Black Cancer Patients Are More Likely to Develop Heart Damage After Cancer Treatment, Study Says

Heart Damage After Cancer for Black Patients

• A new study shows that Black patients or patients of African ancestry have 71% higher odds of cardiotoxicity following cancer treatment compared to white patients.
• This highlights the critical racial disparities that exist in cancer care despite the significant advances made in the understanding of cancer and how to treat it.
• Racial disparities in cancer arise from longstanding issues in cancer research, screening, and treatment.
• Some chemotherapy drugs can be toxic to patients' heart function.
• Understanding these disparities will hopefully lead to clinicians having more conversations about reducing cardiovascular risk associated with chemotherapy and targeted efforts to cater to groups at higher risk.
• Black patients should not avoid chemotherapy, but rather, discuss their options with physicians.

A new study shows that Black patients are significantly more likely to develop heart damage after cancer treatment, known as cardiotoxicity, highlighting the critical racial disparities that exist in cancer care. The study was presented at the American College of Cardiology's Advancing the Cardiovascular Care of the Oncology Patient 2023 conference. It demonstrated that Black patients or patients of African ancestry have 71% higher odds of cardiotoxicity following cancer treatment compared to white patients. Cardiotoxicity can be caused by certain chemotherapy or targeted therapy drugs, as well as radiation to the chest, according to Cleveland Clinic. It can lead to low or high blood pressure, heart attacks, or heart failure (a condition where the heart does not pump blood as well as it should). For example, anthracyclines are an important and highly effective class of drugs in the treatment of some common types of cancers, such as leukemias, lymphomas, breast cancer and lung cancer. Unfortunately, this class of drug can also be toxic to the patients' heart function. This highlights the delicate and critical balance between using powerful drugs to cure cancer while mitigating damage to healthy tissue. "Patients may be completely free of cancer and in remission, and the most likely thing that becomes part of their life is the development of heart disease," Dr. Jean-Bernard Durand, a cardiologist at MD Anderson Cancer Center, previously told SurvivorNet. However, patients should not stop taking their chemotherapy drugs. It's important to be aware of these higher odds of cardiotoxicity, so both patients and clinicians can openly discuss this topic in an effort to reduce the cardiovascular risk for Black patients.

About the Study

The investigators performed a systematic search of several medical databases to analyze patient outcomes in all studies reporting on cardiovascular toxicity that involved patients with cancer of different racial/ethnic backgrounds receiving chemotherapy. The groups screened 7,057 studies but included 24 studies at the end. That represented 683,749 patients in the final review. Breast cancer was the most commonly reported malignancy. Other common malignancies were prostate, kidney, and hematologic malignancies such as leukemia and lymphoma. Drugs included anthracyclines (doxorubicin, daunorubicin), trastuzumab (a type of monoclonal antibody) and hormonal therapies . They discovered that Black patients or patients with African ancestry had a 71% increased risk of chemotherapy-associated cardiotoxicity (i.e. damage to the heart and/or cardiovascular system, including heart valves and vessels). The treatment was also associated with a 92% increased risk of developing congestive heart failure. One may have expected that the cardiotoxicity levels would be similar between Black and non-Black patients, since it is the chemotherapy that is injuring the heart, and one may expect the same chemotherapy to be given to Black and non-Black patients with a given cancer. However, it's important to note that the investigators didn't adjust their results for potential underlying factors. Because of that, it is utterly important to await the adjusted analysis, as well as details of the type of cancers and treatment used, before any clinical implications can be discussed.

