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Cardiovascular screening outcomes in the Dutch survivorship care program for Hodgkin lymphoma survivors
Eline M J Lammers1, Annelies Nijdam1, Josée M Zijlstra2
1Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Insights
Cardiovascular screening for Hodgkin lymphoma survivors shows good adherence to guidelines. The program effectively identifies numerous cardiovascular risk factors and conditions, enabling timely intervention for late cardiotoxicity.
Area of Science:
- Cardiology
- Oncology
- Public Health
Background:
- Hodgkin lymphoma (HL) survivors face elevated cardiovascular disease (CVD) risk due to cancer treatments.
- Cardiovascular screening was implemented in Dutch survivorship clinics for 5-year HL survivors in 2013.
Purpose of the Study:
- To evaluate adherence to national cardiovascular screening guidelines for HL survivors.
- To determine the effectiveness of the screening program in identifying CVD and its risk factors.
Main Methods:
- Retrospective analysis of medical records from 186 HL survivors (2013-2021) at three Dutch University Medical Centers.
- Data collected included patient characteristics, screening procedures (blood tests, ECG, echocardiography), and outcomes.
Main Results:
- Screening adherence was reasonable to good, with high rates of ECG (93.0%) and echocardiography (94.6%) performed.
- 55% of survivors had at least one modifiable cardiovascular risk factor.
- Screening detected CVD in 31.1% of survivors, including new valve dysfunction in 51.0% and impaired ejection fraction in 10.3%.
Conclusions:
- The Dutch HL survivorship care program demonstrates good adherence to cardiovascular screening guidelines.
- The screening program successfully identifies a significant number of actionable CVD risk factors and conditions in HL survivors.
Purpose:
Hodgkin lymphoma (HL) survivors are at increased risk of cardiovascular disease (CVD) due to former lymphoma treatment. In 2013, cardiovascular screening for 5-year HL survivors according to national guidelines was implemented in Dutch survivorship clinics. We aim to assess the following: (1) adherence to screening guidelines and (2) the yield of (risk factors for) CVD in the screening program.
Methods:
The study population consisted of 5-year HL survivors who received survivorship care at three University Medical Centers from 2013 to 2016 through 2021. Patient characteristics, cardiovascular screening procedures, and outcomes were collected from the medical records.
Results:
In 186 survivors eligible for cardiovascular screening (mean age 47.8 years, 60.8% female), the following diagnostics were performed: complete blood tests (81.0%, median frequency: yearly instead of advised 5-yearly evaluation), electrocardiogram (93.0%), echocardiography (94.6%). Fifty-five percent of survivors had at least one modifiable cardiovascular risk factor (i.e., current smoking, overweight, new/insufficiently controlled hypertension, dyslipidemia, or diabetes). Screening detected ≥ 1 CVD in 31.1% of survivors. Among survivors with available echocardiography report (n = 106), screening detected new aortic and/or mitral valve dysfunction(s) in 51.0% (with grades 3-4 in 4.9%) and impaired left ventricular ejection fraction in 10.3%.
Conclusions:
Adherence to the screening guidelines in the Dutch HL survivorship care program was reasonable to good and a substantial number of actionable (risk factors for) CVD were diagnosed.
Implications For Cancer Survivors:
Our findings inform HL survivors at high risk of late cardiotoxicity about cardiovascular screening findings and demonstrate appropriate therapeutic actions after diagnosis of (risk factors for) CVD.
