Cardiomyopathy Screening Adherence Among Medicaid-Enrolled Long-Term Survivors of Childhood Cancer

Childhood cancer survivors face increased risks of adverse cardiovascular outcomes due to treatment exposures. National guidelines recommend periodic cardiomyopathy screening for survivors exposed to anthracyclines or radiation. We examined the receipt of and the adherence to guideline-recommended cardiomyopathy testing (echocardiogram, multigated acquisition scan, magnetic resonance imaging) among Medicaid-enrolled childhood cancer survivors.

Using data from the Childhood Cancer Survivor Study linked to administrative Medicaid claims, we analyzed 1062 at-risk survivors aged 18-64 years who were continuously enrolled in Medicaid each year throughout 2015-2019.

We found that 26.8% received any cardiomyopathy test, and 9.6% adhered to guidelines. Residence in Medicaid expansion (vs. non-expansion) states was associated with 6.9% points (95% CI = 0.7-13.1) higher likelihood of receiving any cardiomyopathy test and 4.2% points (95% CI = 0.4-7.9) higher likelihood of adherence.

These findings suggest low receipt and poor adherence to guideline-recommended cardiomyopathy screening among long-term survivors of childhood cancer. Our data further underscore the critical role of Medicaid programs in supporting access to quality survivorship care for this vulnerable population.