Racial Disparities In Cancer

Racial disparities in cancer incidence and outcomes are widely known . They are driven by a combination of structural, economic, and socioenvironmental inequities that are rooted in racism and discrimination, as well as genetic and hereditary factors that may be influenced by the environment. Despite significant advancements and improvements in cancer outcomes and treatment over time, disparities persist. It's a fact that people of color receive later-stage diagnoses for some types of cancer compared to their white counterparts. Black patients are also more likely to be uninsured and to face other barriers that may limit access to cancer screening, care, and treatment. According to the American Association for Cancer Research, Black and Hispanic patients with breast, lung, colorectal, and prostate cancer are almost 30% less likely than white patients to enroll in clinical trials testing treatments for these four types of cancer. This fact could lead to chemotherapeutic agents being poorly optimized in this population relative to other racial/ethnic groups. Some other major disparities know are:

• African American women have double the incidence rate of triplenegative breast cancer compared with white women.
• African American men have a prostate cancer death rate more than double that of men in other racial groups.
• Black people are at the highest risk for cancer death even though white patients have the highest rate of new cancers.
• American Indians/Alaska Natives are less likely to be up to date with colorectal cancer screening compared to white adults 64% vs. 48%.
• Hispanic women are 69% more likely to be diagnosed with breast cancer at an advanced stage than white women.

What Is Heart Failure?

Heart failure refers to a condition that affects the heart's ability to do its job (pump blood). Because the heart is struggling to meet the body's needs, fluid backs up in the body, and organs do not get as much blood as they need. It doesn't actually mean the heart is failing to work, but that it is not functioning as well as it could be. Heart failure is a very valid concern for patients fter cancer treatment, Dr. Durand said. To understand heart failure, it's important to understand how the heart works. Your heart is roughly the size of a fist and sits in the middle of your chest, slightly to the left. It's the muscle at the center of your circulation system, pumping blood around your body as your heart beats. This blood sends oxygen and nutrients to all parts of your body, and carries away unwanted carbon dioxide and waste products. Chronic heart failure can impact the kidneys, liver, and lungs when it exists for a prolonged period of time, typically, more than six months.

Symptoms of Heart Failure

Because heart failure can lead to many other health issues, its important to be aware of symptoms. These may include:

• Weakness/tiredness
• Feeling lightheaded/dizzy
• Difficulty breathing
• Racing heart/palpitations
• Lower limb swelling (specifically in the feet and ankles)
• Need to urinate while resting at night
• Dry, hacking cough
• Nausea

Symptoms of heart failure can range from mild to severe and may come and go. Unfortunately, heart failure usually gets worse over time. As it worsens, you may have more or different signs or symptoms. Doctors want to give cancer patients the best quality of life after treatment. So there are methods (like technologies and medication) they use to treat these heart conditions and manage symptoms. These techniques "can enhance their life, prolong their life, and allow them to have a new quality of life" in the face of heart damage after cancer treatment, said Dr. Durand. The treatment approach will depend on the type of heart condition a person has and may, in part, be influenced by what caused the disease. For example, diuretics are one option for managing the symptoms of heart failure. Often referred to as "water pills," they help the body get rid of salt (sodium) and water. When you have heart failure, your heart is not pumping enough blood. As a result, fluid backs up in the body, especially in the lungs and in your legs (a condition called edema). Diruetics can help decrease blood volume, so the heart has less to pump with each beat, which in turn eases your heart's work. And a drug called vericiguat (brand name Verquvo) may be helpful for people who have been diagnosed with heart failure and have been hospitalized or need outpatient IV diuretics. The drug works by decreasing the heart's workload by dilating the blood vessels.

Adopting Healthy Habits to Manage Heart Failure

According to the American Heart Association , following recommendations about diet, exercise, and other habits can help alleviate heart failure symptoms, slow your disease's progression, and improve your everyday life. In fact, people with mild to moderate heart failure often can lead nearly normal lives as a result. Making some of these lifestyle changes can be easier said than done. But working these changes into your daily routine can make a real difference in your quality of life. Here are some other suggestions as far as healthy habits go, including:

• Staying moderately active
• Losing weight
• Eating a balanced diet
• Avoiding excessive alcohol intake
• Quitting smoking
• Managing stress

For more, SurvivorNet has put together a special resource guide just for you: How Lifestyle Changes Can Help With Managing Heart Failure.

Questions to Ask Your Doctor

• Is this cancer drug safe for me? Or are there safer options?
• Can my heart handle this drug?
• Am I more likely to develop treatment-related adverse effects, compared to a white friend of mine?