Racial/Ethnic Differences In Cardiac Surveillance Evaluation For Cancer Patients Treated With Anthracycline-Based Chemotherapy: The Oneflorida Clinical Research Consortium

Introduction: Anthracyclines remain a key treatment for many malignancies but can increase the risk of heart failure or cardiomyopathy. Different guidelines recommend echocardiography (echo) and BNP or NT-proBNP evaluation before and 6-12 months after treatment. It is unknown however if racial/ethnic disparities exist in the cardiac surveillance of cancer survivors exposed to anthracyclines. Hypothesis: Racial/ethnic disparities are present in the adoption rates of cardiac surveillance guidelines among survivors treated with anthracyclines. Methods: 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 (OR) and 95% confidence intervals (CI) for receiving echo, BNP or NT-proBNP at 6 months prior (baseline), 6 months after (6M), and 12 months after (12M) treatment among different racial/ethnic groups. Results: A total of 2758 patients were identified, with mean age of 54 ± 16 years and 60% were women. Among the entire cohort, 43% had a baseline echo, with 18% receiving an echo at 6M and 21% at 12M. BNP or NT-proBNP were lower: 5.3% at baseline, 6.5% at 6M and 8.7% at 12M. The prevalence of baseline cardiovascular risk factors ranged from 13% for hyperlipidemia and diabetes to 19% for obesity and 29% for hypertension. Compared to Whites, Blacks (OR: 0.56, 95% CI: 0.45-0.70) and Hispanics (0.52, 0.43-0.64) were less likely to receive echo surveillance at baseline. These differences were also observed at 6M and 12M in Hispanics (Figure). Conclusions: Significant racial/ethnic differences in cardiac surveillance among cancer survivors were present before and after anthracycline-based treatment as Hispanics are least likely to receive cardiac surveillance. This points to the need for improved education and outreach to ensure all cancer survivors receive appropriate and equitable care.