Cardiovascular (CV) disease is a significant competing cause of death for many survivors of common early-stage cancers. Up to 90% of survivors have multiple CV risk factors, and many receive cancer therapies with potentially cardiotoxic side effects. Yet cardiovascular health (CVH) is rarely addressed during routine post-treatment survivorship care. CVH assessment could increase patient and provider awareness of CVH and treatment-related cardiotoxicity risk, and promote CVH and cardiotoxicity management during survivorship care, thereby reducing CV disease and cancer recurrence. Such an assessment may be especially critical for the 20% of survivors who do not have a primary care provider and those who received potentially cardiotoxic treatments. Our electronic subsequently adapted Community usability factors clinical examine cancer research team developed an automated health record (EHR)-based CVH assessment tool, deployed it in a primary care setting, and adapted it for use with cancer survivors. Here we propose to implement and evaluate this tool, called the Automated Heart Health Application (AH-HA), among survivors in the NCI Oncology Research Program (NCORP) network. Evaluations in our pilot indicated high and acceptability among oncology providers and survivors. AH-HA incorporates traditional CV risk and potentially cardiotoxic cancer treatment data, and can be easily implemented into routine practice. Thus, we propose a mixed methods, hybrid effectiveness-implementation study to the effects of the AH-HA tool among survivors of breast, prostate, colorectal, and endometrial who are now in survivorship care.Our central hypothesis is that the AH-HA tool will increase (1) CVH awareness and discussions among patients and oncology providers, (2) appropriate referrals and visits to primary care and cardiology, and (3) CV risk reduction and health promotion activities compared to usual care. We seek to speed translation of the AH-HA tool into practice by simultaneously collecting mixed method process data regarding current and future implementation, guided by the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework.
Our Specific Aims are to: (1) Assess the impact of the AH-HA tool on providers' efforts to discuss CVH, refer survivors to primary care and cardiology, and manage CV risk; (2) Measure the impact of the AH-HA tool on survivors' completed primary care and cardiology visits and CVH; and (3) Examine factors influencing current and future implementation of the AH-HA tool. The results of our proposed study will guide future dissemination efforts, with the ultimate goal of improving CVH among the rapidly growing population of cancer survivors. Use of the established NCORP network is efficient and provides an excellent opportunity to test our intervention in community oncology settings, where most cancer survivors receive care.

Public Health Relevance

Survivors of early-stage cancers are susceptible to cardiovascular disease due to pre-existing cardiovascular risk factors and receipt of potentially cardiotoxic cancer treatments. Our automated electronic health record (EHR)-based tool addresses the growing burden of cardiovascular disease among cancer survivors in the United States by empowering oncologists to discuss cardiovascular health with their patients and facilitating appropriate care for cardiovascular disease risk factors. In this study, we will test whether our pragmatic EHR-based cardiovascular health tool ? which incorporates patient risk factor and cancer treatment data ? will improve cardiovascular health discussion, completed visits, and cardiovascular risk factors in a real-world setting, with the ultimate goal of improving cancer survivors' morbidity and mortality. 1

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Shelburne, Nonniekaye F
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Wake Forest University Health Sciences
Public Health & Prev Medicine
Schools of Medicine
United States
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