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Remote monitoring of cardiac function in childhood cancer survivors

远程监测儿童癌症幸存者的心脏功能

基本信息

批准号：
10456314
负责人：
Saro Armenian
金额：
$ 17.44万
依托单位：
BECKMAN RESEARCH INSTITUTE/CITY OF HOPE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10456314
关键词：
Acoustics Address Adult Age Anthracycline Biometry Bluetooth Breast Cancer survivor COVID-19 pandemic Cancer Center Cancer Survivor Cancer Survivorship Cardiac Cardiology Cardiotoxicity Cardiovascular system Caring Cellular Phone Chest Chronic Disease Clinic Clinical Development Devices Diagnosis Diagnostic Diagnostic Imaging Disease Disease Management Dose EFRAC Early Diagnosis Echocardiography Enrollment Ensure Face Freedom Guidelines Healthcare Heart Diseases Heart Transplantation Heart failure High-Risk Cancer Home Immunotherapy Knowledge Left Ventricular Ejection Fraction Long Term Survivorship Long-Term Survivors Longterm Follow-up Lymphoma Magnetic Resonance Malignant Childhood Neoplasm Measures Medical Monitor Morbidity - disease rate Myocardial dysfunction Oncology Outcome Patients Penetration Periodicity Persons Pharmacology Population Prevention strategy Prior Therapy Radiation therapy Reporting Reproducibility Research Research Priority Risk Schools Self Administration Survivors Technology Testing Time Trastuzumab Treatment-Related Cancer Ventricular Remodeling Visit Work base biomechanical engineering cancer risk cancer therapy cardiac magnetic resonance imaging cardiovascular disorder risk cardiovascular risk factor childhood cancer survivor clinical care clinical development clinically relevant community setting cost cost effective cost effectiveness early screening follow-up health economics heart function heart imaging imaging approach mHealth markov model mobile computing mortality multidisciplinary point of care primary care setting prospective remote monitoring response routine screening screening standard of care survivorship wireless electronic

项目摘要

Abstract Cardiovascular complications are a leading cause of morbidity and mortality in survivors of childhood cancer. These survivors have a greater than four-fold risk of developing heart failure (HF) when compared to age- matched controls, and there is a strong dose-dependent association between anthracycline exposure and the risk of heart failure. Outcome following HF is poor, emphasizing the importance of early detection of cardiac dysfunction (e.g. abnormal left ventricular ejection fraction [EF]) with cardiac imaging and initiation of pharmacologic therapy prior to the development of clinically overt disease. Unfortunately, the period in time when survivors are at the greatest risk of HF also corresponds to the time when they are least engaged in risk- based survivorship care. New paradigms in clinical care and chronic disease management are needed for these survivors. Recent advances in mobile technology have facilitated the development of a new sector of mobile healthcare diagnostics (mHealth) that has the potential to combine the utility of standard of care cardiac monitoring by echocardiography with the accuracy of more advanced diagnostic imaging (cardiac magnetic resonance [CMR]). However, neither the reproducibility nor the cost-effectiveness of this mHealth technology for prospective clinic- or home-based cardiac monitoring in cancer survivors is known. To address these knowledge gaps, we will enroll 200 long-term childhood cancer survivors who previously underwent a one-time assessment of cardiac EF by echocardiography, CMR, and a handheld Bluetooth-enabled device (Vivio) to validate the accuracy of Vivio EF in the clinic setting, and to determine its reproducibility at home (Aim 1). We will also leverage the expertise of our investigative team to determine the cost-effectiveness of Vivio-based screening using Markov modeling (Aim 2). This study will: 1) provide an important follow-up timepoint that will confirm the accuracy of EF, as measured using Vivio, in anthracycline-exposed survivors; 2) demonstrate the reproducibility of self-administered home-based measures of cardiac function in survivors who may no longer be able to maintain survivorship-focused care at the cancer center; and 3) establish whether Vivio-based screening is a cost-effective alternative to current standard of care cardiac imaging approaches. Information obtained from the current study can be used to develop strategies that facilitate screening and management of cardiac dysfunction during cancer treatment, or after completion of therapy in other at-risk cancer populations (e.g. adult survivors of lymphoma treated with known cardiotoxic [anthracyclines, chest radiation] therapies or newer immunotherapies, adult survivors of breast cancer treated with anthracyclines and/or trastuzumab) who face similar challenges in long-term follow-up. The growing population of long-term cancer survivors at risk for cardiovascular disease makes development of screening and prevention strategies imperative, to ensure that these survivors live long and healthy lives well after completion of their cancer treatment.

摘要