Unpacking the Multi-level Drivers of Cardiotoxicity Disparities in Breast Cancer Survivors - Abstract
The improvement in breast cancer survival is partially due to improvements in treatments. However, these
treatments are not without mild to life-threatening side effects. For example, anthracycline chemotherapies (e.g.
doxorubicin) and human epidermal growth factor receptor-2 (HER-2) targeted therapies have been shown to
cause cardiotoxicity (CTX), or damage to the heart. This side effect is of great concern as survivors are more
likely to die of heart disease than any other diagnosis and racial disparities exist with regard to prevalence of
CTX and risk of heart-related mortality. Factors that have been shown to contribute to cardiotoxicity include Black
race and the presence of comorbidities. While the cardiovascular disease literature includes the roles of
psychosocial and sociocultural factors in its prevalence and the racial disparity in its manifestation and
progression, these factors are unexplored in the context CTX. Additionally, cancer care delivery factors, including
maintenance of CTX, deserves attention as there may be opportunities to address gaps or differences in care
that may exacerbate the CTX disparity. Addressing psychosocial and sociocultural factors may provide
intervention targets to mitigate CTX disparities. Guided by the Social Ecological Model, I will conduct
retrospective analyses and a historical-prospective cohort study to identify factors related to the racial disparity
in CTX. During the K99 mentored phase, I will abstract electronic hospital data on breast cancer survivors treated
with anthracycline chemotherapy or Her-2 targeted therapies to elucidate sociodemographic, clinical, and
maintenance factors that relate to onset of and racial differences in CTX (Aim 1). In Aim 2, I will conduct in-depth
interviews with Black and White survivors (n=20) with and without CTX to understand psychosocial and
sociocultural experiences that may contribute to CTX. During the R00 phase (Aim 3), I will use the information
learned from the in-depth interviews to inform a survey that will be distributed to n=150 Black and White breast
cancer survivors who were treated with adjuvant therapies. This survey, coupled with medical record data, will
be used to assess relationships between psychosocial and socio-cultural factors and racial differences in CTX.
In order to successfully execute these aims the candidate will receive strategic planning in cancer care delivery,
cardio-oncology, and mixed methods research. These training aims will ensure the candidate's goal of
successfully transitioning to independence and establishing a research program involving the development of
interventions that will address racial disparities in cancer care delivery and outcomes. The expertise and
guidance of the mentoring and advisory teams in addition to the wealth of resources and commitment to training
provided through the institutional environment will ensure the success of the candidate's research project and
transition to independence.
