions and Relevance: This cross-sectional study of adult survivors of childhood cancer at increased risk of cardiovascular disease found low adherence to recommended cardiac testing and documentation of risk for these individuals. Improving accuracy of reporting of survivors' exposures and risks within the medical record may improve screening.
- Subjects
CARDIOVASCULAR disease diagnosis; CANCER patient psychology; RESEARCH; CONFIDENCE intervals; CROSS-sectional method; MEDICAL screening; PRIMARY health care; TUMORS in children; DESCRIPTIVE statistics; RESEARCH funding; LOGISTIC regression analysis; ODDS ratio; DATA analysis software; ADULTS
- Publication
JAMA Network Open, 2023, Vol 6, Issue 12, pe2347449
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.47449