Grant Number:	1R01CA297448-01A1 Interpret this number
Primary Investigator:	Ehrhardt, Matthew
Organization:	St. Jude Children'S Research Hospital
Project Title:	Evaluation of Cardiovascular Health Outcomes Among Survivors 2 (Echos-2)
Fiscal Year:	2025

ABSTRACT Greater than 85% of children newly diagnosed with cancer will be cured and become long-term survivors. Compared to the general population, survivors are at increased risk for cardiomyopathy (i.e., heart muscle injury) and progression to symptomatic and potentially fatal heart failure, largely due to anthracycline chemotherapy and / or chest-directed radiation exposure. Approximately two-thirds of survivors received one or both, placing most at risk for cardiomyopathy. Practice guidelines exist to facilitate early screening for and detection of asymptomatic cardiomyopathy in an effort to reduce progressive or symptomatic disease. However, adherence rates are poor, with fewer than 40% actually completing screening. Most survivors are unaware of their risks and followed by primary care providers who are poorly informed about recommended follow-up screening. In our previous randomized controlled trial Evaluation of Cardiovascular Health Outcomes among Survivors (ECHOS- 1; R01 NR011322; MPI: Hudson/Cox), we demonstrated that advanced practice nurse (APN) led motivational interviewing doubled screening adherence rates (52.2% vs. 22.3%) compared to mailed educational materials alone. While effective, the APN-led intervention was not scalable to larger survivor groups. To address this, we developed and tested an eHealth version of ECHOS-1, i.e., the Healthy Hearts pilot study. We now propose the ECHOS-2 study, which will test the efficacy of the Healthy Hearts, eHealth-delivered intervention on cardiomyopathy surveillance adherence. Among adult survivors participating in the Childhood Cancer Survivor Study (CCSS; U24 CA055727; PI: Armstrong), 2,037 were treated with anthracyclines or chest-directed radiation and have not received cardiomyopathy screening in the preceding 5-years, thus are eligible to participate. Of these, 350 will be randomly assigned to the (1) control or (2) eHealth intervention arms. All will receive the standard of care (educational handouts and a survivorship care plan). In addition to these same materials, the eHealth arm will receive the Healthy Hearts, eHealth-delivered intervention, including avatar-led interaction and video vignettes derived using motivational interviewing techniques. Vignettes have been designed to address common barriers previously identified in ECHOS-1 and the Healthy Hearts pilot study, and are tailored to individual patient’s baseline ECHOS-2 survey responses. The primary outcome is cardiac screening adherence, defined as completion of an echocardiogram, confirmed by medical record review. A broad-based health behavior model adapted to childhood cancer survivors will guide the intervention. Secondary aims will evaluate whether behavioral constructs mediate the effect of the intervention on screening adherence, and whether or not elements of the intervention are acceptable to survivors. Knowledge derived from this research will provide the background for future evaluations of the impact of health screening on improving quality of care and reducing cancer-related morbidity in childhood cancer survivors.





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