Skip to main content Accessibility help
×
×
Home

Improving paediatric cardiologists’ awareness about the needs of childhood cancer survivors: results of a single-centre directed educational initiative

  • Kirsten Rose-Felker (a1) (a2), Karen Effinger (a3) (a2), Michael S Kelleman (a4), Ritu Sachdeva (a1) (a2), Lillian R. Meacham (a3) (a2) and William L. Border (a1) (a2)...

Abstract

Background:

Cardiovascular disease is a leading cause of morbidity and mortality in childhood cancer survivors. Cardiologists must be aware of risk factors and long-term follow-up guidelines, which have historically been the purview of oncologists. Little is known about paediatric cardiologists’ knowledge regarding the cardiotoxicity of cancer treatment and how to improve this knowledge.

Methods:

A total of 58 paediatric cardiologists anonymously completed a 21-question, web-based survey focused on four cardio-oncology themes: cancer treatment-related risk factors (n = 6), patient-related risk factors (n = 6), recommended surveillance (n = 3), and cardiac-specific considerations (n = 6). Following the baseline survey, a multi-disciplinary team of paediatric cardiologists and cancer survivor providers developed an in-person and web-based educational intervention. A post-intervention survey was conducted 5 months later.

Results:

The response rate was 41/58 (70.7%) pre-intervention and 30/58 (51.7%) post-intervention. On the baseline survey, the percentage of correct answers was 68.8 ± 10.3%, which improved to 79.2 ± 16.2% after the intervention (p = 0.009). The theme with the most profound knowledge deficit was surveillance; however, it also had the greatest improvement after the intervention (49.6 ± 26.7 versus 66.7 ± 27.7% correct, p = 0.025). Individual questions with the largest per cent improvement pertained to risk of cardiac dysfunction with time since treatment (52.4 versus 93.1%, p = 0.002) and the role of dexrazoxane (48.8 versus 82.8%, p = 0.020).

Conclusion:

Specific knowledge deficits about the care of paediatric cancer survivors were identified amongst cardiologists using a web-based survey. Knowledge of surveillance was initially lowest but improved the most after an educational intervention. This highlights the need for cardio-oncology-based educational initiatives among paediatric cardiologists.

Copyright

Corresponding author

Author for correspondence: William L Border, MD, Department of Pediatrics, Sibley Heart Center Cardiology, Emory University, 1405 Clifton Rd NE, Atlanta, GA 30322, USA. Tel: (404)256-2593; E-mail: borderw@kidsheart.com

References

Hide All
1.Howlader, NNA, Krapcho, M, Miller, D, et al. (eds) SEER Cancer Statistics Review, 1975–2014. National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER web site, April 2017.
2.Mertens, AC, Liu, Q, Neglia, JP, et al. Cause-specific late mortality among 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst 2008; 100: 13681379.
3.Barac, A, Murtagh, G, Carver, JR, et al. Cardiovascular health of patients with cancer and cancer survivors: a roadmap to the next level. J Am Coll Cardiol 2015; 65: 27392746.
4.Yoon, GJ, Telli, ML, Kao, DP, Matsuda, KY, Carlson, RW, Witteles, RM. Left ventricular dysfunction in patients receiving cardiotoxic cancer therapies are clinicians responding optimally? J Am Coll Cardiol 2010; 56: 16441650.
5.Ammon, M, Arenja, N, Leibundgut, G, et al. Cardiovascular management of cancer patients with chemotherapy-associated left ventricular systolic dysfunction in real-world clinical practice. J Card Fail 2013; 19: 629634.
6.Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood. Adolescent and Young Adult Cancer. 2013; http://www.survivorshipguidelines.org/pdf/LTFUGuidelines_40.pdf.
7.Hudson, MM, Rai, SN, Nunez, C, et al. Noninvasive evaluation of late anthracycline cardiac toxicity in childhood cancer survivors. J Clin Oncol 2007; 25: 36353643.
8.Mulrooney, DA, Yeazel, MW, Kawashima, T, et al. Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort. BMJ 2009; 339: b4606.
9.Lipshultz, SE, Scully, RE, Lipsitz, SR, et al. Assessment of dexrazoxane as a cardioprotectant in doxorubicin-treated children with high-risk acute lymphoblastic leukaemia: long-term follow-up of a prospective, randomised, multicentre trial. Lancet Oncol 2010; 11: 950961.
10.Lipshultz, SE, Rifai, N, Dalton, VM, et al. The effect of dexrazoxane on myocardial injury in doxorubicin-treated children with acute lymphoblastic leukemia. N Engl J Med 2004; 351: 145153.
11.Chow, EJ, Chen, Y, Kremer, LC, et al. Individual prediction of heart failure among childhood cancer survivors. J Clin Oncol 2015; 33: 394402.
12.Jovenaux, L, Cautela, J, Resseguier, N, et al. Practices in management of cancer treatment-related cardiovascular toxicity: a cardio-oncology survey. Int J Cardiol 2017; 241: 387392.
13.Shelburne, N, Adhikari, B, Brell, J, et al. Cancer treatment-related cardiotoxicity: current state of knowledge and future research priorities. J Natl Cancer Inst 2014; 106: dju232.
14.Plana, JC, Galderisi, M, Barac, A, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. JASE 2014; 27: 911939.
15.Ruddy, K, Moslehi, J. Cardiac complications of cancer therapy. ASCO University. Retrieved February 1, 2018, from https://university.asco.org/cardiac-complications-cancer-therapy
16.Mulrooney, DA, Armstrong, GT, Huang, S, et al. Cardiac outcomes in adult survivors of childhood cancer exposed to cardiotoxic therapy: a cross-sectional study. Ann Intern Med 2016; 164: 93101.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
WORD
Supplementary materials

Rose-Felker et al. supplementary material
Supplemental Table

 Word (147 KB)
147 KB

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed