CV health tool effectively promotes discussions during routine follow-up in cancer survivors
A novel electronic health record (EHR) clinical decision support tool, otherwise called the AH-HA* tool, was effective in promoting cardiovascular health (CVH) discussions among cancer survivors during routine follow-up. This was the primary result of a clinic-randomized, hybrid effectiveness-implementation trial presented at ASCO 2023.
“We developed the AH-HA tool with input from patients and oncologists. It focuses on the assessment of the AHA** Simple 7*** CVH factors,” said Dr Kathryn Weaver from the Wake Forest University School of Medicine, Winston-Salem, North Carolina, US.
Weaver pointed out that although these data are available in EHRs, these are spread across various places, making it difficult at point-of-care to immediately access which risk factors would be significant for cancer patients.
“Our overarching goal was to improve the delivery of guideline-recommended CVH assessment and counselling for post-treatment cancer survivors, with the goal of improving some of the burden of CV disease, which is very significant among post-treatment survivors,” she said.
“Cancer survivors have almost twice the risk of fatal heart disease compared with the general population. Deaths related to heart disease exceed those from cancer for many common early-stage cancers,” Weaver continued.
The team enrolled 645 cancer survivors (mean age 62 years, 96 percent female) who were receiving routine care ≥6 months post-treatment. Of these, 349 patients received usual care, while 298 comprised the intervention arm which used the AH-HA tool plus provider education. [ASCO 2023, abstract LBA12007]
About 3 percent did not complete the post-clinic survey, leaving the team with 627 evaluable cases. Baseline characteristics between arms were similar, except for cancer types. The intervention arm had more breast cancer survivors than the usual care arm (92.9 percent vs 73.3 percent) but fewer endometrial cancer cases (0.3 percent vs 15.2 percent).
The rate of self-reported discussions with providers was nearly double in the intervention vs the usual care arm (98 percent vs 55 percent; p<0.001).
There was a relatively low number of CVH factors discussed in the usual care vs the intervention arm (mean, 1.23 vs 4.12; p<0.001). “We were able to verify this when we looked at the factors documented in the EHR. There was a mean of about 1 in the usual care clinics compared with four in the AH-HA clinics,” Weaver noted.
AH-HA was also effective in promoting referrals to primary care than usual care (39 percent vs 24 percent; p=0.03). “This was our goal. We do not intend to turn oncologists to primary care doctors; rather, we want to get patients back to primary care to have their risk factors managed,” Weaver stressed.
Looking at the individual CVH topics discussed, there was a 50–60 percent increase in discussions about each of the CVH risk factors in AH-HA vs usual care clinics (p<0.001 for all factors). “This suggests that very little discussion is happening in usual care clinics, and we were able to substantially increase those discussions [with the AH-HA tool],” she said.
“Importantly, AH-HA was acceptable among our providers. This was a major concern,” she stressed. “By and large, [providers noted that the tool] provided useful information, was easy to use, and met their needs when providing post-treatment survivorship care.”
The study however had limited ethnic and racial diversity, which could have been driven by the COVID-19 pandemic. Also, there was a preponderance of breast cancer survivors, but this is reflective of the population that is mostly seen in community oncology practices for post-treatment survivorship care.
The current findings are also limited to the tool’s short-term impact. “[Nonetheless,] we will continue to follow patients for another year,” shared Weaver.