Cost-Effectiveness of Screening for Asymptomatic Left Ventricular Dysfunction in Childhood Cancer Survivors
Authors: Richard M. Steingart, Jennifer E. Liu, Kevin C. Oeffinger
Journal: Annals of Internal Medicine (2014)

Editorials20 May 2014Cost-Effectiveness of Screening for Asymptomatic Left Ventricular Dysfunction in Childhood Cancer SurvivorsRichard M. Steingart, MD, Jennifer E. Liu, MD, and Kevin C. Oeffinger, MDRichard M. Steingart, MDFrom Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, New York.Search for more papers by this author, Jennifer E. Liu, MDFrom Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, New York.Search for more papers by this author, and Kevin C. Oeffinger, MDFrom Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-0823 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail It has long been recognized that anthracycline chemotherapy can cause early- and late-onset congestive heart failure (CHF) and cardiomyopathy, which may progress to cardiac-specific death (1). Thus, children treated with anthracycline are monitored during and periodically after therapy. The Children's Oncology Group (COG) developed the Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers (COG-LTFU) in 2003 (2). In brief, periodic lifetime screening is recommended, based on age at treatment, cumulative anthracycline dose, and whether the heart was irradiated. These recommendations have been widely adopted.In this issue, 2 groups separately examined these recommendations and report on ...References1. Gilladoga AC, Manuel C, Tan CT, Wollner N, Sternberg SS, Murphy ML. The cardiotoxicity of adriamycin and daunomycin in children. Cancer. 1976;37:1070-8. [PMID: 1253124] CrossrefMedlineGoogle Scholar2. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. Version 3.0. Accessed at www.survivorshipguidelines.org on 2 April 2014. Google Scholar3. Wong FL, Bhatia S, Landier W, Francisco L, Leisenring W, Hudson MM, et al. Cost-effectiveness of the Children's Oncology Group long-term follow-up screening guidelines for childhood cancer survivors at risk for treatment-related heart failure. Ann Intern Med. 2014;160:672-83. LinkGoogle Scholar4. Yeh JM, Nohria A, Diller L. Routine echocardiography screening for asymptomatic left ventricular dysfunction in childhood cancer survivors: a model-based estimation of the clinical and economic effects. Ann Intern Med. 2014;160:661-71. LinkGoogle Scholar5. Russell LB, Gold MR, Siegel JE, Daniels N, Weinstein MC. The role of cost-effectiveness analysis in health and medicine. Panel on Cost-Effectiveness in Health and Medicine. JAMA. 1996;276:1172-7. [PMID: 8827972] CrossrefMedlineGoogle Scholar6. Mulrooney DA, Yeazel MW, Kawashima T, Mertens AC, Mitby P, Stovall M, et al. Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort. BMJ. 2009;339:b4606. [PMID: 19996459] CrossrefMedlineGoogle Scholar7. Armstrong GT, Plana JC, Zhang N, Srivastava D, Green DM, Ness KK, et al. Screening adult survivors of childhood cancer for cardiomyopathy: comparison of echocardiography and cardiac magnetic resonance imaging. J Clin Oncol. 2012;30:2876-84. [PMID: 22802310] CrossrefMedlineGoogle Scholar8. Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging. 2009;2:356-64. [PMID: 19808623] CrossrefMedlineGoogle Scholar9. Bertini M, Ng AC, Antoni ML, Nucifora G, Ewe SH, Auger D, et al. Global longitudinal strain predicts long-term survival in patients with chronic ischemic cardiomyopathy. Circ Cardiovasc Imaging. 2012;5:383-91. [PMID: 22412068] CrossrefMedlineGoogle Scholar10. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigators. N Engl J Med. 1992;327:685-91. [PMID: 1463530] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, New York.Acknowledgment: The authors thank Jersey Chen, MD, from the Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, for his thoughtful comments on cost-effectiveness analyses.Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0823.Corresponding Author: Richard M. Steingart, MD, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065; e-mail, [email protected]org.Current Author Addresses: Drs. Steingart and Liu: Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.Dr. Oeffinger: Memorial Sloan Kettering Breast and Imaging Center, 300 East 66th Street, New York, NY 10065. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRoutine Echocardiography Screening for Asymptomatic Left Ventricular Dysfunction in Childhood Cancer Survivors: A Model-Based Estimation of the Clinical and Economic Effects Jennifer M. Yeh , Anju Nohria , and Lisa Diller Cost-Effectiveness of the Children's Oncology Group Long-Term Follow-up Screening Guidelines for Childhood Cancer Survivors at Risk for Treatment-Related Heart Failure F. Lennie Wong , Smita Bhatia , Wendy Landier , Liton Francisco , Wendy Leisenring , Melissa M. Hudson , Gregory T. Armstrong , Ann Mertens , Marilyn Stovall , Leslie L. Robison , Gary H. Lyman , Steven E. Lipshultz , and Saro H. Armenian Routine Echocardiography Screening for Asymptomatic Left Ventricular Dysfunction in Childhood Cancer Survivors: A Model-Based Estimation of the Clinical and Economic Effects Jennifer M. Yeh , Anju Nohria , and Lisa Diller Cost-Effectiveness of the Children's Oncology Group Long-Term Follow-up Screening Guidelines for Childhood Cancer Survivors at Risk for Treatment-Related Heart Failure F. Lennie Wong , Smita Bhatia , Wendy Landier , Liton Francisco , Wendy Leisenring , Melissa M. Hudson , Gregory T. Armstrong , Ann Mertens , Marilyn Stovall , Leslie L. Robison , Gary H. Lyman , Steven E. Lipshultz , and Saro H. Armenian Metrics Cited ByChemotherapy-induced cardiotoxicity in childrenCardiovascular Risk in Survivors of CancerLate cardiotoxicity in aging adult survivors of childhood cancerDexrazoxane for reducing anthracycline-related cardiotoxicity in children with cancer: An update of the evidence 20 May 2014Volume 160, Issue 10Page: 731-732KeywordsCancer screeningCardiomyopathiesChemotherapyChildrenDecision analysisDrug therapyEchocardiographyHeart failureHypertension ePublished: 20 May 2014 Issue Published: 20 May 2014 CopyrightCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...