Understanding and Reducing Racial Disparities in High Risk Cardio-Oncology Communities

Project: Research project

Project Details

Description

Race-associated differences in health outcomes have been described in various populations in the United States, but remain poorly understood, particularly in cardio-oncology. Black Americans have a nearly 30% increased cardiovascular disease mortality and an overall shorter life expectancy by 3.4 years as compared to Whites. Moreover, survival after an out-of-hospital cardiac arrest is worse in Blacks and Hispanics, and most recent data indicate that overall age-adjusted mortality rates are worsening in Blacks and Hispanics. Broad and deep racial and ethnic disparities exist with cardiovascular risk factor and disease control. Similar inequities also exist in oncology, with marked variability in cancer prevention, early detection and treatment outcomes according to race and ethnicity. For example, Black race is associated with worse prognosis in breast cancer; Blacks present with tumors with more advanced features (stage, hormonal status and size) and suffer 50% worse survival compared with Whites. Similarly, the incidence of prostate cancer is 64% greater in Blacks compared to Whites, and is associated with a 134% increased mortality.
Race is both a biologic and social construct. The impact of the biology of race on cardiovascular disease risk remains incompletely defined, particularly in cardio-oncology. Similarly, the social construct of race is also poorly understood in cardio-oncology. Despite an established association between race and health in human disease, critical knowledge gaps remain, including how mechanisms of cancer therapy cardiotoxicity differ by race and how structural
inequities affect cardiotoxicity risk in cancer patients and survivors. Moreover, strategies to mitigate racial inequities and improve overall health in historically marginalized cancer survivors do not yet exist. The overall objective of our proposed research network is to comprehensively define and mitigate the biologic, structural and personal determinants of racial disparities in high cardiovascular risk cancer patients and survivors.
We focus on two high cardiovascular risk and high priority cancer populations that comprise a significant public health concern: breast and prostate cancer. Breast and prostate cancer survivors together represent nearly half of the 16.9 million cancer survivors alive in the US today. In addition to representing the two most common cancers in men and women, respectively, breast and prostate cancer patients also suffer from a substantial burden of cardiovascular comorbidities. In a retrospective analysis of 1,460 breast cancer patients enrolled across five clinical trials, the prevalence of hypertension was 73% and hyperlipidemia 57%. The risk of all-cause mortality increased with each additional cardiovascular risk factor. Moreover, in a population-based cohort study of 98,999 women, amongst those 66 years or older, the risk of cardiovascular death exceeded that of cancer-related death at 10 years from diagnosis. Similarly, amongst 5-year survivors with a history of prior cardiovascular disease, cardiovascular death rates exceeded breast cancer mortality. Multiple breast cancer therapies contribute to this disease risk: anthracyclines, Her2+ targeted therapies, targeted hormonal therapy, and radiation therapy. Prostate cancer patients also have a high burden of cardiovascular risk factors, with one clinical trial noting > 90% of patients having at least one cardiovascular risk factor at time of enrollment. Androgen deprivation therapy (ADT), fundamental to the treatment of prostate cancer, results in worse metaboli
StatusActive
Effective start/end date7/1/216/30/22

Funding

  • University of Pennsylvania (582595//AGMT Yancy 9/3/21)
  • American Heart Association (582595//AGMT Yancy 9/3/21)

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