Improving Screening Practices in Childhood Cancer Survivors at Risk for Treatment-Related Heart Failure
Mené auprès de 472 survivants d'un cancer et inclus dans la cohorte "the Childhood Cancer Survivor Study" (âge moyen : 40,1 ans), cet essai randomisé évalue l'intérêt d'une intervention par téléphone, en complément de la diffusion d'une brochure d'information, pour améliorer l'adhésion à un examen de détection d'une cardiomyopathie chez les patients à risque
Advances in diagnostic precision, therapy, and supportive care for children with cancer have resulted in marked improvements in long-term survival1; overall 5-year survival for most children with cancer exceeds 80%,1 contributing to a growing number of childhood cancer survivors in the United States. However, research on survivorship issues over the past three decades has demonstrated well-established associations between therapeutic exposures and subsequent adverse health-related complications such as second malignant neoplasms, premature cardiovascular disease, endocrinopathies, growth and musculoskeletal complications, and neurocognitive disorders.2 It is estimated that by age 50, up to half of all childhood cancer survivors will develop a severe or life-threatening health-related complication, with no plateau of risk over time.3 Many of these complications do not become clinically apparent until years after completion of therapy, a time when many survivors are no longer in active follow-up at their primary cancer treatment center.
Recognizing the importance of developing a systematic plan for lifelong surveillance of health-related complications, the Children's Oncology Group (COG) developed guidelines (Long Term Follow-up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers) that provide risk-based, exposure-related recommendations for early screening, regardless of clinical setting.4 Importantly, these guidelines are readily accessible5 and include informational patient-directed Health Links to enhance health promotion in this population. Nevertheless, despite the availability of these guidelines, many childhood cancer survivors do not receive risk-based follow-up care. For example, in the Childhood Cancer Survivor Study (CCSS), only 28% of childhood cancer survivors identified to be at high risk of developing heart failure (HF) reported having had a screening echocardiogram in the previous 2 years.6 This is especially sobering because cardiovascular complications such as HF have emerged as a leading cause of long-term morbidity and mortality in the growing population of childhood cancer survivors.7 The lack of appropriate risk-based follow-up care in this population is attributed to a number of inadequacies, including availability of established long-term follow-up programs at the primary treatment center, systems to facilitate transition from pediatric to adult-centered care, and knowledge among survivors about their treatment and subsequent risk for health-related complications. Furthermore, obstacles within the health care system contribute to this lack of risk-based follow-up care, such as lack of health insurance and access to preventive care (....)
Journal of Clinical Oncology , éditorial en libre accès, 2014