Chemotherapy may be associated with a 71% increased risk of treatment-related cardiotoxicity—including heart failure and cerebrovascular disease—among Black patients or patients of African ancestry compared with White patients, according to new findings presented by Gebeyehu et al at the American College of Cardiology (ACC) Advancing the Cardiovascular Care of the Oncology Patient 2023 conference.
Background
Cardiotoxicities of chemotherapy agents and radiation can lead to several cardiovascular complications—including heart failure, cardiomyopathy, and arrhythmias. Certain cancer treatments may have a higher risk of causing cardiotoxicities, including anthracyclines, which are used to treat leukemias, lymphomas, breast cancer, gastric cancer, endometrial cancer, ovarian cancer, and lung cancer.
“Research shows that Black patients have poorer outcomes for almost every disease,” stressed lead study author Wondewossen Gebeyehu, BSc, a medical student at the University of Toronto.
Study Methods and Results
In the new study, the investigators performed a systematic search of several databases—including Medline, Embase, and PubMed—to analyze patient outcomes in all studies reporting on cardiovascular toxicity that involved patients with cancer of different racial/ethnic backgrounds receiving chemotherapy. After screening 7,057 studies, the investigators included 24 studies representing 683,749 patients in the final review.
They discovered that Black patients or patients with African ancestry had a 71% increased risk of chemotherapy-associated cardiotoxicity. The treatment was also associated with an increased risk of developing congestive heart failure.
“In this case, one could have expected that the differences would be minimal since it is the chemotherapy that is injuring the heart, and we would expect the same chemotherapy to be given to Black [patients] and non-Black patients with a given cancer,” noted Mr. Gebeyehu. “Unfortunately, we were not surprised [by the findings]. [T]his systematic review indicates that the inequities in health outcomes extend to the odds of cardiotoxicity after cancer treatment,” he added.
Conclusions
“These results may reflect the direct effects of racism—particularly structural racism—which leads to worse determinants of health for Black patients. It is well-documented that most health-care settings are not perceived as safe by Black patients, which may increase their vulnerability to diseases and decrease opportunities for preventive care,” Mr. Gebeyehu emphasized.
“Furthermore, decreased representation of Black patients in clinical trials may lead to treatments being developed that are not as effective or which may be riskier for Black patients. Importantly, these results should prompt further inquiry into the many possible contributors to disparities observed in Black patients,” he underscored.
The investigators noted that the study quantified the increased odds of chemotherapy-associated cardiotoxicity for Black cancer patients and highlighted the need for further studies to determine the underlying factors contributing to these health disparities in an effort to reduce cardiotoxicity among Black patients and those with African ancestry.
“The … message for patients is that they 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,” Mr. Gebeyehu said. “For clinicians, it is important to be aware of these higher odds of cardiotoxicity faced by Black patients. Understanding these disparities will hopefully lead to clinicians having more conversations around reducing cardiovascular risk associated with chemotherapy and targeted efforts to cater to groups at higher risk,” he concluded.
