Racial and Ethnic Differences in Cardiac Surveillance Evaluation of Patients Treated With Anthracycline‐Based Chemotherapy

Abstract

Background Anthracyclines remain a key treatment for many malignancies but can increase the risk of heart failure or cardiomyopathy. Specific guidelines recommend echocardiography and serum cardiac biomarkers such as BNP (B‐type natriuretic peptide) or NT‐proBNP (N‐terminal proBNP) evaluation before and 6 to 12 months after treatment. Our objective was to evaluate associations between racial and ethnic groups in cardiac surveillance of survivors of cancer after exposure to anthracyclines. Methods and Results Adult patients in the OneFlorida Consortium without prior cardiovascular disease who received at least 2 cycles of anthracyclines were included in the analysis. Multivariable logistic regression was performed to estimate the odds ratios (ORs) and 95% CIs for receiving cardiac surveillance at baseline before anthracycline therapy, 6 months after, and 12 months after anthracycline exposure among different racial and ethnic groups. Among the entire cohort of 5430 patients, 63.4% had a baseline echocardiogram, with 22.3% receiving an echocardiogram at 6 months and 25% at 12 months. Non‐Hispanic Black (NHB) patients had a lower likelihood of receiving a baseline echocardiogram than Non‐Hispanic White (NHW) patients (OR, 0.75 [95% CI, 0.63–0.88]; P =0.0006) or any baseline cardiac surveillance (OR, 0.76 [95% CI, 0.64–0.89]; P =0.001). Compared with NHW patients, Hispanic patients received significantly less cardiac surveillance at the 6‐month (OR, 0.84 [95% CI, 0.72–0.98]; P =0.03) and 12‐month (OR, 0.85 [95% CI, 0.74–0.98]; P =0.03) time points, respectively. Conclusions There were significant racial and ethnic differences in cardiac surveillance among survivors of cancer at baseline and following anthracycline‐based treatment in NHB and Hispanic cohorts. Health care providers need to be cognizant of these social inequities and initiate efforts to ensure recommended cardiac surveillance occurs following anthracyclines.

Research summary of poster presentations at the 2023 Florida cardio-oncology symposium

“… Poster no. Presenter College Department/division Abstract title 1 a Katelyn Bruno Medicine Cardiovascular Medicine Trpc6 promotes doxorubicin-induced cardiomyopathy in male mice with pleiotropic differences between males and females [ 1 ] 2 Camara Casson Herbert Wertheim College of Engineering Biomedical Engineering Integrative control of cardiac tissue biomechanical and biomolecular changes due to doxorubicin 3 a David DeRemer Pharmacy Pharmacotherapy and Translational Research Racial and ethnic differences in cardiac surveillance evaluation of patients treated with anthracycline-based chemotherapy [ 3 ] 4 Jennifer Dungan Nursing Biobehavioral Nursing Science Candidate genes for survivorship with coronary heart disease include cancer and tumor suppressor genes [ 7 , 8 ] 5 a Branden Nguyen Health and Human Performance Applied Physiology and Kinesiology The effects of moderate intensity and high-intensity interval training on cardiorespiratory capacity and body composition during doxorubicin treatment [ 2 ] 6 Walter O'Dell Medicine Radiation Oncology Effects of uncertainty in left ventricular border delineation on global longitudinal strain and versus LV ejection fraction calculations 7 Walter O'Dell Medicine Radiation Oncology Detection of radiation-induced defects in heart perfusion in breast cancer patients 8 Walter O'Dell Medicine Radiation Oncology Proton therapy preserves acute left ventricular ejection fraction relative to conventional X-ray therapy in breast cancer 9 Nathalie Roumi Pharmacy Pharmacotherapy and Translational Research Dexrazoxane and all-cause mortality in anthracycline-treated cancer patients 10 a Samia Shab...…”

“…Non-Hispanic black participants received significantly less cardiac surveillance compared to non-Hispanic white participants at baseline (odds ratio, OR = 0.76, 95 % confidence interval (CI): 0.64–0.89, p = 0.001). Compared to non-Hispanic white participants, Hispanic survivors of cancer received significantly less cardiac surveillance at 6-month (OR = 0.84, 0.72–0.98, p = 0.03) and 12-month (OR = 0.85, 0.74–0.98, p = 0.03) time points respectively (poster #3) [ 3 ].…”

Possible protective effect of rosuvastatin in chemotherapy-induced cardiotoxicity in HER2 positive breast cancer patients: a randomized controlled trial

“…Many clinical variables predispose patients to this unfavorable adverse effect. Besides old age, history of cardiac dysfunction, diabetes and hypertension, racial and ethnic differences are known to affect incidence of cardiotoxicity in those patients [ 8 , 9 ].…”