Caring for Vulnerable Populations: Dr. Tochi Okwuosa

Our hosts Dr. Stephen Caselli and co-hosts Dr. Arjun K Ghosh and Dr. Daniel Lenihan are interviewing Dr. Tochukwu M. Okwuosa to discuss the following topic “Social disparities in Cardio-oncology care”. Dr. Okwuosa is a cardiologist and a professor of medicine at Rush University. She is the Director of Cardio-Oncology Services at Rush University Medical Center. She initiated and developed the cardio-oncology program at the Karmanos Cancer Center in Detroit and left shortly afterward to develop and build the now successful cardio-oncology program at Rush University Medical Center. Episode Pearls 1. The interplay of various socio-economic determinants has an impact on the clinical outcomes of cancer patients with co-existing cardiovascular diseases (CVD) 1 . Prior studies have shown that marrying both cancer and cardiovascular disease increases mortality, especially in counties with higher social vulnerability based on the social vulnerability index 2. 2. African Americans (AA) had a three times higher risk of developing cardiotoxicity with doxorubicin compared to non-AA patients, and in breast cancer patients receiving trastuzumab therapy, AA women had 4 times fold of developing cardiotoxicity compared to white women 3,4. 3. Healthcare accessibility is an important social determinant of health and a major factor in the healthcare gap between rural and urban regions worldwide. Cardio-oncology Clinics based on telehealth platforms might decrease the gap in providing cardio-oncology care 5 . 4. Raising awareness about Cardio-oncology and enhancing education is one of the pillars of decreasing social disparities among cancer patients. Establishing collaborative educational platforms such as the Chicago Citywide Cardio-Oncology Rounds (CCCR) helps to facilitate the exchange of clinical knowledge and scientific experience 6 . Reproducing such initiatives on a nationwide basis will help in eliminating geographical barriers to accessing cardio-oncology care. 5. Building registries collaboratively will help identify patients’ social disparities such as Global Cardio-Oncology Registry (G-COR, ClinicalTrials.gov Identifier:NCT05598879). Another example is how building a registry for Immune checkpoint Inhibitors Myocarditis (ICI) has raised awareness about identifying patients presenting with ICI-myocarditis. References 1. Ahmad J, Muthyala A, Kumar A, Dani SS, Ganatra S. Disparities in Cardio-oncology: Effects On Outcomes and Opportunities for Improvement. Curr Cardiol Rep. 2022;24(9):1117-1127. doi:10.1007/s11886-022-01732-2 2. Ganatra S, Dani SS, Kumar A, et al. Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States. JACC CardioOncol. 2022;4(3):326-337. Published 2022 Sep 20. doi:10.1016/j.jaccao.2022.06.005 3. Hasan S, Dinh K, Lombardo F, Kark J. Doxorubicin cardiotoxicity in African Americans. J Natl Med Assoc. 2004;96(2):196-199. 4. Litvak A, Batukbhai B, Russell SD, et al. Racial disparities in the rate of cardiotoxicity of HER2-targeted therapies among women with early breast cancer. Cancer. 2018;124(9):1904-1911. doi:10.1002/cncr.31260 5. Kappel C, Rushton-Marovac M, Leong D, Dent S. Pursuing Connectivity in Cardio- Oncology Care-The Future of Telemedicine and Artificial Intelligence in Providing Equity and Access to Rural Communities. Front Cardiovasc Med. 2022;9:927769. Published 2022 Jun 13. doi:10.3389/fcvm.2022.927769 6. Minga I, Okwuosa T, Akhter N, et al. Developing a Model for Cross-Institutional Educational Collaborations. J Am Coll Cardiol CardioOnc. 2023 Apr, 5 (2) 262–266. 7. Power JR, Alexandre J, Choudhary A, et al. Electrocardiographic Manifestations of Immune Checkpoint Inhibitor Myocarditis [published correction appears in Circulation. 2021 Dec 7;144(23):e490]. Circulation. 2021;144(18):1521-1523. doi:10.1161/CIRCULATIONAHA.121.055816 Show Notes provided by: Abdelrahman Ali, MDCardio-Oncology FellowMD Anderson Cancer Center Department of Cardiology

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