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Grant Details

Grant Number: 6R01CA204378-06 Interpret this number
Primary Investigator: Chow, Eric
Organization: Fred Hutchinson Cancer Center
Project Title: Improving Treatment of Cardiovascular Risk Factors in Childhood Cancer Survivors
Fiscal Year: 2021


ABSTRACT Children and adolescents diagnosed with cancer now have on average >80% 5-year survival. However, premature cardiovascular (CV) disease has become the leading non-cancer cause of late mortality among childhood cancer survivors. Our existing work has shown that traditional CV risk factors such as hypertension, dyslipidemia, insulin resistance/diabetes remain very important, by increasing (in synergistic fashion) the risk of major CV events such as ischemic heart disease and heart failure. However, the existing research has been limited by misclassification of CV risk factor status (i.e., when defined by self-report or medication usage alone), including issues with both underdiagnosis (i.e., people with these risk factors present but who are unaware) and uncertainty of disease control (i.e., potential undertreatment). This proposal will utilize the largest, best characterized childhood cancer survivor cohort in the world, the Childhood Cancer Survivor Study (CCSS; n=24,466), a NCI-funded resource. We will use CCSS-derived validated risk prediction algorithms to select survivors at high risk of serious heart disease (n=800) based on past cancer treatment exposures. Among these 800 survivors, we propose to determine the magnitude of underdiagnosis and undertreatment of hypertension, dyslipidemia, and diabetes via in-person (home-based) measurements supplemented by medical record review. We predict that around 60% of survivors (n~480) will be underdiagnosed or undertreated with respect to one of these three CV risk factors. Survivors who are underdiagnosed or undertreated will then be eligible to participate in a 1-year long randomized controlled trial, where we will measure the efficacy of an Institute of Medicine (IOM) recommended personalized survivorship care plan (SCP) emphasizing CV risk, supplemented by a remotely delivered clinician-led self-management counseling intervention, to improve control of these three CV risk factors (i.e., reduce rates of undertreated hypertension, dyslipidemia, and diabetes). Survivors randomized to the control arm can receive the intervention on a delayed basis. Finally, our proposal seeks to better understand barriers among survivors and their primary healthcare providers that contribute to CV risk factor undertreatment. Knowledge derived from this study will improve the assessment and treatment of important CV risk factors in this high risk population. The proposed intervention, if successful, will be disseminable and low cost, and will have the potential to improve health and reduce mortality in these younger adults who live the majority of their lives as cancer survivors at increased risk of serious CV disease.


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PMID: 38091040
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Experiences of adult survivors of childhood cancer in a randomized cardiovascular health promotion trial: a qualitative report from the Childhood Cancer Survivor Study.
Authors: Cai C.R. , Cornelius S. , Demedis J. , Hagen A.M. , Abbey-Lambertz M. , Armstrong G.T. , Oeffinger K.C. , Syrjala K.L. , Taylor S.L. , Yi J.C. , et al. .
Source: Journal of cancer survivorship : research and practice, 2023-05-30; , p. 1-9.
EPub date: 2023-05-30.
PMID: 37253902
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Mitigating, monitoring, and managing long-term chemotherapy- and radiation-induced cardiac toxicity.
Authors: Bottinor W. , Chow E.J. .
Source: Hematology. American Society of Hematology. Education Program, 2022-12-09; 2022(1), p. 251-258.
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Underdiagnosis and Undertreatment of Modifiable Cardiovascular Risk Factors Among Survivors of Childhood Cancer.
Authors: Chow E.J. , Chen Y. , Armstrong G.T. , Baldwin L.M. , Cai C.R. , Gibson T.M. , Hudson M.M. , McDonald A. , Nathan P.C. , Olgin J.E. , et al. .
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EPub date: 2022-06-08.
PMID: 35674343
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Feasibility of a behavioral intervention using mobile health applications to reduce cardiovascular risk factors in cancer survivors: a pilot randomized controlled trial.
Authors: Chow E.J. , Doody D.R. , Di C. , Armenian S.H. , Baker K.S. , Bricker J.B. , Gopal A.K. , Hagen A.M. , Ketterl T.G. , Lee S.J. , et al. .
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EPub date: 2020-10-10.
PMID: 33037989
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Authors: Han C.J. , Gigic B. , Schneider M. , Kulu Y. , Peoples A.R. , Ose J. , K├Âlsch T. , Jacobsen P.B. , Colditz G.A. , Figueiredo J.C. , et al. .
Source: Journal of cancer survivorship : research and practice, 2020 Jun; 14(3), p. 305-315.
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PMID: 32166576
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Traditional Cardiovascular Risk Factors and Individual Prediction of Cardiovascular Events in Childhood Cancer Survivors.
Authors: Chen Y. , Chow E.J. , Oeffinger K.C. , Border W.L. , Leisenring W.M. , Meacham L.R. , Mulrooney D.A. , Sklar C.A. , Stovall M. , Robison L.L. , et al. .
Source: Journal of the National Cancer Institute, 2020-03-01; 112(3), p. 256-265.
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Current and coming challenges in the management of the survivorship population.
Authors: Chow E.J. , Ness K.K. , Armstrong G.T. , Bhakta N. , Yeh J.M. , Bhatia S. , Landier W. , Constine L.S. , Hudson M.M. , Nathan P.C. .
Source: Seminars in oncology, 2020 Feb; 47(1), p. 23-39.
EPub date: 2020-03-04.
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Communicating health information and improving coordination with primary care (CHIIP): Rationale and design of a randomized cardiovascular health promotion trial for adult survivors of childhood cancer.
Authors: Chow E.J. , Baldwin L.M. , Hagen A.M. , Hudson M.M. , Gibson T.M. , Kochar K. , McDonald A. , Nathan P.C. , Syrjala K.L. , Taylor S.L. , et al. .
Source: Contemporary clinical trials, 2020 Feb; 89, p. 105915.
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Key considerations for advancing the development and testing of mHealth interventions in adolescent and young adult oncology.
Authors: Walsh C.A. , Rosenberg A.R. , Lau N. , Syrjala K.L. .
Source: Psycho-oncology, 2020 Jan; 29(1), p. 220-223.
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Lasting effects of cancer and its treatment on employment and finances in adolescent and young adult cancer survivors.
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Paediatric cardio-oncology: epidemiology, screening, prevention, and treatment.
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Source: Hematology. American Society of Hematology. Education Program, 2018-11-30; 2018(1), p. 146-153.
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Prediction of cardiovascular disease among hematopoietic cell transplantation survivors.
Authors: Armenian S.H. , Yang D. , Teh J.B. , Atencio L.C. , Gonzales A. , Wong F.L. , Leisenring W.M. , Forman S.J. , Nakamura R. , Chow E.J. .
Source: Blood advances, 2018-07-24; 2(14), p. 1756-1764.
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Prediction of Ischemic Heart Disease and Stroke in Survivors of Childhood Cancer.
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Source: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-01-01; 36(1), p. 44-52.
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