159 - Feasibility and Acceptability of Carotid Ultrasound to Identify Head and Neck Cancer Survivors with High Cardiovascular Risk after Radiation Therapy: Results of a Prospective Study
Presenter(s)
R. T. Hughes1, C. H. Tegeler2, C. L. Nightingale3, A. C. Snavely4, H. D. Pacholke1,5, B. R. Chinnasami5, G. H. Sanders5, C. M. Furdui6, D. R. Soto-Pantoja7, T. C. Register8, K. E. Weaver3, and G. J. Lesser9; 1Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, NC, 2Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, 3Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, NC, 4Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, NC, 5Atrium Health Wake Forest Baptist Hayworth Cancer Center, High Point, NC, 6Department of Internal Medicine, Section of Molecular Medicine, Wake Forest University School of Medicine, Winston Salem, NC, 7Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, 8Department of Pathology, Comparative Medicine, Wake Forest University School of Medicine, Winston Salem, NC, 9Department of Internal Medicine, Section of Hematology and Oncology, Wake Forest University School of Medicine, Winston Salem, NC
Purpose/Objective(s): Radiotherapy (RT) for head and neck cancer (HNC) is associated with multiple late toxicities and may be a potential driver of accelerated atherosclerosis and a higher risk of carotid artery stenosis (CAS), cerebrovascular and cardiovascular diseases. To inform future prospective studies of a screening program, data on the feasibility and acceptability of carotid artery ultrasound (CUS) as a part of HNC survivorship care are needed.
Materials/Methods: In this prospective multi-site pilot study (NCT05490875), patients who completed RT for HNC at least 2 years prior with no evidence of disease were enrolled. Patients with a history of CAS, stroke, transient ischemic attack, carotid endarterectomy, carotid stent, prior CUS, recurrent HNC, re-irradiation, or ECOG 2+ were excluded. Eligible patients underwent a single CUS screening examination for evaluation of stenosis, other high-risk features, and intima-media thickness (IMT). The primary endpoint was feasibility, with the hypothesis that at least 60% of enrolled patients would successfully undergo study examination. Secondary endpoints included acceptability of the CUS (measured using the Acceptability of Intervention Measure [AIM], treatment in the event of an actionable finding, and screening CUS frequency as a survivorship activity. Barriers to CUS were elicited using a study-specific measure.
Results: In total, 60 patients were enrolled between October 2022 and October 2024. Most patients (67%) were men with oropharynx (45%) or oral cavity (23%) cancer. ECOG performance status was 0 in 57% and 1 in 43%; 57% of patients were current or former smokers. The most common comorbidities were hypertension (48%), arrhythmia (10%), diabetes (10%) and myocardial infarction (6%). Fifty patients (83%, 95% CI 72-92) underwent CUS; 10 did not due to technical delays with the study CUS machine. Acceptability of the intervention was high with 96-98% agreement or complete agreement across all 4 AIM items. Acceptability of treatment (if CUS were to identify an actionable finding) was also high: 90% were willing to take a medication or undergo a procedural intervention if warranted, and 98% would be willing to attend additional medical visits for further workup and discussion regarding risk-lowering therapy. All patients were willing to undergo repeat CUS in the future; 98% were agreeable to annual CUS, all patients were agreeable to every 2-3 years, and 68% were willing to return for routine screening for their remaining life (if indicated). Barriers to CUS (identified in >5%) included cost, fatigue related to medical testing, worry/fear of abnormal finding, and distance to healthcare facilities.
Conclusion: Screening CUS to identify head and neck cancer survivors at elevated risk of cerebrovascular/cardiovascular disease after RT is feasible and associated with high acceptability. Future studies testing the clinical impacts and cost effectiveness of a screening program and methods to reduce barriers to survivorship care are warranted.