Health Literacy, Individual and Community Engagement, and Cardiovascular Risks and Disparities: JACC: CardioOncology State-of-the-Art Review

Abstract

Cardiovascular and cancer outcomes intersect within the realm of cardio-oncology survivorship care, marked by disparities across ethnic, racial, social, and geographical landscapes. Although the clinical community is increasingly aware of this complex issue, effective solutions are trailing. To attain substantial public health impact, examinations of cancer types and cardiovascular risk mitigation require complementary approaches that elicit the patient's perspective, scale it to a population level, and focus on actionable population health interventions. Adopting such a multidisciplinary approach will deepen our understanding of patient awareness, motivation, health literacy, and community resources for addressing the unique challenges of cardio-oncology. Geospatial analysis aids in identifying key communities in need within both granular and broader contexts. In this review, we delineate a pathway that navigates barriers from individual to community levels. Data gleaned from these perspectives are critical in informing interventions that empower individuals within diverse communities and improve cardio-oncology survivorship.

Keywords: cancer survivorship; cardiomyopathy; disparities; patient education; prostate cancer; provider education; risk factor; risk prediction; screening; women's oncology.

Graphical abstract

Central Illustration

Patient-Centered Approaches to Improve Cardiovascular Disparities in Cancer Care The health care team, health systems, information resources, and community resources—intersect with internal, patient-centered factors—culture and beliefs, health care literacy, understanding, motivation, and engagement. These internal factors are as important as external ones for long-term health outcomes, especially in cancer survivorship disparities.

Figure 1

U.S. Distribution of Cancer Mortality, Cardiovascular Mortality, and Cardio-Oncology Centers (A) U.S. state-level cancer mortality between 2015 and 2019. (B) U.S. state-level cardiovascular mortality between 2015 and 2019. (C) U.S. state-level distribution of Cardio-Oncology Programs based on the International Cardio-Oncology Society Global Directory of Cardio-Oncology Programs and search on Google of “cardio-oncology” and “state name” in February 2024.