Social Determinants of Health in Cardio-Oncology: Multi-Level Strategies to Overcome Disparities in Care: JACC: CardioOncology State-of-the-Art Review

Foster Osei Baah; Sonal Sharda; Kimberly Davidow; Sadhana Jackson; Daphney Kernizan; Joshua A Jacobs; Yvonne Baumer; Corinna L Schultz; Carissa M Baker-Smith; Tiffany M Powell-Wiley

doi:10.1016/j.jaccao.2024.02.009

Social Determinants of Health in Cardio-Oncology: Multi-Level Strategies to Overcome Disparities in Care: JACC: CardioOncology State-of-the-Art Review

JACC CardioOncol. 2024 May 7;6(3):331-346. doi: 10.1016/j.jaccao.2024.02.009. eCollection 2024 Jun.

Authors

Foster Osei Baah^{1

2}, Sonal Sharda¹, Kimberly Davidow³, Sadhana Jackson^{4

5}, Daphney Kernizan^{6

7}, Joshua A Jacobs⁸, Yvonne Baumer¹, Corinna L Schultz³, Carissa M Baker-Smith⁹, Tiffany M Powell-Wiley^{1

10}

Affiliations

¹ Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
² Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
³ Lisa Dean Moseley Foundation Institute for Cancer and Blood Disorders, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA.
⁴ Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
⁵ Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
⁶ Preventive Cardiology Program, Cardiac Center, Nemours Children's Health, Panama City, Florida, USA.
⁷ College of Medicine, University of Central Florida, Orlando, Florida, USA.
⁸ Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
⁹ Preventive Cardiology Program, Cardiac Center, Nemours Children's Health, Wilmington, Delaware, USA.
¹⁰ Intramural Research Program, National Institute on Minority Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.

Abstract

Addressing the need for more equitable cardio-oncology care requires attention to existing disparities in cardio-oncologic disease prevention and outcomes. This is particularly important among those affected by adverse social determinants of health (SDOH). The intricate relationship of SDOH, cancer diagnosis, and outcomes from cardiotoxicities associated with oncologic therapies is influenced by sociopolitical, economic, and cultural factors. Furthermore, mechanisms in cell signaling and epigenetic effects on gene expression link adverse SDOH to cancer and the CVD-related complications of oncologic therapies. To mitigate these disparities, a multifaceted strategy is needed that includes attention to health care access, policy, and community engagement for improved disease screening and management. Interdisciplinary teams must also promote cultural humility and competency and leverage new health technology to foster collaboration in addressing the impact of adverse SDOH in cardio-oncologic outcomes.

Keywords: cardio-oncology; cardiology; care delivery model; disparities; epidemiology; lifestyle risk factors; signaling pathways; social determinants of health.

Publication types

Review