Abstract
BackgroundCardiovascular health is of increasing concern to breast cancer survivors and their health care providers, as many survivors are more likely to die from cardiovascular disease than cancer. Implementing clinical decision support tools to address cardiovascular risk factor awareness in the oncology setting may enhance survivors’ attainment or maintenance of cardiovascular health.ObjectiveWe sought to evaluate survivors’ awareness of cardiovascular risk factors and examine the usability of a novel electronic health record enabled cardiovascular health tool from the perspective of both breast cancer survivors and oncology providers.MethodsBreast cancer survivors (n=49) recruited from a survivorship clinic interacted with the cardiovascular health tool and completed pre and posttool assessments about cardiovascular health knowledge and perceptions of the tool. Oncologists, physician assistants, and nurse practitioners (n=20) who provide care to survivors also viewed the cardiovascular health tool and completed assessments of perceived usability and acceptability.ResultsEnrolled breast cancer survivors (84% White race, 4% Hispanic ethnicity) had been diagnosed 10.8 years ago (SD 6.0) with American Joint Committee on Cancer stage 0, I, or II (45/49, 92%). Prior to viewing the tool, 65% of survivors (32/49) reported not knowing their level for one or more cardiovascular health factors (range 0-4). On average, only 45% (range 0%-86%) of survivors’ known cardiovascular health factors were at an ideal level. More than 50% of survivors had ideal smoking status (45/48, 94%) or blood glucose level (29/45, 64%); meanwhile, less than 50% had ideal blood pressure (12/49, 24%), body mass index (12/49, 24%), cholesterol level (17/35, 49%), diet (7/49, 14%), and physical activity (10/49. 20%). More than 90% of survivors thought the tool was easy to understand (46/47, 98%), improved their understanding (43/47, 91%), and was helpful (45/47, 96%); overall, 94% (44/47 survivors) liked the tool. A majority of survivors (44/47, 94%) thought oncologists should discuss cardiovascular health during survivorship care. Most (12/20, 60%) oncology providers (female: 12/20, 60%; physicians: 14/20, 70%) had been practicing for more than 5 years. Most providers agreed the tool provided useful information (18/20, 90%), would help their effectiveness (18/20, 90%), was easy to use (20/20, 100%), and presented information in a useful format (19/20, 95%); and 85% of providers (17/20) reported they would use the tool most or all of the time when providing survivorship care.ConclusionsThese usability data demonstrate acceptability of a cardiovascular health clinical decision support tool in oncology practices. Oncology providers and breast cancer survivors would likely value the integration of such apps in survivorship care. By increasing awareness and communication regarding cardiovascular health, electronic health record–enabled tools may improve survivorship care delivery for breast cancer and ultimately patient outcomes.
Highlights
Oncology providers and breast cancer survivors would likely value the integration of such apps in survivorship care
Cardiovascular health is of increasing concern to breast cancer survivors and their health care providers [1,2], since older, postmenopausal survivors are more likely to die of cardiovascular disease rather than of cancer [3,4]
We evaluated the acceptability of the new Automated Heart-Health Assessment tool (AH-HA, Figure 1) among oncology providers and the Vigor-Us mobile app (Figure 1) among breast cancer survivors
Summary
Cardiovascular health is of increasing concern to breast cancer survivors and their health care providers [1,2], since older, postmenopausal survivors are more likely to die of cardiovascular disease rather than of cancer [3,4]. According to 1582 long-term cancer survivors surveyed in California, 62% were overweight or obese, 55% were hypertensive, 21% were diabetic, 18% were physically inactive, and 5% were current smokers [11]. An analysis of these California cancer registry data highlighted the possible role of shared risk factors in the development of both cancer and cardiovascular disease, reporting that cancer survivors tend to have multiple cardiovascular disease risk factors and that survivorship care often does not address these risk factors [11,12].
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