Black people with cancer more likely to experience heart damage with chemotherapy, study results show

Canadian researchers said they were surprised by their results, which could suggest structural racism within healthcare.
Someone having chemotherapy drip

Black patients with cancer have a 71% higher risk of cardiotoxicity related to chemotherapy, compared with white patients with cancer, an analysis study has revealed.

The systematic review and meta-analysis, presented at the American College of Cardiology’s Advancing the Cardiovascular Care of the Oncology Patient 2023 conference in Washington DC, reviewed studies that reported on cardiovascular toxicity in people with cancer, showing results from different racial or ethnic backgrounds receiving chemotherapy.

The final review included 24 studies with data from 683,749 participants globally, showing results from treatment with the chemotherapy agents anthracyclines and trastuzumab, and hormonal therapies.

The results showed that black patients, or those with African ancestry, had increased odds of chemotherapy-associated cardiotoxicity (unadjusted odds ratio [OR], 1.71; 95% CI, 1.40–2.10).

The review also revealed a 92% increased risk of congestive heart failure in patients who were of black or African ancestry (unadjusted odds ratio [OR] 1.92, 95% confidence interval [CI] 1.68–2.19). However, this finding was based on only three studies.

Some forms of chemotherapy, such as anthracyclines, can lead to heart failure, cardiomyopathy, cerebrovascular disease and irregular heart rhythms.

Wondewossen Gebeyehu, lead author of the meta-analysis and a medical student at the University of Toronto, said: “Unfortunately, we were not surprised. Research has shown that black patients have poorer outcomes for almost every disease.”

Nevertheless, Gebeyehu was surprised by the extent of the difference. “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 and non-black patients with a given cancer.

“These results may reflect the direct effects of racism, particularly structural racism, which leads to worse determinants of health for black patients,” Gebeyehu added.

“It is well-documented that most healthcare settings are not perceived as safe by black patients, which may increase their vulnerability to disease and decrease opportunities for preventative care.”

The rates were not adjusted for potential confounding factors, such as socioeconomic status or stage of cancer.

Last updated
The Pharmaceutical Journal, PJ, April 2023, Vol 310, No 7972;310(7972)::DOI:10.1211/PJ.2023.1.182301

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