Cardiovascular screening in long-term Hodgkin lymphoma survivors.

Abstract

e20592 Background: Hodgkin Lymphoma (HL) is highly curable, with an 85% 5-year survival rate. HL survivors have higher mortality rates than their peers, in part due to increased rates of cardiovascular (CV) disease. Therefore, consensus and expert recommendations include aggressive management of CV risk factors and consideration of screening for CV disease, depending on exposure to chemotherapy and radiotherapy. However, the frequency of compliance with these recommendations is not known. Methods: Patients treated for HL at Mayo Clinic Rochester from 1998-2008 were identified. Those who received radiation therapy >25 Gy and/or anthracycline chemotherapy >240 mg/m2 and had follow-up medical records after 2010 were reviewed to determine provider specialty and if CV screening or counseling regarding CV risk factors was documented. P-values were calculated using Chi squared method. Results: 96 patients were identified who were a mean of 9.3 years (range 5-15) from HL diagnosis. 32 (33%) patients had documented counseling about CV risk factors, but “history of HL treatment” was stated as the rationale for counseling in only the minority (16%) of cases. All patients had BP measured, 85 (89%) had glucose testing, and 44 (46%) had lipid testing. 19 (20%) received a CV screening test (most commonly echocardiogram (19%), followed by stress test (4%) and coronary CT (3%)). Among patients seen by a hematologist, 29% (23/79) had documented counseling on CV risks, compared to 53% (9/17) with primary care follow-up alone (p=.059). However, 18% (15/79) seen by a hematologist were counseled specifically referencing HL, compared to 0% (0/17) with primary care follow-up alone (p = .047). Among patients seen by a hematologist, 20% (16/79) received cardiac tests, compared to 18% (3/17) with primary care follow-up alone (p=.80). 11% (9/79) received testing due to their HL history when seen by a hematologist, compared to 0% (0/17) with primary care follow-up alone (p = 0.14). Conclusions: Despite the CV risk related to HL therapy, in this retrospective review few survivors had documented counseling or screening for CV disease. Rates were low among both primary care and hematology physicians. Integrated survivorship care and education of providers should remain a high priority.