Parabel USA, 1991 74th Avenue, Suite B, Vero Beach, FL, 32966, USA.
School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL, 35233, USA.
J Cancer Surviv. 2021 Oct;15(5):738-747. doi: 10.1007/s11764-020-00965-w. Epub 2020 Nov 10.
Cancer survivors are at risk for late effects from therapeutic exposures, including cardiovascular complications. To improve outcomes among adolescents and young adults (AYA) with cancer, the National Comprehensive Cancer Network (NCCN) released guidelines for screening services (based on the Children's Oncology Group Long-Term Follow-Up [LTFU] guidelines) for survivors of AYA cancer. To better understand survivorship care gaps, we conducted a baseline evaluation of cardiomyopathy screening among survivors of AYA cancers.
Members of Kaiser Permanente Southern California diagnosed with cancer between ages 15 and 39 from 2000 to 2010 with at least 5-year survival after diagnosis who were exposed to chest radiation and/or anthracyclines were included. We calculated the Prevention Index ([PI], proportion of person-time covered by receipt of preventive services relative to the total person-time eligible) to evaluate adherence to recommended cardiomyopathy screenings based on the LTFU through 2016. Predictors for screening were evaluated in multivariable logistic regression.
Among 479 survivors recommended for cardiomyopathy screening, 28 received at least one screening, and the mean PI was 2.38% (SD = 13.05%, median = 0.00%). Compared to stage I, survivors of stage II (odds ratio [OR] = 5.56 [1.05-29.46]) and stage III/IV cancer (OR = 6.08 [1.10-33.54]) were more likely to receive cardiomyopathy screening.
Cardiomyopathy screening among survivors was low around the time when NCCN AYA oncology guidelines were released.
Our study highlights significant room for improvement for adherence to cardiomyopathy screening recommendations among survivors of AYA cancer. Attention is needed to ensure that recommended cardiomyopathy screenings are met for better management of cardiomyopathy late effects.
癌症幸存者面临治疗暴露引起的晚期效应风险，包括心血管并发症。为了改善青少年和年轻成人（AYA）癌症患者的预后，美国国家综合癌症网络（NCCN）根据儿童肿瘤学组长期随访（LTFU）指南，为 AYA 癌症幸存者发布了筛查服务指南。为了更好地了解生存者护理差距，我们对 AYA 癌症幸存者的心肌病筛查进行了基线评估。
Kaiser Permanente Southern California 招募了 2000 年至 2010 年期间年龄在 15 至 39 岁之间被诊断患有癌症且至少有 5 年生存时间的患者，这些患者在诊断后接受过胸部放疗和/或蒽环类药物治疗。我们计算了预防指数（PI，接受预防服务的人数与符合条件的总人数之比），以根据 LTFU 评估到 2016 年的推荐心肌病筛查的依从性。采用多变量逻辑回归评估筛查的预测因素。
在 479 名建议进行心肌病筛查的幸存者中，有 28 名接受了至少一次筛查，平均 PI 为 2.38%（SD=13.05%，中位数=0.00%）。与 I 期相比，II 期（比值比[OR] = 5.56 [1.05-29.46]）和 III/IV 期癌症（OR = 6.08 [1.10-33.54]）幸存者更有可能接受心肌病筛查。
在 NCCN AYA 肿瘤学指南发布时，幸存者的心肌病筛查率较低。
我们的研究强调了需要改进 AYA 癌症幸存者对心肌病筛查建议的依从性。需要注意确保满足推荐的心肌病筛查，以更好地管理心肌病的晚期效应。
