An NCI-designated Comprehensive Cancer Center
By Maxine Nunes | June 22, 2018
saro armenian 256x256 Saro Armenian, D.O., M.P.H
For some childhood cancer survivors, regular cardiovascular monitoring is a lifelong necessity. Certain types of radiation and chemotherapies can cause life-threatening cardiac complications years after treatment has ended, and there’s a tremendous need for more effective ways of screening these at-risk patients.
A new electronic monitor called Vivio, developed by Caltech with City of Hope, promises to make cardiac screening easier and more accessible for patients and physicians.
The small handheld device is placed on a person’s neck over the carotid pulse, and a sensor detects information about heart function. That real-time data is relayed via Bluetooth to a smartphone or tablet to be reviewed by a physician.
The first phase of the Vivio trial has just been completed. The results — which indicated a remarkable level of accuracy — were published yesterday in Clinical Cancer Research.
It’s the first step in a new paradigm of thinking about how to care for survivors for decades after their cancer treatment,” said Saro Armenian, D.O., M.P.H., a pediatric oncologist and director of the Childhood Cancer Survivorship Clinic at City of Hope, who was part of the Vivio trial team.
Nearly 200 childhood cancer survivors took part in the Vivio trial, which was conducted at City of Hope. They were, on average, about 10 years from completion of therapy, the time of highest risk for developing cardiac dysfunction.
The device was tested for accuracy against the current standard for cardiovascular monitoring, echocardiography, as well as the gold standard, cardiac MRI.
The results? Vivio’s accuracy was comparable to both types of standard screenings — and it gave fewer false negatives than echocardiography.

The Need for a New Solution

Armenian first became aware of the importance of cardiovascular screening for cancer survivors about 10 years ago, when he was a medical fellow.

“There was a patient in her teens who had advanced-stage lymphoma. It was treated with chemotherapy and she was cured,” he recalled. “A few years later she went to college out of state, where she developed cardiomyopathy. That led to heart failure and eventually a heart transplant.”
With regular screening, her heart issues would have been caught earlier and the nearly fatal complications prevented, but her college was far from the cancer center where she had been treated, and the local doctor wasn’t aware of the link between cardiac problems and childhood cancer. She wasn’t monitored or given the proper care until her condition became acute.
Unfortunately, her situation isn’t unique. About 70 percent of at-risk cancer survivors are not actively engaged in screenings, and there are many reasons for this.
Sometimes it’s geographically difficult for people to get to a cancer center or medical facility that does screenings. Sometimes personal physicians don’t realize that childhood cancer survivors must be screened for cardiovascular issues their entire lives. Sometimes people lose contact with the medical system because of insurance issues or because they don’t realize how crucial screenings are.
What’s more, we’ve become so successful at treating cancer, the number of survivors in hugely increasing. We now cure between 80 and 90 percent of childhood cancer patients, who currently number about half a million. Cancer centers and other medical facilities may not be equipped to deal with the increasing volume of routine screenings.
“This small, handheld device can hopefully help us bridge some of these issues so that we can prevent and possibly even reverse life-threatening heart conditions for these survivors,” said Armenian.
Vivio is not intended to replace the echocardiogram or cardiac MRI, which give a much more complete picture of the heart and its function. Rather, it’s a way to bring screening technology out of the cancer center and into the community. The next step is developing the device for use by individuals at home and by doctors in an office setting.
For Armenian, working to perfect this new technology is a labor of love.
The resilience of children with cancer is truly inspiring,” he said. “And my responsibility to them isn’t just during their cancer treatment. It’s a lifelong commitment to them and their families.”

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