A randomized study found that early screening for risk factors was as helpful as screening plus one-on-one counseling.

Adults who survived childhood cancer don’t get any added benefit from tailored counseling beyond what’s achieved with standard CV risk assessments, new data from a randomized clinical trial suggest.

But researchers say their study, though technically negative, in fact provides some good news: a simple approach to gauging and communicating risk may well be sufficient in this population. The findings were published recently in JAMA Network Open.

Lead author Eric J. Chow, MD, MPH (Fred Hutchinson Cancer Center, Seattle, WA), told TCTMD that adult survivors of childhood cancer are probably “not the typical patients that most cardiologists or primary care providers usually think about when they’re seeing patients.”

Approximately 500,000 survivors of childhood cancer live in the US. Due to the cancer therapies they received years prior, many face early onset of cardiovascular disease—by age 50, around 10% of those exposed to cardiotoxic treatments such as anthracyclines or chest radiotherapy will develop ischemic heart disease and/or heart failure.

“It was obviously a little bit disappointing” to see no advantage with the more intensive, customized approach, said Chow, but it seems “performing the screening and finding . . . abnormal results is an important first step and that’s actually much easier to do.”

It’s also possible that the study design—wherein controls received enhanced care involving early screening for CVD but no counseling—didn’t fully capture the advantage the intervention would have over usual care. Chow said that they designed their study in this way due to ethical concerns. “These were all clinically actionable lab tests, so we didn’t feel like . . . we could hide those results, especially since we were processing them in real time,” he explained.

Chow said that, regardless of the specific findings, the study will hopefully raise awareness among clinicians that adult survivors face outsized heart risks. The American Heart Association, in 2025, released a scientific statement exploring cardiovascular toxicity in patients treated for childhood cancer.

CHIIP Findings

The Communicating Health Information and Improving Coordination With Primary Care (CHIIP) Study, part of the Childhood Cancer Survivor Study, enrolled 347 adult survivors of childhood cancer (mean age 40.5 years; 52.4% male) across nine US metropolitan areas between 2017 and 2020. All had been exposed to cardiotoxic cancer therapies as children.

To start, a trained home examiner tested the study participants’ blood pressure, lipid profile, and glucose and hemoglobin A1c levels. A little more than half (53.0%) were found to have undertreated hypertension at baseline, 51.9% had undertreated dyslipidemia, and 49.0% had undertreated glucose intolerance. Fully 43.2% had more than one such condition, and 10.7% had all three.

Participants randomized to the intervention group, after that testing, were mailed a survivorship care plan (SCP) with personalized CV risk information then took part in a remote counseling session to review measurements and develop an action plan for CV risk factor management, plus a follow-up session 4 months later. Those randomized to the control group received enhanced usual care consisting of their CV assessment results and advice to follow up with their primary care clinician regarding any abnormal values.

Additionally, study participants’ primary care clinicians received all of the materials sent to their patients.

By 1 year, 26% of individuals in the intervention group and 30.2% of enhanced-care controls had less undertreatment for hypertension, dyslipidemia, and glucose intolerance, a nonsignificant between-group difference (OR 1.31; 95% CI 0.84-2.05). Both groups had decreases in diastolic blood pressure and LDL cholesterol compared with baseline. The intervention group had a significant reduction in systolic blood pressure (-4.6 mm Hg; 95% CI -7.1 to -2.1 mm Hg), and the controls had a significant reduction in triglycerides (-48.9 mg/dL; 95% CI -91.9 to -5.8 mg/dL).

Among the intervention participants, greater engagement with their counseling sessions and action plan was tied to less undertreatment at 1-year follow-up (OR 0.31; 95% CI 0.18-0.72). The intervention group, compared with controls, also had better documentation of cancer history and CV risk in their health records, with improvements of 14.8% versus 0.9%, respectively (P = 0.002).

“There’s a possibility that down the road that this might have implications” for cardiovascular health, said Chow. Earlier work has shown “a fair percentage of people who had cancer as children weren’t necessarily documented as having had cancer at all” in their medical records, he added, and those who were didn’t always have details of which cancer treatments they received at the time.

Without those details, clinicians now seeing an adult survivor might understandably not be on the alert for early cardiovascular disease. And even if they do know their patient’s history, they may not be aware of its relevance. “Most primary care providers, if they decide to screen it’s based on general population guidelines,” which tend to focus on older patients, said Chow.

Next up, he said, the research team will be looking in greater detail at how CHIIP Study participants may have had their medications adjusted based on their lab results. In a separate study, they also plan to look at how lifestyle modification might impact CV risk in adult survivors.

But Would More Be Better?

Stephanie B. Dixon, MD, MPH (St. Jude Children’s Research Hospital, Memphis, TN), and Bonnie Ky, MD (University of Pennsylvania, Philadelphia), in an accompanying editorial, suggest several explanations for the CHIIP Study findings. Among them are that intervention and control groups each saw more improvement than was initially expected. “It is also possible that further improvement in CV risk factor control among survivors requires more intensive intervention for primary care providers, survivors, or both,” they write.

For example, patients in the CHIIP study’s intervention arm were given the SCP, Dixon and Ky note. Both the National Academy of Medicine and American Society of Clinical Oncology “recommend generation of an SCP soon after completion of cancer-directed therapy as a tool to communicate treatment information and associated risk or need for surveillance. [But] the clinical impact of these have been mixed, and there is still little evidence that their provision improves health outcomes and care delivery for survivors.”

This lack of impact may stem from the fact that the “specific contents of SCPs and how they can be optimally delivered and utilized to improve care coordination and health outcomes for survivors still needs to be defined,” the editorialists point out.

“Research to optimize interventions for CV risk factor management that are not only effective but also scalable and easily disseminated to the diverse network of healthcare practitioners caring for adult survivors are urgently needed in this growing population,” they conclude.