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

Abstract

Advances in cancer therapeutics have revolutionized survival outcomes in patients with cancer. However, cardiovascular toxicities associated with specific cancer therapeutics adversely affect the outcomes of patients with cancer. Recent studies have uncovered excess risks of these cardiotoxic events, especially in traditionally underrepresented populations. Despite advances in strategies to limit the risks of cardiovascular events among cancer survivors, relatively limited guidance is available to address the rapidly growing problem of disparate cardiotoxic risks among women and underrepresented patient populations. Previously decentralized and sporadic evaluations have led to a lack of consensus on the definitions, investigation, and potential optimal strategies to address disparate cardiotoxicity in contemporary cancer care (eg, with immunotherapy, biologic, or cytotoxic therapies) settings. This scientific statement aims to define the current state of evidence for disparate cardiotoxicity while proposing uniform and novel methodological approaches to inform the identification and mitigation of disparate cardio-oncology outcomes in future clinical trials, registries, and daily clinical care settings. We also propose an evidence-based integrated approach to identify and mitigate disparities in the routine clinical setting. This consensus scientific statement summarizes and clarifies available evidence while providing guidance on addressing inequities in the era of emerging anticancer therapies.

Social Determinants of Health Data Improve the Prediction of Cardiac Outcomes in Females with Breast Cancer

“…From a practical standpoint, the findings of our study align with the principles outlined in the 2023 American Heart Association statement titled "Equity in Cardio-Oncology Care and Research", emphasizing the need to implement strategies that mitigate inequalities and address the healthcare needs of underserved populations [77]. The results underscore the urgency of developing public health policies aimed at addressing disparities in SDOH.…”

Social Determinants of Health in Cardio-Oncology

“…Additionally, being aware of the impact of structural racism within communities and how it contributes to health disparities is crucial. 12 Structural racism leads to “differential access to the goods, services, and opportunities of society by race,” 116 determining societal values and power hierarchies, all of which underlie persistent health disparities in the United States. The presidential advisory statement for the American Heart Association acknowledged and emphasized that a society free from structural racism results in considerable social, economic, and health benefits for all those living in the United States, including those who are direct beneficiaries of the status quo and historically marginalized populations.…”

“…Significant disparities in excess CVD risk related to cancer and specific cancer therapeutics continue to exist in groups traditionally under-represented in biomedical research ( Table 1 ). 12 Table 1 illustrates key examples of SDOH domains that have been demonstrated in prior research to impact disparities in cardio-oncology populations. As noted, NHB populations have the highest comorbid age-adjusted CVD- and cancer-related mortality compared to NHW populations in the United States.…”

“…The social determinants of cardio-oncologic health disparities framework ( Figure 1 ) integrates Powell-Wiley et al’s health equity–focused framework 1 with the drivers of inequity in cardio-oncology 12 to illustrate the increased burden and worsened outcomes relating to the intersection of adverse SDOH with cardiovascular outcomes in patients with cancer. Structural SDOH domains within the framework reflect the sociopolitical, economic, and cultural context (ie, structural racism and discrimination, access to quality education and health care, socioeconomic status [SES], and neighborhood environment) that shape the social risks and lived experience of an individual within a specific social and community context (intermediate SDOH domain).…”

Exercise as Medicine

“… 4 These adverse effects are more pronounced in Black/African-American women, with a 3-fold increase in risk for cardiotoxicity after anthracyclines. 5 Importantly, cardiotoxicity can limit BC treatment options and contributes significantly to cardiovascular (CV) morbidity and mortality in BC survivors. Cardiovascular disease (CVD) is now the leading cause of noncancer death among women treated for BC.…”