Development and Validation of a Clinical Score for Cardiovascular Risk Stratification of Long-Term Childhood Cancer Survivors

Oikonomou, Evangelos; Athanasopoulou, Sofia; Kampaktsis, Polydoros; Kokkinidis, Damianos G.; Papanastasiou, Christos A.; Fehér, Attila; Steingart, Richard M.; Oeffinger, Kevin C.; Gupta, Dhiraj

doi:10.1634/theoncologist.2017-0502

Cited by 6 publications

(3 citation statements)

References 40 publications

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“…Five articles reported racial/ethnic disparities in chronic health conditions (Table 4). The type of chronic health condition disparities assessed for non-Hispanic Black survivors included vitamin-D deficiency (27), subsequent neoplasms (31), cardiovascular disorders (31), cardiovascular risks (38), and serious/life-threatening health conditions (43). The type of chronic health condition disparities assessed for Hispanic survivors included vitamin-D deficiency (27), obesity (29), subsequent neoplasm (31), endocrine condition (31) attainment, household income), and lifestyle health risk for chronic health conditions (BMI and cardiovascular risk factors including obesity, diabetes, hypertension and dyslipidemia).…”

Section: Disparities In Chronic Health Conditionsmentioning

confidence: 99%

“…Particularly for Hispanic survivors, family dynamics (e.g., language spoken at home) should be further investigated as they are potentially protective factors for poor patient-reported outcomes. In chronic health conditions, most articles found that racial/ethnic disparities remained statistically significant after risk modulators (e.g., clinical factors, individual demographic and SES factors, and cardiovascular risk factors) were included in the multivariable modeling (27,29,31,38,43). It is possible that underlying biological mechanisms (e.g., inherited genetic predisposition to disease risks and epigenetic modifications due to life experiences or environmental exposures) and disadvantaged neighborhood environments may elevate disparities in chronic health conditions beyond the influence of individual SES and clinical risk.…”

Section: Disparity-specific Risk Modulatorsmentioning

confidence: 99%

“…A more inclusive, need-based financial assistance program for individual survivors should be considered for minority survivors to reduce the risk of health disparities. In addition, the first two to three years from cancer diagnosis (25,38,43) and primary caregiver education background and proximity/access to care (39) were associated with elevated risk of health disparities in minority childhood cancer survivors. Therefore, healthcare systems should assess the disparity status for minority childhood cancer survivors immediately following completion of therapy and provide social support or resources to address these issues (e.g., coordinating transportation aids for minority families) toward improving follow-up care and reducing disease burden.…”

Section: Racial/ethnic Disparity-specific Interventionsmentioning

confidence: 99%

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Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review

Reeves

Mathis

Bauer

et al. 2021

Front. Public Health

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The five-year survival rate of childhood cancer has increased substantially over the past 50 yr; however, racial/ethnic disparities in health outcomes of survival have not been systematically reviewed. This scoping review summarized health disparities between racial/ethnic minorities (specifically non-Hispanic Black and Hispanic) and non-Hispanic White childhood cancer survivors, and elucidated factors that may explain disparities in health outcomes. We used the terms “race”, “ethnicity”, “childhood cancer”, “pediatric cancer”, and “survivor” to search the title and abstract for the articles published in PubMed and Scopus from inception to February 2021. After removing duplicates, 189 articles were screened, and 23 empirical articles were included in this review study. All study populations were from North America, and the mean distribution of race/ethnicity was 6.9% for non-Hispanic Black and 4.5% for Hispanic. Health outcomes were categorized as healthcare utilization, patient-reported outcomes, chronic health conditions, and survival status. We found robust evidence of racial/ethnic disparities over four domains of health outcomes. However, health disparities were explained by clinical factors (e.g., diagnosis, treatment), demographic (e.g., age, sex), individual-level socioeconomic status (SES; e.g., educational attainment, personal income, health insurance coverage), family-level SES (e.g., family income, parent educational attainment), neighborhood-level SES (e.g., geographic location), and lifestyle health risk (e.g., cardiovascular risk) in some but not all articles. We discuss the importance of collecting comprehensive social determinants of racial/ethnic disparities inclusive of individual-level, family-level, and neighborhood-level SES. We suggest integrating these variables into healthcare systems (e.g., electronic health records), and utilizing information technology and analytics to better understand the disparity gap for racial/ethnic minorities of childhood cancer survivors. Furthermore, we suggest national and local efforts to close the gap through improving health insurance access, education and transportation aid, racial-culture-specific social learning interventions, and diversity informed training.

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