Socioeconomic and Engagement Barriers to Cardiovascular Risk Awareness Among Cancer Survivors

Purpose To assess the prevalence of self-reported awareness of treatment-related CVD risk among cancer survivors and evaluate how socioeconomic, racial, clinical, and access-related factors shape awareness. A secondary objective was to examine non-linear and intersectional patterns. Methods A cross-sectional survey of 614 cancer survivors was conducted between November 2023 and January 2025 to examine factors associated with awareness of treatment-related CVD risk. Respondents’ 10-year ASCVD risk was estimated using pooled cohort equations. Multivariable logistic regression estimated independent predictors, and decision tree analysis and interaction plots examined non-linear and intersectional patterns. Results Respondents had a mean age of 54.3 years; 60% identified as Black/African American and 53% as female. Over half (54.2%) were classified as low ASCVD risk, while 16.2% were high risk. Awareness declined as clinical risk increased; with only 14% of high-risk survivors reporting awareness. Older age (β = 0.048, p  < 0.001), lower income (β = −0.140, p  = 0.010), and hypertension (β = -0.753, p  = 0.005) were associated with non-awareness. Oncology engagement improved awareness, however, substantially more for White than Black/AA survivors (β =−1.178, p  = 0.027). Decision tree showed that survivors with frequent engagement, sociodemographic factors impacted CVD risk awareness, whereas among those with fewer visits, structural access barriers were more influential. Conclusion CVD risk awareness among cancer survivors remains low and patterned by socioeconomic and engagement-related factors. Implications for Cancer Survivors Enhancing communication and engagement and addressing structural access barriers in survivorship care is essential to improve cardiovascular risk recognition and long-term health outcomes.