# Counseling and Cardiovascular Disease Risk Factor Control in Long-Term Cancer Survivors: A Randomized Clinical Trial

## TL;DR

A study found that adding counseling to CVD risk assessments for childhood cancer survivors did not significantly improve risk factor control compared to just providing test results.

## Contribution

The study evaluates a counseling intervention's effectiveness in improving cardiovascular risk factor management in childhood cancer survivors.

## Key findings

- Self-management counseling did not significantly reduce undertreatment of cardiovascular risk factors compared to standard care.
- Greater engagement with the intervention was associated with less undertreatment at 1 year.
- Primary care clinician documentation of CVD risk improved more in the intervention group.

## Abstract

Among adult survivors of childhood cancer with undertreated hypertension, dyslipidemia, or glucose intolerance, can remotely delivered, clinician-led, self-management counseling sessions reduce undertreatment more than provision of screening results alone?

In a randomized clinical trial of 347 participants, there was no significant difference after 1 year between the study groups: 26% of intervention participants and 30% of enhanced usual care control participants had less undertreatment of cardiovascular disease risk factors.

In this study, self-management counseling did not reduce cardiovascular risk factor undertreatment beyond simply providing hypertension, lipid level, and diabetes screening results to high-risk cancer survivors and their primary care clinicians.

This randomized clinical trial assesses whether a survivorship care plan with remotely delivered counseling increases control of risk factors for cardiovascular disease among adult survivors of childhood cancer.

Survivors of childhood cancer have an increased risk of cardiovascular disease (CVD). However, many survivors at high risk do not receive recommended CVD screening tests as young adults.

To assess whether a survivorship care plan (SCP)–based counseling intervention improves CVD risk factor control in high-risk survivors.

The Communicating Health Information and Improving Coordination With Primary Care (CHIIP) Study was a randomized clinical trial that enrolled eligible participants from the Childhood Cancer Survivor Study cohort in 9 US metropolitan areas between August 2017 and April 2020, with follow-up completed July 2022. Participants included adult survivors of childhood cancer exposed to cardiotoxic cancer therapies with undertreated CVD risk factors (hypertension, dyslipidemia, and glucose intolerance defined by standard guidelines); of 1840 survivors approached, 842 consented to participate, and 347 met all eligibility requirements and were randomized after a baseline home assessment. Data analysis was completed March 18, 2025.

The intervention consisted of a single remote session to review measurements and a SCP with personalized CVD risk information and to develop a CVD risk factor management plan, with a booster session 4 months later. Enhanced care controls received measurements with abnormal findings noted and written encouragement to follow up with their primary care clinician (PCC). PCCs received all materials sent to participants.

Blood pressure, lipid profile, and glucose and hemoglobin A1c levels collected by a trained home examiner at baseline and 1-year follow-up, with undertreatment defined by standard guidelines.

A total of 347 cancer survivors (mean [SD] age, 40.5 [9.4] years; 182 [52.4%] male) were randomized, 175 to the intervention group and 172 to the enhanced care control group. Of these, 194 participants (53.0%) participants had undertreated hypertension at baseline; 180 (51.9%), undertreated dyslipidemia; and 170 (49.0%) undertreated glucose intolerance. After 1 year, 45 of 173 surviving intervention participants (26.0%) and 52 of 172 enhanced care control participants (30.2%) had less undertreatment, with lower percentages for each condition vs baseline. Although the intervention did not reduce undertreatment compared with the control condition (odds ratio, 1.31; 95% CI, 0.84-2.05), greater engagement was associated with less undertreatment at 1 year among intervention participants (odds ratio, 0.31; 95% CI, 0.18-0.72). The intervention group had improved PCC documentation of CVD risk vs controls after 1 year (14.8% improvement vs 0.9%; P = .002).

In this randomized clinical trial of long-term survivors of childhood cancer, the addition of survivorship-based self-management counseling did not reduce undertreatment beyond simply providing CVD risk assessments to survivors and PCCs. Additional strategies to mitigate CVD risk in high-risk survivors should be examined in the future.

ClinicalTrials.gov Identifier: NCT03104543