Q&A: A call to action to end disparities in cardio-oncology research and care
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Drivers of racial and ethnic disparities in cardio-oncology include increased risk factors among historically underrepresented groups, underrepresentation in clinical trials and socioeconomic barriers, researchers reported.
In a call-to-action statement published in JACC: CardioOncology, June-Wha Rhee, MD, instructor at the Stanford Cardiovascular Institute at Stanford University School of Medicine, and colleagues proposed a framework of solutions that address these issues and more.
“In oncology, cancer incidence and mortality are generally highest among Black individuals compared with other races. Additionally, although CVD is the leading cause of death in non-Hispanic groups, cancer was the leading cause of death for Hispanic individuals, accounting for 21% of deaths in adult Hispanic individuals in 2016,” Rhee and colleagues wrote. “These differences stem from structural factors such as lower educational attainment, decreased financial security, lack of health insurance and less access to high-quality health care, thus leading to lower rates of preventive health services such as cancer screening and a greater prevalence of cancer risk factors such as obesity and smoking.”
Healio discussed the prevalence of these disparities with Rhee as well as what steps can be taken to achieve health equity.
Healio: What are the main takeaways for cardiologists and oncologists?
Rhee: It is well established that racial and ethnic health care disparities exist in CV outcomes of patients with cancer. These disparities stem from structural racism, which in turn result in higher rates of CV risk factors and reduced access to specialty care among historically underrepresented individuals. A multidisciplinary approach is required to dismantle these disparities and should include key stakeholders, including health care policymakers, scientists and clinicians.
Healio: What are the most pervasive disparities observed among historically underrepresented individuals?
Rhee: While only limited data are available, patients from historically marginalized racial and ethnic backgrounds were at least twice as likely to suffer from cardiotoxicity of cancer therapies such as the HER2-targeted therapies doxorubicin or trastuzumab (Herceptin, Genentech) than their counterparts. These cardiac complications often lead to treatment interruption, resulting in worse oncologic and cardiac outcomes.
Healio: Previous research shows that CVDs and certain cancers may share common risk factors. Do the disparities described in your research strengthen this relationship within this population ?
Rhee: Absolutely this is a concern. We know that disparities exist in both fields of cardiology and oncology (eg, higher rates of CVD, CVD risk factors and cancer incidences/outcomes among historically underrepresented individuals compared with their counterparts), and patients with preexisting CVD and CVD risk factors are more likely to be diagnosed with cancer. Putting the two together, it is very likely that the disparities in cardiac or oncologic care would exacerbate this relationship. However, since cardio-oncology is a new field, there is little known about the intersectionality between CVD and cancer. Our group and others are working to disentangle this complex relationship.
Healio: What are the first steps to addressing eliminating these disparities (patient education, improving clinician awareness, community-based interventions, etc)?
Rhee: It is critical for all stakeholders (clinicians, policymakers, scientists) not only to be aware of this issue, but be willing to prioritize and tackle this so that systemic and multidisciplinary efforts can be taken simultaneously.
Healio: At a policymaking level, what is your call to action?
Rhee: Socioeconomic factors and lack of access to specialty care play important roles in the observed disparities in cardio-oncology. Policy changes to ensure access to affordable and quality care among people from historically marginalized racial and ethnic backgrounds would be critical. Additionally, establishing community health centers and programs in low socioeconomic areas to increase access to specialty care such as cardio-oncology would be necessary. Finally, there needs to be a government-wide, systemic approach to find an innovative solution such as the use of digital and wearable technologies to improve the cardio-oncology quality of care among historically marginalized groups.
Healio: Anything else you would like to add?
Rhee: We need to be intentional and deliberate in reducing disparities in cardio-oncology.
Reference:
Fazal M, et al. JACC CardioOncol. 2021;doi:10.1016/j.jaccao.2021.05.001.
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