Factors supporting cardiomyopathy screening among at-risk adult survivors of pediatric malignancies
- 362 Downloads
Anthracyclines and chest irradiation place adult survivors of childhood cancer at risk of cardiomyopathy; many survivors do not obtain the recommended screening. Based on our recent clinical trial, the addition of telephone counseling to a printed survivorship care plan more than doubled survivors’ risk-based screening. Here, we sought to measure the impact of specific factors targeted in the intervention for their impact on survivors’ screening participation.
Study population—survivors participating in a randomized longitudinal intervention trial. Survivor questionnaires and medical records at baseline and 1-year follow-up provided the data. Within- and between-group differences in factors were assessed at baseline and follow-up; structural equation modeling (SEM) identified direct and indirect effects on screening participation.
Of the 411 survivors, 55.3% were female, 89.3% white, 38.9% college graduates, and age 26–59 years (mean = 41 years, SD = 7.68 years). At follow-up, the counseling group demonstrated higher scores for intent to undergo screening (p < 0.001), adherence determination (p < 0.001), autonomous regulation (p < 0.001), competency (p = 0.03), perceived effort warranted for screening (p < 0.001), and perceived value of screening (p = 0.02). SEM identified four factors that directly influenced screening participation (n = 411, RMSEA = 0.02 [90% CI = 0.000–0.05]; CFI = 0.99; TLI = 0.99; WRMR = 0.63): the counseling intervention (p < 0.0001), intrinsic motivation (p < 0.0001), competency (p < 0.0001), and decisional control (p = 0.001); intrinsic motivation was also a mediator (p = 0.002) of screening participation.
Direct interpersonal interaction that focused on multiple modifiable, autonomy-supportive factors powerfully enhances the efficacy of a print survivorship care plan in increasing survivors’ screening participation. This finding challenges providers to reach beyond the disease treatment focus and embrace these strategies in their behavior change efforts.
KeywordsCardiomyopathy Echocardiogram Survivors Pediatric cancer Late effects
Compliance with ethical standards
NIH grants R01 NR011322 (CL Cox and MM Hudson, Co-PIs), CA55727 (GT Armstrong, PI), Cancer Center Support (CORE) grant (CA21765, C. Roberts, PI), and the American Lebanese Syrian Associated Charities (ALSAC).
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The overall study was approved by the St. Jude Children’s Research Hospital Institutional Review Board and at each of the 27 participating institutions in the Childhood Cancer Survivor Study.
Informed consent was obtained from all individual participants included in the study.
- 1.Lipshultz SE, Adams MJ, Colan SD, Constine LS, Herman EH, Hsu DT, Hudson MM, Kremer LC, Landy DC, Miller TL, Oeffinger KC, Rosenthal DN, Sable CA, Sallan SE, Singh GK, Steinberger J, Cochran TR, Wilkinson JD, American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Basic Cardiovascular Sciences, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Radiolo (2013) Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions: a scientific statement from the American Heart Association. Circulation 128(19):e394. doi: 10.1161/CIR.0b013e3182a88099 CrossRefGoogle Scholar
- 2.Mulrooney DA, Yeazel MW, Kawashima T, Mertens AC, Mitby P, Stoval M, Donaldson SS, Green DM, Sklar CA, Robinson LL, Leisenring WM (2009) Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort. BMJ 339:b4606. doi: 10.1136/bmj.b4606 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Armstrong GT, Kawashima T, Leisenring W, Stratton K, Stovall M, Hudson MM, Sklar CA, Robison LL, Oeffinger KC (2014) Aging and risk of severe, disabling, life-threatening, and fatal events in the Childhood Cancer Survivor Study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 32:1218–1224CrossRefGoogle Scholar
- 6.Armstrong GT, Liu Q, Yasui Y, Neglia JP, Leisenring W, Robison LL, Mertens AC (2009) Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 27:2328–2338CrossRefGoogle Scholar
- 7.Armenian SH, Hudson MM, Mulder RL, Chen MH, Constine LS, Dwyer M, Nathan PC, Tissing WJE, Shankar S, Sieswerda E, Skinner R, Steinberger J, Van Dalen EC, Van der Pal HJ, Wallace WH, Levitt G, Kremer LC (2015) Recommendations for cardiomyopathy surveillance for survivors of childhood cancer: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 16:e123–e136. doi: 10.1016/S1470-2045(14)70409-7 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Scottish Intercollegiate Guidelines Network (2013) Long term follow up of survivors of childhood cancer: a national clinical guideline. http://www.sign.ac.uk/guidelines/fulltext/132/index.html . Accessed 10 Feb 2016
