Nearly 80% of children and adolescents with cancer survive 5 or more years after diagnosis and are effectively cured. A significant number of childhood cancer survivors are at risk for cardiovascular (CV) disease resulting from treatment with anthracycline chemotherapy and radiation to CV structures. Previous studies indicate that the frequency of premature CV disease is substantial in this young adult population, and it significantly increases the risk of early mortality. Because most at-risk childhood cancer survivors are asymptomatic, periodic monitoring for late CV complications is critical. However, few survivors undergo CV screening and social and behavioral factors such as knowledge deficits, lack of access to preventive care, and unhealthy lifestyles may exacerbate risk of CV complications. Prevention of CV disease in this growing, at-risk population requires individualized information based on specific treatment exposures and individualized support based on important behavioral constructs. This proposal aims to test a 2-tiered tailored intervention-Evaluation of Cardiovascular Health Outcomes among Survivors (ECHOS)-designed to inform childhood cancer survivors about their individual cardiac risk and follow-up recommendations and to provide motivational support for CV screening. The ECHOS trial will test if the addition of telephone motivational interviewing, tailored to behavioral constructs, is superior to the current standard of care in increasing survivors'CV screening;815 adult survivors whose cancer was treated with chest radiation and/or anthracycline chemotherapy and who have not had CV screening in the past five years will be eligible to participate. Of these, 652 will be randomly assigned to receive either: 1) a mailed individualized cancer treatment summary with recommendations for CV follow-up and lifestyle modification (standard care) or 2) standard care plus telephone counseling by an advanced- practice nurse that incorporates motivational interviewing techniques tailored to survivors'baseline measures of knowledge, beliefs, readiness for follow-up, motivation, self-efficacy, affect, fear, and survivor-provider interaction. The primary outcome is CV screening adherence, defined as completion or failure to complete an imaging evaluation of left ventricular systolic function (i.e., echocardiogram, multiple uptake gated acquisition scan, or cardiac magnetic resonance imaging). The study population will be recruited from a well- defined cohort of childhood cancer survivors participating in the Childhood Cancer Survivor Study (CCSS). A broad-based health behavior model adapted to childhood cancer survivors will guide the intervention. Secondary aims will evaluate the intervention's cost-effectiveness as well as intervention-related changes in survivors'knowledge, motivation, fear, beliefs, affect, readiness for medical follow-up, and self-efficacy. Knowledge derived from this research will provide the background for future evaluations of the impact of health screening on improving quality of care and reducing cancer-related morbidity in childhood cancer survivors.

Public Health Relevance

Because most pediatric malignancies can now be cured, there is an increasing number of survivors at risk of late cardiovascular (CV) complications of anthracycline chemotherapy and/or irradiation of CV structures. In this group, the risk of cardiac death is 6 to 10 times that of the age- and gender-matched population, yet few adults surviving childhood cancer undergo CV screening. CV complications may be exacerbated by social and behavioral factors, such as knowledge deficits, lack of access to preventive care, and unhealthy lifestyle. We therefore propose to test a 2-armed tailored intervention-Evaluation of Cardiovascular Health Outcomes among Survivors (ECHOS)-designed to provide adult childhood cancer survivors with their individual cardiac risk and follow-up recommendations and to provide motivational support to promote CV screening. We expect the intervention to increase childhood cancer survivors'CV screening adherence, and therefore potentially significantly modify the morbidity and mortality of CV disease in this at-risk population.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Nursing Science: Children and Families Study Section (NSCF)
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Huss, Karen
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St. Jude Children's Research Hospital
United States
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Cox, Cheryl L; Zhu, Liang; Ojha, Rohit P et al. (2017) Factors supporting cardiomyopathy screening among at-risk adult survivors of pediatric malignancies. Support Care Cancer 25:1307-1316
Cox, Cheryl L; Andersen, M Robyn; Santucci, Aimee K et al. (2016) Increasing Cardiomyopathy Screening in Childhood Cancer Survivors: A Cost Analysis of Advanced Practice Nurse Phone Counseling. Oncol Nurs Forum 43:E242-E250
Hudson, Melissa M; Leisenring, Wendy; Stratton, Kayla K et al. (2014) Increasing cardiomyopathy screening in at-risk adult survivors of pediatric malignancies: a randomized controlled trial. J Clin Oncol 32:3974-81