Communicating cardiovascular risk to high-risk cancer survivors: a mixed-methods pilot study of a statin risk communication tool.

PURPOSE: Childhood, adolescent, and young adult cancer survivors treated with radiation therapy (RT) may be unaware of their high cardiovascular disease (CVD) risk or how to mitigate it. Tools are needed to improve understanding. We developed and pilot-tested a risk communication tool for shared decision-making with survivors regarding CVD risk reduction with statin therapy. We included quantitative and qualitative arms to further tool development and testing. METHODS: The statin risk communication tool was adapted from a previously validated tool. Patients were at increased risk for CVD due to history of chest RT and recruited to usual care and intervention arms. The post-visit survey included Likert-like scales to explore acceptability of the tool, knowledge questions, and a decisional conflict scale. This pilot study used descriptive statistics and was not powered for significance. Semi-structured interviews with intervention arm participants explored shared decision-making processes. RESULTS: Median participant (n = 46) age was 45. Most intervention patients (22/24, 92%) and 50% (11/22) of controls found statin information acceptable while 31% (7/22) of the control arm selected "not applicable" regarding information acceptability. Most participants were unaware of their personal CVD risk or potential statin side effects. In semi-structured interviews, participants found the tool is helpful to visualize risk and aid conversations. CONCLUSIONS: The risk communication tool was acceptable. Qualitative data suggested the tool improved decisional clarity and comfort. IMPLICATIONS FOR CANCER SURVIVORS: Poor knowledge of CVD and statins and poor recall of CVD risk conversation suggest a need to continue to optimize conversations regarding cardiovascular risk and statin therapy.

Utilization of clinical genetic counseling among childhood and young adult cancer survivors in a registry trial.

We describe utilization of clinical genetic services among survivors of childhood and young adult cancer after participation in a genetic registry. Clinical genetic counselors flagged 162 out of 1069 pedigrees (15.2%) as suggestive of inheritable cancer susceptibility, resulting in 126 (11.8%) referral letters. Following delivery of the referral letters, 19 (15.1%) participants completed clinical genetic counseling, 16 (12.7%) received testing, and four (3.2%) were found to have actionable results. Our results suggest a discordance between reported willingness to undergo genetic counseling and real-world utilization.

Promoting Breast Cancer Surveillance: The EMPOWER Study, a Randomized Clinical Trial in the Childhood Cancer Survivor Study.

PURPOSE: The aim of the current study was to increase the uptake of screening mammography among high-risk women who were treated for a childhood cancer with chest radiotherapy. PATIENTS AND METHODS: Two hundred four female survivors in the Childhood Cancer Survivor Study who were treated with chest radiotherapy with 20 Gy or greater, age 25 to 50 years, and without breast imaging in the past 24 months were randomly assigned 2:1 to receive a mailed informational packet followed by a tailored telephone-delivered brief motivational interview (intervention) versus an attention control. Primary outcome was the difference in the proportion of participants who completed a screening mammogram by 12 months as evaluated in an intent-to-treat analysis. Stratum-adjusted relative risk (RR) and 95% CI were estimated using the Cochran-Mantel-Haenszel method. Secondary outcomes included the completion of screening breast magnetic resonance imaging (MRI) and barriers to screening and moderating factors. RESULTS: Women in the intervention group were significantly more likely than those in the control group to report a mammogram (45 [33.1%] of 136 v 12 [17.6%] of 68; RR, 1.9; 95% CI, 1.1 to 3.3). The intervention was more successful among women age 25 to 39 years (RR, 2.2; 95% CI, 1.1 to 4.7) than among those age 40 to 50 years (RR, 1.4; 95% CI, 0.6 to 3.2). The proportion of women who reported a breast MRI at 12 months was similar between the two groups: 16.2% (intervention) compared with 13.2% (control; RR, 1.2; 95% CI, 0.6 to 2.5). Primary barriers to completing a screening mammogram and/or breast MRI included lack of physician recommendation, deferred action by survivor, cost, and absence of symptoms. CONCLUSION: Use of mailed materials followed by telephone-delivered counseling increased mammography screening rates in survivors at high risk for breast cancer; however, this approach did not increase the rate of breast MRI. Cost of imaging and physician recommendation were important barriers that should be addressed in future studies.