Racial and Socioeconomic Disparities in Cardiotoxicity Among Women With HER2-Positive Breast Cancer

Al‐Sadawi, Mohammed; Hussain, Yasin; Copeland‐Halperin, Robert S.; Moskowitz, Chaya S.; Dang, Chau T.; Liu, Jennifer E.; Steingart, Richard M.; Johnson, Michelle N.; Yu, Anthony F.

doi:10.1016/j.amjcard.2021.02.013

Cited by 28 publications

(17 citation statements)

References 28 publications

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“…An example of these differences, and ultimately of the aforementioned need, is the higher risk of cardiovascular toxicity among Black women compared with White women with HER2-positive breast cancer receiving trastuzumab. 51 Black women also had worse clinical outcomes despite similar 21-gene assay recurrence score results and comparable systemic therapy in the Trial Assigning Individualized Options for Treatment. 52 These findings could not have been addressed or realized were it not for the inclusion of Black women in the trials.…”

Section: Need For Inclusion In Multinational Clinical Trialsmentioning

confidence: 94%

Breast Cancer Priorities in Limited-Resource Environments: The Price-Efficacy Dilemma in Cancer Care

Al-Sukhun¹,

Tbaishat

Hammad

2022

American Society of Clinical Oncology Educational Book

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Breast cancer has become one of the leading causes of morbidity and mortality in low- and middle-income countries, where 62% of the world’s total new cases are diagnosed. Therefore, the productivity loss because of premature death resulting from female breast cancer is also on the rise. The major challenge in low- and middle-income countries is to reduce the proportion of women presenting with advanced-stage disease, a challenge unlikely to be overcome by adoption of expensive national mammography screening programs. Awareness and education campaigns should focus not only on patients and societies but also on policy makers to address and optimize breast cancer care. Adaptation of existing guidelines and prioritization according to local resources are essential to address the unique needs and overcome the unique barriers of each society to facilitate practical implementation and improve outcomes. Emphasis on the principle of a cancer groundshot in addressing value in cancer care is vital to improving access to therapies that are proven to work rather than chasing after new drugs or innovations of doubtful or marginal clinical benefit. Until we have drug-pricing interventions that take into account the local income of each society, we must acknowledge the fact that the delivery of cancer care will never be the same all around the world.

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Section: Need For Inclusion In Multinational Clinical Trialsmentioning

confidence: 94%

Breast Cancer Priorities in Limited-Resource Environments: The Price-Efficacy Dilemma in Cancer Care

Al-Sukhun¹,

Tbaishat

Hammad

2022

American Society of Clinical Oncology Educational Book

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“…Another larger study on trastuzumab-related cardiotoxicity showed that AA women had a higher prevalence of risk factors for CVD. The risk of cardiotoxicity was significantly higher in AA women compared to White women even after controlling for cardiovascular risk factors [ 17 ]. Our study found that Asian & Pacific Islanders and Hispanics had the highest relative increase in cardio-oncology mortality between the 4th and 1st SVI quartiles.…”

Section: Disparities In Cardio-oncologymentioning

confidence: 99%

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

et al. 2022

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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.

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“…AAs experience higher rates of cardiotoxicity from anthracyclines and trastuzumab than Caucasians [ 78 ] due to increased CV risk factors and likely due to suboptimal surveillance as well as management of such risk factors, driven by th e social determinants of health (SDOH). There is also insufficient representation in research, including medications that prevent cardiotoxicity like statins and dexrazoxane [ 79 ].…”

Section: Strategies For Cardio-oncology Care During the Covid-19 Pand...mentioning

confidence: 99%

Strategies for Cardio-Oncology Care During the COVID-19 Pandemic

Abraham

Manohar

Patel

et al. 2022

Curr Treat Options Cardio Med

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Purpose of review The COVID-19 pandemic has disrupted healthcare and has disproportionately affected the marginalized populations. Patients with cancer and cardiovascular disease (cardio-oncology population) are uniquely affected. In this review, we explore the current data on COVID-19 vulnerability and outcomes in these patients and discuss strategies for cardio-oncology care with a focus on healthcare innovation, health equity, and inclusion. Recent findings The growing evidence suggest increased morbidity and mortality from COVID-19 in patients with comorbid cancer and cardiovascular disease. Additionally, de novo cardiovascular complications such as myocarditis, myocardial infarction, arrhythmia, heart failure, and thromboembolic events have increasingly emerged, possibly due to an accentuated host immune response and cytokine release syndrome. Summary Patient-centric policies are helpful for cardio-oncology surveillance like remote monitoring, increased use of biomarker-based surveillance, imaging modalities like CT scan, and point-of-care ultrasound to minimize the exposure for high-risk patients. Abundant prior experience in cancer therapy scaffolded the repurposed use of corticosteroids, IL-6 inhibitors, and Janus kinase inhibitors in the treatment of COVID-19 infection. COVID-19 vaccine timing and dose frequency present a challenge due to overlapping toxicities and immune cell depletion in patients receiving cancer therapies. The SARS-CoV-2 pandemic laid bare social and ethnic disparities in healthcare but also steered in innovation to combat problems of patient outreach, particularly with virtual care. In the recovery phase, the backlog in cardio-oncology care, interplay of cancer therapy-related side effects, and long COVID-19 syndrome are crucial issues to address.

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Racial and Socioeconomic Disparities in Cardiotoxicity Among Women With HER2-Positive Breast Cancer

Cited by 28 publications

References 28 publications

Breast Cancer Priorities in Limited-Resource Environments: The Price-Efficacy Dilemma in Cancer Care

Breast Cancer Priorities in Limited-Resource Environments: The Price-Efficacy Dilemma in Cancer Care

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

Strategies for Cardio-Oncology Care During the COVID-19 Pandemic

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