Childhood cancer survivors might not need as-frequent heart screenings
May 19, 2014 | by Hiu Chung So
Childhood cancer survivors who have been treated with a class of drugs called anthracyclines will face an increased risk of heart problems later in life. Thus, oncologists recommend that they undergo regular monitoring with echocardiograms so that this late effect can be detected and treated before it becomes life-threatening.
Currently, for childhood cancer survivors who were treated with anthracyclines or chest radiation, the Children's Oncology Group (COG) recommends an echocardiogram every one to five years throughout the survivors' lives, depending on their risk profile. However, a less-frequent screening schedule may be just as effective while significantly saving costs, according to a City of Hope-led study that was published in the May 20 issue of Annals of Internal Medicine.
"Screening too frequently is an unnecessary waste of valuable resources, while screening too infrequently results in a delay of providing needed treatment," said F. Lennie Wong, Ph.D., associate professor in the Division of Outcomes Research/Intervention and first author of the paper. "So we incorporated the available evidence to set up a computer model to determine the efficacy and cost-effectiveness of the COG recommended screening schedules and to find the ideal monitoring schedule that can detect treatment-related asymptomatic heart failure in a timely yet more cost-effective manner."
Wong noted that the current COG follow-up recommendations are based on consensus of its expert panel of clinicians and researchers. The panel takes into account published research on heart disease risk factors for childhood cancer survivors, but no data are available about the efficacy of its recommended screening schedule or its cost-effectiveness.
For this research, Wong's team ran a probability-based computer model that simulated the life histories of 10 million childhood cancer survivors from five years post-diagnosis until death assuming no follow-up screening took place. After validating the model with cohort studies of human patients, they then ran simulations to take into account recurring echocardiograms over different schedules, including COG's recommended follow-up schedule, to calculate quality-adjusted life years added due to those screenings and subsequent interventions.
After analyzing the health benefits and taking the cost of the echocardiograms, follow-up tests and treatments into consideration, Wong and her colleagues found that the COG recommended schedule is beneficial. Compared to no screening at all, the COG-recommended schedule of echocardiograms helps cut the risk of treatment-related heart failures by 18 percent after 30 years of treatment. This schedule costs $61,500 per quality-adjusted life year added.
But Wong also found that reducing screening frequency — some by as much as once every 10 years — preserves 80 percent of the risk-reduction benefit while nearly halving the costs to $33,200 per quality-adjusted life year added.
Based on this finding, the Annals editor wrote that "although routine echocardiography may reduce incidence of heart failure, less frequent screenings every 1 to 5 years are more cost-effective and maintain most of the health benefits."
Learn more about City of Hope's outcomes research program.
Research reported in this publication was supported by the National Institutes of Health under grant numbers U24CA55727, U10CA098543 and K12CA001727-14. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Additional support for this research came from the Lance Armstrong Foundation.