- 9.United Kingdom Children’s Cancer Study Group Late Effects Group (2005) Therapy based long term follow up practice statement. http://www.birminghamcancer.nhs.uk/uploads/document_file/document/4ea01eff358e980efb00006a/national_long_term_follow-up_guidelines_pdf. Accessed 10 Feb 2016
- 10.Dutch Childhood Oncology Group (2010) Richtlijn follow-up na kinderkanker (Directive follow-up after cancer in childhood: more than 5 years after diagnosis) Den Haag. https://www.skion.nl/workspace/uploads/richtlijn_follow-up_na_kinderkanker_deel_1.pdf. Accessed 10 Feb 2016
- 11.Children’s Oncology Group (2008) Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers (version 3.0). http://www.survivorshipguidelines.org/pdf/ltfuguidelines.pdf. Accessed Feb 10 2016
- 12.Nathan PC, Greenberg ML, Ness KK, Hudson MM, Mertens AC, Mahoney MC, Gurney JG, Donaldson SS, Leisenring W, Robison LL, Oeffinger KC (2008) Medical care in long-term survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol Off J Am Soc Clin Oncol 26:4401–4409. doi: 10.1200/JCO.2008.16.9607 CrossRefGoogle Scholar
- 13.Oeffinger KC, Hudson MM, Mertens AC, SS M, Mitby PA, Eshelman-Kent DA, Ford JS, Jones JK, Kamani S, Robison LL (2011) Increasing rates of breast cancer and cardiac surveillance among high-risk survivors of childhood Hodgkin lymphoma following a mailed, one-page survivorship care plan. Pediatr Blood Cancer 56:818–824. doi: 10.1002/pbc.22696 CrossRefPubMedGoogle Scholar
- 14.Hudson MM, Leisenring W, Stratton K, Tinner N, Steen BD, Ogg S, Barnes L, Oeffinger KC, Robison LL, Cox CL (2014) Increasing cardiomyopathy screening in at-risk adult survivors of pediatric malignancies: a randomized controlled trial. J Clin Oncol Off J Am Soc Clin Oncol 10:3974–3791. doi: 10.1200/JCO.2014.57.3493 CrossRefGoogle Scholar
- 15.Deci EL (1980) The psychology of self-determination. Lexington Books, Lexington, MAGoogle Scholar
- 21.Schiller JS, Ward BW, Freeman G, Peregoy JA (2013) Early release of selected estimates based on data from the 2012 National Health Interview Survey. http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201306.pdf . Accessed 10 Feb 2016
- 23.Derogatis LR (1993) Brief symptom inventory (BSI), administration, scoring and procedure manual. National Computer Systems, Minneapolis, MinnesotaGoogle Scholar
- 25.Common Terminology Criteria for Adverse Events (CTCAE) (2015). http://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm#ctc_40. Accessed 10 Feb 2016
- 27.Childhood Cancer Survivor Study (2008) Health care needs survey. http://www.stjude.org/SJFiles/ccss_healthneed.pdf . Accessed 10 Feb 2016
- 29.Williams GC, Ryan RM, Deci EL (2008) Health-care, self-determination theory questionnaire packet. http://www.psych.rochester.edu/SDT/measures/health.html . Accessed 10 Feb 2016
- 33.Browne M, Cudeck R (1993) Alternative ways of assessing model fit. In: Bollen KA, Long JA (eds) Testing structural equation models. Sage, Newbury Park, CA, pp. 136–162Google Scholar
- 36.Yu CY, Muthen BO (2002) Evaluation of model fit indices for latent variable models with categorical and continuous outcomes. UCLA, Graduate School of Education and Information Studies, Los AngelesGoogle Scholar
- 37.Krull KR, Brinkman TM, Li C, Armstrong GT, Ness KK, Srivastava DK, Gurney JG, Kimberg C, Krasin MJ, Pui CH, Robison LL, Hudson MM (2013) Neurocognitive outcomes decades after treatment for childhood acute lymphoblastic leukemia: a report from the St Jude Lifetime Cohort Study. J Clin Oncol 31:4407–4415CrossRefGoogle Scholar
- 39.Henderson TO, Hlubocky FJ, Wroblewski KE, Diller L, Daugherty CK (2010) Physician preferences and knowledge gaps regarding the care of childhood cancer survivors: a mailed survey of pediatric oncologists. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 28:878–883. doi: 10.1200/JCO.2009.25.6107 CrossRefGoogle Scholar
- 40.Nathan PC, Daugherty CK, Wroblewski KE, Kigin ML, Stewart TV, Hlubocky FJ, Grunfeld E, Del Giudice ME, Oeffinger KC, Henderson TO (2013) Family physician preferences and knowledge gaps regarding the care of adolescent and young adult survivors of childhood cancer. J Cancer Surviv 7:275–282CrossRefGoogle Scholar
- 41.Suh E, Daugherty CK, Wroblewski KE, Lee H, Kigin ML, Rasinski KA, Ford JS, Tonorezos ES, Nathan PC, Oeffinger KC, Henderson TO (2014) General internists’ preferences and knowledge about the care of adult survivors of childhood cancer: a cross-sectional survey. Ann Intern Med 160:11–17CrossRefGoogle Scholar
- 42.Landier W, Bhatia S, Eshelman DA, Forte KJ, Sweeney T, Hester AL, Darling J, Armstrong FD, Blatt J, Constine LS, Freedman ZR, Friedman DL, Green DM, Marina N, Meadows AT, Neglia JP, Oeffinger KC, Robison LL, Ruccione KS, Sklar CA, Hudson MM (2004) Development of risk-based guidelines for pediatric cancer survivors: the Children’s Oncology Group Long-Term Follow-Up guidelines from the Children’s Oncology Group Late Effects Committee and Nursing Discipline. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 22(24):4979–4990. doi: 10.1200/JCO.2004.11.032 CrossRefGoogle Scholar