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Communicating cardiovascular risk to high-risk cancer survivors: a mixed-methods pilot study of a statin risk communication tool



Childhood, adolescent, and young adult cancer survivors treated with radiation therapy (RT) may be unaware of their high cardiovascular disease (CVD) risk or how to mitigate it. Tools are needed to improve understanding. We developed and pilot-tested a risk communication tool for shared decision-making with survivors regarding CVD risk reduction with statin therapy. We included quantitative and qualitative arms to further tool development and testing.


The statin risk communication tool was adapted from a previously validated tool. Patients were at increased risk for CVD due to history of chest RT and recruited to usual care and intervention arms. The post-visit survey included Likert-like scales to explore acceptability of the tool, knowledge questions, and a decisional conflict scale. This pilot study used descriptive statistics and was not powered for significance. Semi-structured interviews with intervention arm participants explored shared decision-making processes.


Median participant (n = 46) age was 45. Most intervention patients (22/24, 92%) and 50% (11/22) of controls found statin information acceptable while 31% (7/22) of the control arm selected “not applicable” regarding information acceptability. Most participants were unaware of their personal CVD risk or potential statin side effects. In semi-structured interviews, participants found the tool is helpful to visualize risk and aid conversations.


The risk communication tool was acceptable. Qualitative data suggested the tool improved decisional clarity and comfort.

Implications for Cancer Survivors

Poor knowledge of CVD and statins and poor recall of CVD risk conversation suggest a need to continue to optimize conversations regarding cardiovascular risk and statin therapy.

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The risk communication tool is modified with permission from the Mayo Clinic Knowledge and Evaluation Research Unit Clinic Statin Choice Decision Aid (https://statindecisionaid.mayoclinic.org/).


Support for this research was provided by grants from the Meg Berté Owen Memorial Fund, the Memorial Sloan Kettering Cancer Center Support Grant/Core Grant (P30 CA008748), the Division of Survivorship and Supportive Care Research Grant program, and the National Institutes of Health/National Center for Achieving Translational Science (NIH/NCATS) Grant KL2TR000458.

Author information

Correspondence to Nirupa J. Raghunathan.

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Conflict of interest

NR declares that she has no conflict of interest. ECZ declares she has no conflict of interest. NA declares she has no conflict of interest. KO declares he has no conflict of interest. EST declares she has no conflict of interest. DK has no personal relationship to industry; her spouse serves on the scientific board of Vedanta Biosciences and as a consultant for Takeda.

Ethical approval

All procedures performed in studies 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. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Table 4 Number (percent) correct of knowledge questionnaire responses, subdivided

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Raghunathan, N.J., Zabor, E.C., Anderson, N. et al. Communicating cardiovascular risk to high-risk cancer survivors: a mixed-methods pilot study of a statin risk communication tool. J Cancer Surviv (2020). https://doi.org/10.1007/s11764-020-00860-4

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  • Cardiovascular risk
  • Risk communication tools
  • Shared decision-making
  • Mixed-methods study
  • Decisional conflict
  • Statins