Fewer cardiac scans in low-risk childhood cancer survivors can safely reduce costs

A less frequent screening schedule would both reduce health care charges and still protect low-risk childhood cancer survivors from heart ailments caused by drug therapy, according to recently published findings.

That's the very exciting and very hopeful bottom line of the recently published study, said co-author Steven Lipshultz, MD, Wayne State University professor and chair of pediatrics and pediatrician-in-chief at the Children's Hospital of Michigan, part of the Detroit Medical Center. He has spent more than 30 years studying the potential harmful impact, known as cardiotoxicity, of drug therapies on the hearts of children who have survived cancer.

The study, published in the Annuals of Internal Medicine (2014; doi:10.7326/M13-2498), reviewed data from patient histories to show that current standard medical guidelines for monitoring childhood cancer survivors for drug treatment-related heart disease and heart failure later in life through periodic echocardiography are overly cautious.

According to the data, the frequency of such postcancer screenings can be safely reduced for low-risk patients—with large cost-savings and little reduction in overall quality of patient care.

"The potential savings to be earned by reducing the frequency of echocardiographic screenings in patients who have survived childhood cancer seem quite promising," Lipshultz said. "The data in our study on the cost-effectiveness of such screenings suggest that we could save 50% of the charges for this heart care screening, while also sparing these children from the rigors of needless heart scanning."

While pointing out that total US spending for health care exceeds $3 trillion a year and amounts to nearly 17% of the entire US gross domestic product, Lipshultz described the breakthrough findings as "a classic example of how effective research in pediatric medicine can both assure the quality of patient care and help in the effort to keep medical costs under control."

According to the findings, the guidelines for the frequency of heart scans among childhood cancer survivors—as devised in 2003 by the nation's standard-setting Children's Oncology Group—could be safely revised, so that instead of undergoing the scans every 1, 2, or 5 years (depending on pertinent health factors), the childhood cancer survivors would be scanned only every 2, 4, 5, or 10 years.

"The National Cancer Institute has estimated that one in every 530 young adults (age 20 to 45 years) is a survivor of childhood cancer," said the veteran researcher, who has published frequently over the years on the subject of cardiotoxic effects from cancer-related drug treatment in childhood cancer survivors. "For these patients, making sure the long-lasting impact of drug therapy doesn't lead to heart disease and heart failure later in life is vitally important.

"For childhood cancer survivors and their families, this new study is very good news, indeed—because it shows that many of them in the low-risk category can safely reduce the frequency of their heart screenings, with a significant reduction in accompanying costs."

Lipshultz pointed out that asking childhood cancer survivors to undergo too-frequent heart scans also carries a social cost, since having frequent scans can differentiate them from their peers and cause an exaggerated focus on their heart health.

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