Disparities in Cardio-oncology: Effects On Outcomes and Opportunities for Improvement

Abstract

Purpose of Review The purpose of this article is to provide a comprehensive review of available data on health disparities and the interconnected social determinants of health (SDOH) in cardio-oncology. We identify the gaps in the literature and suggest areas for future research. In addition, we propose strategies to address these disparities at various levels. Recent Findings There has been increasing recognition of health disparities and the role of SODH on an individual’s access to health care, quality of care, and outcomes of the illness. There is growing evidence of sex and race-based differences in cancer therapy-related cardiotoxicity. Recent studies have shown how access and quality of health care are affected by financial stability and rurality. Our recent study utilizing the social vulnerability index (SVI) and county-level patient data found graded increase in county-level cardio-oncology mortality with greater social vulnerability. The incremental impact of social vulnerability was higher for cardio-oncology mortality than for mortality related to either cancer or CVD alone. The mortality rates in these patients were higher in rural areas compared to urban areas regardless of social vulnerability. Additionally, for those within the counties within highest social vulnerability, Black individuals had significantly higher cardio-oncology mortality compared with White individuals. Summary Disparities in the cardio-oncology population are deep-rooted and widespread, leading to poor quality of life and increased mortality. It is crucial to integrate SDOH, not only in clinical care delivery but also in future research, and registry data to improve our understanding and the outcomes in our unique subset of cardio-oncology patients.

Equity in Cardio-Oncology Care and Research: A Scientific Statement From the American Heart Association

“…Environmental and psychosocial stressors have been recognized to contribute to disparate CVD. [55][56][57] Structural racism 58 limits opportunities for social, economic, and financial advancement and was recently identified in a presidential advisory from the American Heart Association as having a significant influence on health and health disparities. This advisory called for a multipronged approach to combating structural racism and environmental challenges that includes restructuring workplace, neighborhood, and school systems to improve conditions that affect health; improving the quality of housing and dismantling residential segregation; eliminating inequities that reduce access to health care; educating, understanding, and transforming attitudes on racism; and researching racism and its effects on health and health disparities.…”

“…1,4,37 In less developed nations, limited access to cardio-oncology services may limit outcomes. 55 Data suggest that for other conditions (eg, hypertension screening) in which access to care for underrepresented populations is improved, poorer outcomes may be reduced.…”

Addressing Cardiovascular Complications of Cancer Therapy

“…18 Emerging evidence suggests that SDOH play a vital role in the health of cardio-oncology patients. 19 Taken together, available and emerging evidence supports the need to assess SDOH in the practice of caring for cardio-oncology patients as well as attention to the strategies designed to improve equity (discussed below).…”

“…Similar to CVD, the role of SDOH in the risks, rates, and survival of multiple cancers is increasingly emphasized; the American Cancer Society recently released a framework of practice, research, and policy to better recognize and address the SDOH in cancer 18 . Emerging evidence suggests that SDOH play a vital role in the health of cardio-oncology patients 19 . Taken together, available and emerging evidence supports the need to assess SDOH in the practice of caring for cardio-oncology patients as well as attention to the strategies designed to improve equity (discussed below).…”

Priorities in Cardio-Oncology Basic and Translational Science

“…To this end, greater efforts should be made by the scientific community to encourage and support clinical trials that improve the representation of women and racial/ethnic minorities, who unfortunately often have a higher inherent propensity to multiple comorbidities. 142 , 143 In addition, knowledge of the impact of individual genetic predisposition on the risk of developing cancer and CTR-CVT remains in its infancy for meaningful use as a risk prediction tool. Opportunities for improvement will become available from more broad studies that employ genomics to predict and potentially prevent cancer therapy–associated cardiotoxicity, enabling clinicians to tailor cancer treatment based on individual susceptibility for developing CTR-CVT.…”