Nurse-Led Counseling Improved Cardiac Screening in Cancer Survivors

More than twice as many cancer survivors at risk for cardiomyopathy underwent screening for the condition when exposed to advanced-practice nurse telephone counseling compared with survivors who received standard care, results of a new study show.

“A distance-delivered intervention that included two brief telephone counseling sessions conducted by an advanced-practice nurse significantly increased the likelihood of cardiomyopathy screening among at-risk survivors of childhood cancer,” wrote Melissa M. Hudson, MD, of St Jude Children’s Research Hospital, and colleagues in the Journal of Clinical Oncology.

According to the study, most childhood cancer survivors at increased risk for cardiomyopathy are asymptomatic. Therefore, proactive surveillance of survivors allows for the early detection of the condition, and intervention by a physician. Unfortunately, rates of cardiomyopathy screening are low in this population.

Hudson and colleagues randomly assigned 472 adult survivors of pediatric cancers aged 25 years or older to standard care with or without two advanced-practice nurse telephone counseling sessions. Standard care was a survivorship care plan summarizing cancer treatment and cardiac screening recommendations.

After 1 year of follow-up, 52.2% of patients assigned to the nurse counseling were shown to have completed cardiomyopathy screening compared with only 22.3% of patients assigned to standard care (P < .001). The researchers adjusted these results, taking into account sex, age, and Children’s Oncology Group cardiomyopathy risk group, and found that survivors exposed to counseling were more than twice as likely as the standard risk group to complete screening (relative risk = 2.31; 95% CI, 1.74-3.07).

Although not all patients underwent cardiomyopathy screening, 26 patients had electrocardiography and self-report of screening was not able to be confirmed in six patients. Survivors listed lack of time, perception that screening was not important, concerns about insurance coverage, and forgetting about the need for screening among the reasons for not undergoing screening.

Among those patients who underwent echocardiography in either group, 52.2% had cardiac abnormalities requiring ongoing monitoring.

“This method of intervention provides pediatric cancer follow-up centers with a long reach to their survivor population that can be adapted to support other types of health-protective screening in other at-risk survivor populations,” the researchers wrote.