Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Pediatrics, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
Cancer Med. 2020 Aug;9(15):5500-5508. doi: 10.1002/cam4.3190. Epub 2020 Jun 18.
It is poorly understood how cardiovascular screening in asymptomatic childhood cancer survivors (CCS) is applied to and impacts clinical care.
To describe the current role of cardiovascular screening in the clinical care of asymptomatic CCS.
At 50 pediatric academic medical centers, a childhood cancer survivorship clinic director, pediatric cardiologist, and adult cardiologist with a focus on CCS were identified and invited to participate in a survey. Surveys were managed electronically. Categorical data were analyzed using nonparametric methods.
Of the 95 (63%) respondents, 39% were survivorship practitioners, and 61% were cardiologists. Eighty-eight percent of survivorship practitioners reported that greater than half of CCS received cardiovascular screening. CCS followed by adult cardiology were more likely to be seen by a cardio-oncologist. Those followed by pediatric cardiology were more likely to be seen by a heart failure/transplant specialist. Common reasons for referral to cardiology were abnormal cardiovascular imaging or concerns a CCS was at high risk for cardiovascular disease. Ninety-two percent of cardiologists initiated angiotensin converting enzyme inhibitor or angiotensin receptor blocker therapy for mild systolic dysfunction. Adult cardiologists initiated beta-blocker therapy for less severe systolic dysfunction compared to pediatric cardiologists (P < .001). Pediatric cardiologists initiated mineralocorticoid therapy for less severe systolic dysfunction compared to adult cardiologists (P = .025). Practitioners (93%) support a multi-institutional collaboration to standardize cardiovascular care for CCS.
While there is much common ground in the clinical approach to CCS, heterogeneity is evident. This highlights the need for cohesive, multi-institutional, standardized approaches to cardiovascular management in CCS.
心血管筛查在无症状儿童癌症幸存者（CCS）中的应用及其对临床护理的影响尚不清楚。
描述心血管筛查在无症状 CCS 临床护理中的当前作用。
在 50 家儿科学术医疗中心，确定了一名儿童癌症生存者诊所主任、一名儿科心脏病专家和一名专注于 CCS 的成人心脏病专家，并邀请他们参与一项调查。调查通过电子方式进行管理。使用非参数方法分析分类数据。
在 95 名（63%）受访者中，39%为生存者从业者，61%为心脏病专家。88%的生存者从业者报告称，超过一半的 CCS 接受了心血管筛查。由成人心脏病学随访的 CCS 更有可能由心脏肿瘤学家就诊。由儿科心脏病学随访的 CCS 更有可能由心力衰竭/移植专家就诊。转诊至心脏病学的常见原因是心血管成像异常或 CCS 有患心血管疾病的高风险。92%的心脏病专家为轻度收缩功能障碍开始使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗。与儿科心脏病专家相比，成人心脏病专家更倾向于为轻度收缩功能障碍开始使用β受体阻滞剂治疗（P<.001）。与成人心脏病专家相比，儿科心脏病专家更倾向于为轻度收缩功能障碍开始使用盐皮质激素受体拮抗剂治疗（P=.025）。从业者（93%）支持建立多机构合作，以标准化 CCS 的心血管护理。
尽管在 CCS 的临床方法方面有很多共同点，但也存在明显的异质性。这凸显了在 CCS 中采用协调一致、多机构、标准化的心血管管理方法的必要性。
