How clinicians can combat health disparities in cardio-oncology

Underserved populations at higher risk for cardio-oncology complications

Addison noted that certain groups, particularly Black, Hispanic, and Native American women, face disproportionately higher rates of anthracycline-induced cardiotoxicity, a well-known side effect of a class of chemotherapy drugs. He also cited emerging evidence suggesting racial and ethnic differences in how patients respond to some immunotherapies, further complicating disparities in cancer and cardiovascular outcomes. 

Some cancer treatments also impact various racial groups differently due to genetics. These differences highlight a problem that is often moire pronounced in the real world rather than in trials, because many past trials did not include diverse patient populations.

"It's an important point and probably something that's even a little bit more exaggerated in the space of cancer, because we know some populations are prone to cancer genetic mutations or are particularly predisposed to certain disease entities. This also may affect the ability of some therapies to work more adequately than others. This impacts both the use rates and the dosing strategies for a number of these therapies, which may be different based on some of these phenomena, and that's on top of all the other social determinants. So if you mix all this together, this makes for an unfortunate recipe for what we see in actual clinical real-world practice," Addison explained.

Cancer clinical trials often fail to reflect the many patient populations

While inequities are clear in day-to-day practice, Addison said they were less apparent in the original clinical trials for cancer and cardiac drugs because of the limited diversity of participants.

"Unfortunately, many trial populations were relatively homogenous, or they were similar and they were somewhat selected," he said.

He explained that many trials did not represent the real-world mix of patients. When oncology then applies the data from these trials to diverse patients, there are clear gaps in how the therapies perform.

A call to action: Policy, advocacy and prevention

Addison said the next step must be a major effort to reduce these disparities through public health advocacy, policy changes and community-level interventions.

"We really need to decrease the burden of things like smoking and increase the ability for people to exercise and really do things that we know in both cancer and cardiovascular disease dramatically improve outcomes," Addison explained.

Increasing access to adequate care for both cancer and cardiovascular treatment could go a long way to help improve outcomes as well, he added.  

The American Heart Association has been on the forefront for decades pushing to decrease smoking and improve environmental exposures, and Addison said much of this relates directly to the space of cardio-oncology. He hopes to keep pushing this forward to help the millions of people who could benefit.