Racial disparities in the rate of cardiotoxicity of HER2‐targeted therapies among women with early breast cancer

Litvak, Anya M.; Batukbhai, Bhavina; Russell, Stuart D.; Tsai, Hua Ling; Rosner, Gary L.; Jeter, Stacie C.; Armstrong, Deborah K.; Emens, Leisha A.; Fetting, John H.; Wolff, Antonio C.; Silhy, Raquel; Stearns, Vered; Connolly, Roisín M.

doi:10.1002/cncr.31260

Cited by 71 publications

(56 citation statements)

References 37 publications

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“…One study looked at rates of cardiotoxicity among females with breast cancer undergoing treatment with trastuzumab and found higher rates of cardiotoxicity in black women compared to white women, resulting in early termination of chemotherapy in black female patients. 15 A similar trend was found in black patients receiving doxorubicin therapy as well. 16 Therefore, enhanced cardiac surveillance and early referral for this population is crucial, especially since guideline-adherent cardiac monitoring was only identi ed in about 46% of all patients.…”

Section: Introductionsupporting

confidence: 59%

Healthcare disparities in cardio oncology: patients receive same level of surveillance regardless of race at a safety net hospital

Chen

Dalsania

Hamad³

2020

Preprint

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Background: Cardiotoxicity remains a dreaded complication for patients undergoing chemotherapy with human epidermal growth factor (HER)-2 receptor antagonists and anthracyclines. Though many studies have looked at racial disparities in heart failure patients, minimal data is present for the cardio-oncology population. Methods: We queried the echocardiogram database at a safety net hospital, defined by a high proportion of patients with Medicaid or no insurance, for patients who received HER2 receptor antagonists and/or anthracyclines from January 2016 to December 2018. Patient demographics, clinical characteristics, and treatment outcomes were collected. Based on US census data in 2019, home ZIP codes were used to group patients into quartiles based on median annual household income. The primary end point studied was referral rate to cardiology for patients undergoing chemotherapy. Results: We identified 149 patients who had echocardiograms and also underwent treatment with HER2 receptor antagonists and/or anthracyclines, of which 70 (47.0%) were referred to the cardio-oncology program at our institution. Basic demographics were similar, but white patients were more likely to live in ZIP codes with higher income quartiles (p<0.00001). Comparing between racial groups, there was no statistical difference in the percentage of patients that had a reduction in ejection fraction (EF) (p=0.75). There was no statistical difference between racial groups in the number of cardiology or oncology appointments attended, number of appointments cancelled, average number of echocardiograms received, additional cardiac imaging received. Black patients were more likely to receive ACEI/ARB post chemotherapy (p=0.047). A logistic regression model was created using race, age, gender, insurance, income quartile by home ZIP code, comorbidities (hypertension, hyperlipidemia, coronary artery disease, arrhythmia, diabetes mellitus, smoking, family history, age >65), procedures (coronary stents, cardiac surgery), medications pre-chemotherapy, cancer type, cancer stage, and chemotherapy. This model found that there was an increased referral rate among patients from higher income quartiles (p=0.017 for quartile 3, p=0.049 for quartile 4), patients with a history of hypertension (p<0.0001), and patients with breast cancer (p=0.02). Conclusions: The results of this study suggest that patients of our cardio-oncology population at a safety net hospital receive the same level of surveillance and treatment, and develop drop in ejection fraction at similar rates regardless of their race. However, patients that reside in ZIP codes associated with higher income quartiles, with hypertension, and with breast cancer, are associated with increased rate of referral.

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Section: Introductionsupporting

confidence: 59%

Healthcare disparities in cardio oncology: patients receive same level of surveillance regardless of race at a safety net hospital

Chen

Dalsania

Hamad³

2020

Preprint

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“…hypertension), lower baseline LVEF, obesity, and prior treatment with anthracycline chemotherapy [15][16][17][18]. In a retrospective analysis by Litvak et al [17], the rate of cardiotoxicity was higher among black patients compared with white patients, although black patients had more cardiovascular comorbidities. Long-term follow-up studies from clinical trials of trastuzumab in the adjuvant setting provide reassuring evidence that late occurrence of cardiotoxicity is uncommon [19][20][21][22].…”

Section: Incidencementioning

confidence: 99%

“…Potential factors associated with increased risk for trastuzumab cardiotoxicity include age, preexisting cardiovascular comorbid conditions (e.g. hypertension), lower baseline LVEF, obesity, and prior treatment with anthracycline chemotherapy [15][16][17][18]. In a retrospective analysis by Litvak et al [17], the rate of cardiotoxicity was higher among black patients compared with white patients, although black patients had more cardiovascular comorbidities.…”

