Differences in the receipt of recommended cardiovascular assessment among cancer survivors in the United States by atherosclerotic cardiovascular disease status.

Abstract

12027 Background: Cardio-oncology guidelines recommend annual cardiovascular (CV) assessment among cancer survivors, particularly those with pre-existing atherosclerotic cardiovascular disease (ASCVD). Despite this, little is known regarding the proportion of cancer survivors receiving comprehensive CV assessment and whether certain subgroups experience suboptimal uptake. We investigated the prevalence and predictors of receiving recommended comprehensive CV assessment (i.e., cholesterol, blood pressure, blood glucose) among cancer survivors in the United States. Methods: We used self-reported, cross-sectional data from the National Health Interview Survey (2012-2018), an annual, weighted survey that uses multistage sampling and interviews to produce nationally representative estimates of the noninstitutionalized U.S. population. Adults with cancer and complete information on ASCVD status (defined as a history of myocardial infarction, stroke, coronary heart disease, or angina) were included. To examine the association between sociodemographic characteristics and lack of recommended CV assessment within the past year, adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression stratified by ASCVD status. Results: Among 16,420 cancer survivors (median age: 65.4 years; 20.1% with ASCVD), representing approximately 15.4 million survivors annually, 38.2% did not receive recommended CV assessment in the past year. Approximately 3.7% of cancer survivors (representing 566,043 individuals annually) received none of the CV assessments. Among cancer survivors with ASCVD, factors associated with increased odds of not receiving recommended CV assessment included lower (vs higher) level of education (aOR, 1.30 [95% CI, 1.01-1.65]). In cancer survivors without ASCVD, these factors included age 18-44 years (vs ≥75 years) (aOR, 1.82 [95% CI, 1.39-2.39]), low/lowest (vs high/middle) income (aOR, 1.23 [95% CI, 1.06-1.44]), uninsured (vs insured) status (aOR, 1.94 [95% CI, 1.37-2.74]), South (vs Northeast) region (aOR, 1.31 [95% CI, 1.05-1.62]), and no (vs yes) usual source of care (aOR, 2.42 [95% CI, 1.66-3.53]). Among all cancer survivors, there was a stepwise increase in receipt of CV assessment with increasing age at initial cancer diagnosis ranging from 52.7% among those aged 18-44 years at diagnosis to 68.5% among those aged 65-74 years at diagnosis (p < 0.001). Conclusions: More than 1 in 3 cancer survivors did not receive recommended annual CV assessment with several subgroups having even lower screening rates, including by age, socioeconomic status, and access to care. Improving awareness of contemporary cardio-oncology guidelines and targeting interventions during cancer survivorship are needed to increase uptake of optimal CV assessment.