They survived childhood cancer; but decades later, a hidden threat quietly emerges: cardiovascular disease. Thanks to advances in treatment, more than 85% of children diagnosed with cancer today will live at least five years past diagnosis. In the United States, that means roughly half a million survivors of childhood cancer are now living as adults, many of them in their 30s, 40s, and beyond. But the very therapies that saved their lives such as anthracycline chemotherapy, and chest radiation, leave lasting marks on the heart. Survivors face elevated risks of heart failure, ischemic heart disease, and stroke at far younger ages than the general population. Now, a new randomized clinical trial from Fred Hutchinson Cancer Center and collaborating institutions asks a pressing question: can we do something about it?
The Communicating Health Information and Improving Coordination With Primary Care (CHIIP) study, led by Dr. Eric Chow at Fred Hutch and published in JAMA Network Open, enrolled 347 adult survivors of childhood cancer who were known to be at elevated cardiovascular risk and found to have undertreated hypertension, high cholesterol, or blood sugar abnormalities. Half were assigned to the intervention group, which received a personalized survivorship care plan (SCP), a document outlining their cancer treatment history, heart disease risk estimates, and tailored recommendations, followed by two remote counseling sessions with a survivorship-trained clinician. The other half received "enhanced usual care," featuring their screening results along with a note flagging any abnormal values and urging them to follow up with their primary care clinician. Trained home examiners measured blood pressure, cholesterol, and blood sugar at the start and one year later.
The headline result was not what the team expected. After one year, both groups improved by similar amounts. About 26% of the intervention group had less undertreatment of their cardiovascular risk factors, compared with 30% in the enhanced care control group. This suggests that providing screening results and prompting follow-up may itself be a powerful and more scalable intervention. And for those who engaged more deeply, the benefits were even greater. Those rated as engaged with their action plans were ~70% less likely to remain undertreated at one year, depending on their level of engagement. The intervention also moved the needle in medical records. Primary care clinicians caring for intervention participants were significantly more likely to document their patients' cardiotoxic treatment history and elevated cardiovascular risk — a 15% improvement compared to less than 1% in controls. Since documented risk is a known predictor of receiving recommended cardiac screening, this paper trail may have long-term value that won't show up in a one-year trial.
The CHIIP results point toward an important question the trial couldn't fully answer: what does it take to close the gap further? "We did not see differences between the two arms in our main study outcomes," Dr. Chow noted. "However, we found that a large majority of participants on the intervention arm wanted more information and help with lifestyle change." That desire prompted a follow-up study now nearing completion. Called SALSA (the Study of Active LifeStyle Activation), it tests specific physical activity and diet change strategies among the same population of long-term cancer survivors. "We have enrolled 374 participants on that trial, which should wrap up later this year," Dr. Chow said. The contrast in study names — CHIIP and SALSA — is something of an inside joke among the research team, but the science behind it is serious. If CHIIP showed that screening and basic care coordination can move outcomes, SALSA is designed to push further into the lifestyle modifications that survivors need but rarely receive.
The CHIIP trial won't be the last word. But it offers a clarifying lesson: sometimes the intervention that matters most is simply making sure people are seen, their risks are named, and their doctors know what they're dealing with. In a population that has already beaten long odds, that kind of visibility may be where the next battle for health is won.
This work was supported by the National Institutes of Health, the Unravel Pediatric Cancer Foundation, Fred Hutchinson Cancer Center, St. Jude Children's Research Hospital, and the American Lebanese-Syrian Associated Charities.
Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium Member Dr. Eric Chow contributed to this research.
Chow, E. J., Chen, Y., Yasui, Y., Baldwin, L. M., Hudson, M. M., Muller, T. M., Nathan, P. C., Ngai, S. L., Ohlsen, T. J. D., Snyder, C., Syrjala, K. L., Tonorezos, E. S., Armstrong, G. T., & Oeffinger, K. C. (2026). Counseling and Cardiovascular Disease Risk Factor Control in Long-Term Cancer Survivors: A Randomized Clinical Trial. JAMA Network Open, 9(2), e2555863.
Science Spotlight writer Darya Moosavi is a postdoctoral research fellow within Johanna Lampe's research group at Fred Hutch. Darya studies the nuanced connections between diet, gut epithelium, and gut microbiome in relation to colorectal cancer using high-dimensional approaches.
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