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Racial Disparities in Cardiotoxicity After Chemotherapy

Black patients with cancer are significantly more likely to experience cardiotoxicity and congestive heart failure related to chemotherapy than White cancer patients are, a research review indicates.

Dr Wondewossen Gebeyehu

“It’s important that both patients and clinicians be aware of these disparities so that more meaningful conversations around long-term cardiac health and cancer treatment can take place,” lead investigator Wondewossen Gebeyehu, with the University of Toronto, Canada, told | Medscape Cardiology.

However, patients “should not avoid chemotherapy, as the most important thing is making sure they get the best cancer treatment possible, and studies already show Black patients may get less optimal cancer treatments,” Gebeyehu added in a statement.

Ana Barac, MD, PHD, chair, cardio-oncology, Inova Schar Cancer Institute and Inova Heart and Vascular Institute, Fairfax, Virginia, who wasn’t involved in the study, agrees.

“The most important message is to look at preexisting cardiovascular disease (CVD), oncology diagnosis, and be aware of existing disparities in a specific cancer and CVD,” Barac told | Medscape Cardiology.

“What should NOT happen is to overinterpret this report of cardiotoxicity as an indication to modify/avoid planned cancer treatment to decrease cardiotoxicity. This approach could worsen oncology outcomes and lead to undertreatment of cancer, therefore posing real danger,” said Barac.

The study was presented April 14 at the American College of Cardiology (ACC) Advancing the Cardiovascular Care of the Oncology Patient 2023 conference.

Causes Unclear

Chemotherapy is known to increase the risk of cardiovascular heart failure and other forms of CVD, but less is known about racial disparities in the incidence of chemotherapy-induced cardiotoxicity.

Gebeyehu and colleagues conducted a systematic review and meta-analysis of the available literature to assess racial disparities in CV adverse effects among cancer patients who were treated with chemotherapeutic agents. They screened 7057 studies, fully reviewed 57, and included 24 studies, representing 683,749 participants, in their analysis.

Breast cancer was the most commonly reported malignancy. Other common malignancies were prostate, kidney, and hematologic malignancies such as leukemia and lymphoma.

Chemotherapeutic agents included anthracyclines (doxorubicin, daunorubicin), trastuzumab, and hormonal therapies.

Black race or African ancestry was associated with increased odds of chemotherapy-associated cardiotoxicity (unadjusted odds ratio [OR], 1.71; 95% CI, 1.40 – 2.10), as well as congestive heart failure (unadjusted OR, 1.92; 95% CI, 1.68 – 2.19).

Gebeyehu told | Medscape Cardiology that it’s hard to speculate on causation with an analysis of preexisting data such as this. “Our initial analysis that we’ve reported on so far are unadjusted values, meaning they don’t adjust for those potential underlying factors,” he noted.

“However, some of the studies individually controlled for socioeconomic factors and still found increased vulnerability to chemotherapy-associated cardiotoxicity in patients of Black race or African ancestry,” Gebeyehu said.

“It’s certainly possible that a mix of both biological and socioeconomic factors are interacting to lead to these disparities. One example could be the underrepresentation of Black patients in clinical trials to develop drugs. These could lead to chemotherapeutic agents being poorly optimized in this population relative to other racial/ethnic groups,” he added.

Barac said this study adds to the growing body of evidence about the importance of racial disparities in CVD and cancer outcomes.

“It is important to note that only the unadjusted odds ratio was reported and that much more detail is needed to understand what may be underlying the disparities. It is critically important to await the adjusted analysis, as well as details of the type of cancers and treatment used, before clinical implications can be discussed,” said Barac, who served as co-director of the conference.

“The risk of cardiotoxicity needs to be presented in the context of the oncology and CV disease burden, as both can influence the risk, and there could be a synergistic effect of disparities,” Barac added.

The study had no specific funding. Gebeyehu and Barac have disclosed no relevant conflicts of interest.

American College of Cardiology (ACC) Scientific Session/World Congress of Cardiology (WCC) 2023: Abstract 56. Presented April 14, 2023.

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