Section: Incidencementioning

confidence: 99%

Cardiotoxicity of HER2-targeted therapies

Copeland‐Halperin

Liu

2019

Current Opinion in Cardiology

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Purpose of review-Cardiotoxicity is a well recognized adverse effect of human epidermal growth factor receptor 2 (HER2)-targeted therapies. The goal of this review is to highlight recent studies that have advanced our knowledge of the diagnosis, prevention, and management of cardiotoxicity associated with HER2-targeted agents. Recent findings-Several clinical risk factors for cardiotoxicity associated with HER2-targeted therapies have been identified including age, low-baseline left ventricular ejection fraction, and treatment with anthracyclines; however, these remain insufficient to identify all patients at risk for cardiotoxicity. Routine cardiac monitoring remains the standard for cardiotoxicity surveillance, although the optimal frequency and modality of monitoring remains uncertain. Global longitudinal strain, T1/T2 weighted CMR imaging protocols, and circulating biomarkers can detect early signs of cardiotoxicity, but studies are needed to investigate whether use of these markers in clinical practice improves patient outcomes. Cardioprotective medications (e.g. beta-blockers or ACEinhibitors) may be of benefit to patients at increased risk for cardiotoxicity from HER2-taregeted therapies, particularly those who are treated with an anthracycline-containing regimen. Summary-Improved risk stratification of patients during HER2-targeted therapy and effective prevention and management strategies for cardiotoxicity are needed to enhance the value of longitudinal cardiac monitoring and increase cardiac safety so that optimal breast cancer treatment can be delivered.

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“…One prior study showed that black female patients had higher rates of cardiotoxicity from trastuzumab compared to white female patients. 19,20 Our study looked at both sexes and included both trastuzumab and anthracyclines, and found no correlation between race and rates of cardiotoxicity.…”

Section: Discussionmentioning

confidence: 87%

Healthcare disparities in cardio oncology: patients receive same level of surveillance regardless of race at a safety net hospital

Chen

Dalsania

Hamad

2020

Preprint

View full text Add to dashboard Cite

Background: Cardiotoxicity remains a dreaded complication for patients undergoing chemotherapy with human epidermal growth factor (HER)-2 receptor antagonists and anthracyclines. Though many studies have looked at racial disparities in heart failure patients, minimal data is present for the cardio-oncology population. Methods: We queried the echocardiogram database at a safety net hospital, defined by a high proportion of patients with Medicaid or no insurance, for patients who received HER2 receptor antagonists and/or anthracyclines from January 2016 to December 2018. Patient demographics, clinical characteristics, and treatment outcomes were collected. Based on US census data in 2019, home ZIP codes were used to group patients into quartiles based on median annual household income. The primary end point studied was referral rate to cardiology for patients undergoing chemotherapy. Results: We identified 151 patients who had echocardiograms and also underwent treatment with HER2 receptor antagonists and/or anthracyclines, of which 70 (46.4%) were referred to the cardio-oncology program at our institution. Basic demographics were similar, but white patients were more likely to live in ZIP codes with higher income quartiles (p<0.00001). Comparing between racial groups, there was no statistical difference in the percentage of patients that had a reduction in ejection fraction (EF) (p=0.78). There was no statistical difference between racial groups in the number of cardiology or oncology appointments attended, number of appointments cancelled, or average number of echocardiograms received. A logistic regression model was created using race, age, gender, insurance, income quartile by home ZIP code, cardiomyopathy risk factors (hypertension, hyperlipidemia, diabetes mellitus, smoking, family history, age >65), cancer type, cancer stage, and chemotherapy. This model found that there was an increased referral rate among patients from higher income quartiles (p=0.004), patients with a history of hypertension (p=0.0001), and patients with breast cancer (p=0.04). Conclusions: The results of this study suggest that patients of our cardio-oncology population at a safety net hospital receive the same level of surveillance and treatment, and develop drop in ejection fraction at similar rates regardless of their race. However, patients that reside in ZIP codes associated with higher income quartiles do trend towards increased referrals.

show abstract

Racial disparities in the rate of cardiotoxicity of HER2‐targeted therapies among women with early breast cancer

Cited by 71 publications

References 37 publications

Healthcare disparities in cardio oncology: patients receive same level of surveillance regardless of race at a safety net hospital

Healthcare disparities in cardio oncology: patients receive same level of surveillance regardless of race at a safety net hospital

Cardiotoxicity of HER2-targeted therapies

Healthcare disparities in cardio oncology: patients receive same level of surveillance regardless of race at a safety net hospital

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