Scientists at St. Jude Children’s Research Hospital have created a simulation model to demonstrate how to best provide cardiac health screening to childhood cancer survivors. The model’s findings support changing current international guidelines to increase screening frequency for high-risk survivors and eliminate screening for those at lowest risk. The work appears as an advance online publication today in the Journal of Clinical Oncology.
“The challenge with survivorship research is that you’re often looking for effects that can occur decades after treatment,” said corresponding author Matthew Ehrhardt, M.D., of St. Jude Oncology. “We created a model using data from both published and ongoing cohort studies to simulate a lifetime of events for a large cohort of individuals. This helped us better understand how screening for cardiac dysfunction can be most effective.”
Childhood cancer survivors are at an increased risk of heart failure and other cardiac late effects. In particular, anthracycline chemotherapy and chest-directed radiation are known to increase risk of cardiac late effects. Survivors can be considered low, moderate or high risk based on the amount and types of treatment they received.
Current guidelines set by the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) recommend echocardiogram screening at least every five years for all risk groups. However, the IGHG classified this recommendation as needing further study and evidence.
This led St. Jude investigators to create a simulation model to explore the parameters and variables that need to be taken into consideration when designing clinical and cost-effective screening guidelines. The scientists leveraged two ongoing long-term follow-up studies of childhood cancer survivors being led by St. Jude investigators: the Childhood Cancer Survivor Study and the St. Jude Lifetime Cohort Study. These studies provided robust data to inform a model that simulates how more or less screening would likely affect survivors.
The findings suggest that the current recommended screening strategies could be refined. For instance, in low-risk survivors, clinicians may safely discontinue screening for asymptomatic left ventricular dysfunction and heart failure. Results also suggested that clinicians increase screening to once every two years for high-risk survivors.
“We regularly monitor emerging evidence from research related to health surveillance for childhood cancer survivors,” said author Melissa Hudson, M.D., St. Jude Cancer Survivorship Division director. “These findings provide important data that will be considered by guideline groups in the risk-stratification of cardiomyopathy screening for childhood cancer survivors treated with cardiotoxic therapies.”
The study’s other St. Jude authors are Daniel Mulrooney, Todd Gibson, Leslie Robison, Gregory Armstrong and Yutaka Yasui. Other authors are Zachary Ward of the Harvard T.H. Chan School of Public Health; Qi Liu of the University of Alberta; Aeysha Chaudhry of Boston Children’s Hospital; Anju Nohria of Brigham and Women’s Hospital; William Border of Emory University School of Medicine; Joy Fulbright of The Children’s Mercy Hospital; Kevin Oeffinger of Duke University; Paul Nathan of The Hospital for Sick Children; Wendy Leisenring of the Fred Hutchinson Cancer Research Center; Louis Constine of the University of Rochester Medical Center; Eric Chow of Seattle Children’s Hospital and the University of Washington; Rebecca Howell of The University of Texas MD Anderson Cancer Center; Lisa Diller of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center; Saro Armenian of City of Hope Medical Center; and Jennifer Yeh of Harvard Medical School.
The research at St. Jude was funded in part by grants from the National Institutes of Health (P30CA21765, U24CA55727 and U01CA195547), the American Cancer Society and ALSAC, the fundraising and awareness organization of St. Jude.
Read the full text of the article:
Journal of Clinical Oncology, Published August 14, 2020