Cardio-Oncology Preventive Care: Racial and Ethnic Disparities
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RACE AND ETHNICITY DISPARITIES (M. ALBERT AND L. BREWER, SECTION EDITORS)
Cardio-Oncology Preventive Care: Racial and Ethnic Disparities Pooja Prasad 1 & Mary Branch 2 & Daniel Asemota 3 & Razan Elsayed 4 & Daniel Addison 5,6 & Sherry-Ann Brown 7,8 Published online: 20 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review As cancer screening and treatment continue to improve, the number of cancer survivors is growing rapidly. Cardiovascular disease is the leading cause of death in cancer survivors. In this review, we explore racial and ethnic disparities in cardiovascular toxicity from cancer therapies, with a particular focus on prevention. In addition, we propose potential solutions to address these disparities. Recent Findings Multiple studies have found that African Americans experience higher rates of cardiotoxicity from chemotherapy than Caucasians. Few studies have explored reasons for these disparities. Social determinants of health and disparities in cardiotoxicity screening and surveillance, as well as risk factor incidence and management, are likely among underlying mediators. Studies about prevention of cardiotoxicity with dexrazoxane, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, statins, and lifestyle modification were reviewed. In published studies, racial/ethnic minorities were generally underrepresented with racial or ethnic demographic information entirely missing in most studies. Summary Addressing critical health disparities in cardio-oncology will require a multidisciplinary approach. Minorities are continually underrepresented in clinical trials. Improving awareness of health disparities among providers, cultural competency training, and the implementation of quality measures to standardize care have the potential to reduce the impact of explicit and implicit bias leading to inferior care for racial/ethnic minorities. Increasing access to cardio-oncology providers in low socioeconomic areas has the potential to improve rates of screening and surveillance. Future applications of precision medicine and innovation in preventive cardio-oncology should be carefully designed and disseminated to alleviate and not worsen disparate care. Keywords Cancer . Survivorship . Cardiotoxicity . Cardio-oncology . Onco-cardiology . Prevention . Disparities . Minorities
This article is part of the Topical Collection on Race and Ethnicity Disparities * Sherry-Ann Brown [email protected]
3
Academic Department of Internal Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
4
Department of Internal Medicine, Englewood Health, Englewood, NJ, USA
Daniel Asemota [email protected]
5
Cardio-Oncology Program, Division of Cardiology, Ohio State University Medical Center, Columbus, OH, USA
Razan Elsayed [email protected]
6
Division of Cancer Prevention and Control, Department of Internal Medicine, College
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