Increasing Cardiomyopathy Screening in At-Risk Adult Survivors of Pediatric Malignancies: A Randomized Controlled Trial
Increasing Cardiomyopathy Screening in At-Risk Adult Survivors of Pediatric Malignancies: A Randomized Controlled Trial
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DOI：
10.1200/jco.2014.57.3493
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发表时间：
2014-12-10
影响因子：
45.3
通讯作者：
Cox, Cheryl L.
中科院分区：
文献类型：
--
作者：
Hudson, Melissa M.;Leisenring, Wendy;Cox, Cheryl L.
目的探讨在打印的生存护理计划（SCP）中加入高级执业护士（APN）电话咨询是否能显著增加完成心肌病筛查的高危幸存者比例。患者和方法参与儿童癌症幸存者研究的年龄在bb0 - 25岁的幸存者，接受心脏毒性治疗，并且报告在过去5年内没有心肌病筛查史，符合入组条件。472名参与者（平均年龄40.1岁，范围25.0 - 59.0岁，53.3%为女性）被随机分配到标准治疗组，包括总结癌症治疗和心脏健康筛查建议的SCP (n = 234)，或标准治疗组加上两次APN电话咨询会议（n = 238）。主要结果——1年内完成心肌病筛查——通过医疗记录得到验证，并使用校正相对危险度（rr） （95% ci）对两组进行比较。结果标准组和APN咨询组的参与者在人口学和临床特征上没有统计学差异。在1年随访时，APN组205例幸存者中有107例（52.2%）完成了筛查，而非APN组206例幸存者中有46例（22.3%）完成了筛查（P < 0.001）。调整性别、年龄（< 30岁）和儿童肿瘤组推荐的筛查频率组（每年、2年或5年）后，APN组幸存者完成推荐的心肌病筛查的可能性比对照组高2倍（RR, 2.31; 95% CI， 1.74至3.07）。结论：电话咨询与心脏健康筛查建议的SCP增加了高危幸存者的心肌病筛查。(C) 2014年由美国临床肿瘤学会出版
PurposeTo determine whether the addition of advanced-practice nurse (APN) telephone counseling to a printed survivorship care plan (SCP) significantly increases the proportion of at-risk survivors who complete cardiomyopathy screening.Patients and MethodsSurvivors age > 25 years participating in the Childhood Cancer Survivor Study who received cardiotoxic therapy and reported no history of cardiomyopathy screening in the previous 5 years were eligible for enrollment. The 472 participants (mean age, 40.1 years; range, 25.0 to 59.0; 53.3% women) were randomly assigned to either standard care, consisting of an SCP summarizing cancer treatment and cardiac health screening recommendations (n = 234), or standard care plus two APN telephone counseling sessions (n = 238). The primary outcome-completion of cardiomyopathy screening within 1 year-was validated by medical records and compared between the two arms using adjusted relative risks (RRs) with 95% CIs.ResultsParticipants in the standard and APN counseling groups were not statistically different by demographic or clinical characteristics. At the time of 1-year follow-up, 107 (52.2%) of 205 survivors in the APN group completed screening compared with 46 (22.3%) of 206 survivors in the non-APN group (P < .001). With adjustment for sex, age (< 30 v >= 30 years), and Children's Oncology Group-recommended screening frequency group (annual, 2 years, or 5 years), survivors in the APN group were > 2 x more likely than those in the control group to complete the recommended cardiomyopathy screening (RR, 2.31; 95% CI, 1.74 to 3.07).Conclusion The addition of telephone counseling to an SCP with cardiac health screening recommendations increases cardiomyopathy screening in at-risk survivors. (C) 2014 by American Society of Clinical Oncology