Many cancer survivors experience complex and interrelated psychosocial and functional problems. The former range from depression, anxiety and altered self-image to difficulties with employment and insurance. The latter include physical impairments from surgery, irradiation and chemotherapy, such as increased risk for second cancer, life-threatening infections, and accelerated heart disease. Providing new information about the delayed consequences of cancer treatment may intensify psychosocial difficulties. This proposal uses a process of notifying cancer survivors of recently recognized risks from treatment as an unique opportunity to evaluate psychosocial response and adaptation to newly perceived physical risks and assesses the impact of a support group intervention through a randomized trial. Recent retrospective studies of Hodgkin's disease patients have associated mediastinal irradiation with significantly increased risks for premature death from heart disease, including a 3 to 4 fold risk of sudden death from acute myocardial infarction and increased morbidity and mortality from pericardial disease, valvular heart disease, and cardiac conduction abnormalities. This study will evaluate whether cardiac testing can identify individuals at increased risk from heart disease within a large population treated for Hodgkin's disease and whether medical intervention decreases late, treatment-related morbidity and mortality. Cardiac risk factors, coronary arterial, pericardial, valvular, and conduction abnormalities will be assessed by interview, focused cardiovascular examination, lipid profiles, electrocardiography and resting and exercise echocardiography. The psychosocial impact of these tests and subsequent interventions will be evaluated before and at several intervals after risk notification and testing. Participants will be offered randomization into a short term support group to assess the impact of this intervention on acute and chronic distress and compliance wit medical or behavioral regimens.
| Heidenreich, Paul A; Schnittger, Ingela; Strauss, H William et al. (2007) Screening for coronary artery disease after mediastinal irradiation for Hodgkin's disease. J Clin Oncol 25:43-9 |
| Heidenreich, Paul A; Hancock, Steven L; Vagelos, Randall H et al. (2005) Diastolic dysfunction after mediastinal irradiation. Am Heart J 150:977-82 |
| Heidenreich, Paul A; Schnittger, Ingela; Hancock, Steven L et al. (2004) A systolic murmur is a common presentation of aortic regurgitation detected by echocardiography. Clin Cardiol 27:502-6 |
| Heidenreich, Paul A; Hancock, Steven L; Lee, Byron K et al. (2003) Asymptomatic cardiac disease following mediastinal irradiation. J Am Coll Cardiol 42:743-9 |
