Top Things to Know: Equity in Cardio-Oncology Care and Research
Published: June 28, 2023
- Cardiovascular disease (CVD) has become a leading cause of non-malignant morbidity and mortality in patients with cancer in the United States.
- Disparately high mortality risk following a cancer diagnosis is seen among females and those from underrepresented racial and ethnic groups. Black patients face up to a 3-fold higher risk of cardiotoxicity and CV death with anticancer therapies.
- The multidisciplinary scientific statement provides practical strategies for reducing inequity in cardio-oncology and aims to move toward equity.
- Inequities cardio-oncology are defined as differences in the optimal allocation of cardio-protective medications, surveillance, and development of adverse outcomes related to cancer therapy-related cardiac disease or outcomes between groups of different race, ethnicity, socioeconomic status, sexual orientation, and gender identity.
- Caution is advised when interpreting clinical trial data in cancer/ cardiotoxicity risk assessment and generalizing the results, as diverse populations are not well represented in these trials.
- Social determinants of health, such as poverty, neighborhood disadvantage, racial discrimination, lack of social support, and social isolation, play a significant role in CV and cancer risk among populations from underrepresented racial and ethnic groups.
- Limited insurance and access to follow-up can lead to adverse outcomes in cancer and CV conditions due to a lack of regular medical care.
- Environmental and structural racism, which limits opportunities for social, economic, and financial advancement, is a significant influence on health disparities. A multi-pronged approach is needed to combat structural racism and environmental challenges.
- Workforce representation is essential, and patients may experience more favorable outcomes when there is gender and/or racial concordance with their health care team. Despite this, key groups are underrepresented within the health care and biomedical research workforce.
- Opportunities to impact the selection process, promotion and support of underrepresented faculty and community practitioners can address the observed gaps in the workforce. More efforts are needed to increase diversity in CV medicine, with specific attention to underrepresented groups.
Citation
Addison D, Branch M, Baik AH, Fradley MG, Okwuosa T, Reding KW, Simpson KE, Suero-Abreu GA, Yang EH, Yancy CW; on behalf of the American Heart Association Cardio-Oncology Committee of the Council on Clinical Cardiology and Council on Genomic and Precision Medicine; Council on Cardiovascular and Stroke Nursing; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; and the Council on Cardiovascular Radiology and Intervention. Equity in cardio-oncology care and research: a scientificstatement from the American Heart Association [published online ahead of print June 28, 2023]. Circulation. doi: 10.1161/CIR.0000000000001158