Standard Cardiovascular Risk Assessment Sufficient for Childhood Cancer Survivors: JAMA study
A randomized clinical trial found that adult survivors of childhood cancer did not gain additional benefit from tailored cardiovascular (CV) counseling compared with standard CV risk assessment. While technically negative, the study offers reassuring evidence that a simple, standardized approach to evaluating and communicating cardiovascular risk may be adequate for this population. The study was published in JAMA Network Open by Eric J. and colleagues.
There is a significantly increased risk of cardiovascular disease among survivors of childhood cancer because of previous treatment with cardiotoxic agents. In spite of the availability of guidelines that recommend screening and aggressive management of risk factors for CVD, high-risk patients are often not followed up or treated appropriately as young adults. The Communicating Health Information and Improving Coordination With Primary Care (CHIIP) Study was conducted to see if an SCP-based counseling intervention could improve control of hypertension, dyslipidemia, and glucose intolerance in this high-risk population.
The CHIIP Study recruited participants from the Childhood Cancer Survivor Study group in 9 metropolitan areas in the US between August 2017 and April 2020, and the follow-up ended in July 2022. Data analysis ended on March 18, 2025.
Of the 1,840 survivors approached:
842 agreed to participate
347 met all eligibility criteria and were randomized
Eligibility criteria were:
Adult survivors of childhood cancer
Exposure to cardiotoxic therapies
Presence of undertreated CVD risk factors, as defined by standard guidelines
Hypertension
Dyslipidemia
Glucose intolerance
Participants underwent a home assessment by trained examiners prior to randomization.
The final randomized group consisted of 347 survivors:
Mean (SD) age: 40.5 (9.4) years
182 participants (52.4%) male
175 assigned to the intervention group
172 assigned to enhanced care control
Key findings
After 1 year of follow-up, 45 of 173 surviving participants in the intervention group (26.0%) demonstrated reduced undertreatment of cardiovascular risk factors, compared with 52 of 172 participants (30.2%) in the enhanced care control group.
The primary comparative analysis yielded an odds ratio (OR) of 1.31 (95% CI, 0.84–2.05) for reduced undertreatment in the intervention group compared with controls, a difference that was not statistically significant.
Participants who were more engaged in the counseling process had lower odds of undertreatment at 1 year (OR, 0.31; 95% CI, 0.18–0.72).
In addition, primary care clinician documentation of cardiovascular risk improved substantially in the intervention group, with a 14.8% increase compared with only a 0.9% increase in the control group (P = 0.002).
In the long-term, survivors of childhood cancer with high cardiovascular risk, the addition of survivorship-based self-management counseling did not decrease undertreatment of hypertension, dyslipidemia, or glucose intolerance beyond the provision of CVD risk assessments to survivors and primary care providers.
Reference:
Chow EJ, Chen Y, Yasui Y, et al. Counseling and Cardiovascular Disease Risk Factor Control in Long-Term Cancer Survivors: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(2):e2555863. doi:10.1001/jamanetworkopen.2025.55863
