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Cardio-oncology care in the era of the coronavirus disease 2019 (COVID-19) pandemic: An International Cardio-Oncology Society (ICOS) statement. ​

Literature Information ​

DOI10.3322/caac.21635
PMID32910493
JournalCA: a cancer journal for clinicians
Impact Factor232.4
JCR QuartileQ1
Publication Year2020
Times Cited24
Keywordsbest practice, cancer, cardiac safety, cardio-oncology, coronavirus disease 2019 (COVID-19)
Literature TypeJournal Article, Practice Guideline, Research Support, N.I.H., Extramural, Review
ISSN0007-9235
Pages480-504
Issue70(6)
AuthorsDaniel Lenihan, Joseph Carver, Charles Porter, Jennifer E Liu, Susan Dent, Paaladinesh Thavendiranathan, Joshua D Mitchell, Anju Nohria, Michael G Fradley, Iskra Pusic, Keith Stockerl-Goldstein, Anne Blaes, Alexander R Lyon, Sarju Ganatra, Teresa López-Fernández, Rupal O'Quinn, Giorgio Minotti, Sebastian Szmit, Daniela Cardinale, Jose Alvarez-Cardona, Giuseppe Curigliano, Tomas G Neilan, Joerg Herrmann

TL;DR ​

This review highlights the heightened risk of severe COVID-19 complications in patients with both cardiovascular disease (CVD) and cancer, emphasizing the urgent need for a unified management approach in the context of the pandemic. It proposes strategic modifications in cardio-oncology practices, including increased use of cardiac biomarkers and focused imaging, to mitigate infection risks while ensuring optimal care for this vulnerable population.

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best practice · cancer · cardiac safety · cardio-oncology · coronavirus disease 2019 (COVID-19)

Abstract ​

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has given rise to a pandemic of unprecedented proportions in the modern era because of its highly contagious nature and impact on human health and society: coronavirus disease 2019 (COVID-19). Patients with cardiovascular (CV) risk factors and established CV disease (CVD) are among those initially identified at the highest risk for serious complications, including death. Subsequent studies have pointed out that patients with cancer are also at high risk for a critical disease course. Therefore, the most vulnerable patients are seemingly those with both cancer and CVD, and a careful, unified approach in the evaluation and management of this patient population is especially needed in times of the COVID-19 pandemic. This review provides an overview of the unique implications of the viral outbreak for the field of cardio-oncology and outlines key modifications in the approach to this ever-increasing patient population. These modifications include a shift toward greater utilization of cardiac biomarkers and a more focused CV imaging approach in the broader context of modifications to typical practice pathways. The goal of this strategic adjustment is to minimize the risk of SARS-CoV-2 infection (or other future viral outbreaks) while not becoming negligent of CVD and its important impact on the overall outcomes of patients who are being treated for cancer.

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Primary Questions Addressed ​

  1. How have the treatment protocols for cancer patients with cardiovascular disease evolved in response to the COVID-19 pandemic?
  2. What specific cardiac biomarkers have shown increased relevance in the management of cancer patients during the pandemic?
  3. In what ways can telemedicine play a role in cardio-oncology care for patients at high risk during viral outbreaks?
  4. What are the long-term implications of COVID-19 on cardiovascular health in cancer survivors?
  5. How can healthcare systems better prepare for future pandemics in the context of managing patients with both cancer and cardiovascular diseases?

Key Findings ​

Research Background and Purpose ​

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has significantly impacted global health, particularly among patients with cardiovascular disease (CVD) and cancer. These populations are at increased risk for severe complications and mortality. This document serves as a consensus statement from the International Cardio-Oncology Society (ICOS), outlining the implications of COVID-19 for cardio-oncology care and providing recommendations for managing patients with concurrent cancer and cardiovascular conditions during the pandemic.

Main Methods/Materials/Experimental Design ​

The review synthesizes current literature and clinical practices related to the management of cancer patients during the COVID-19 pandemic. It emphasizes the importance of a unified approach between oncologists and cardiologists to optimize patient care while minimizing the risk of SARS-CoV-2 infection.

Technical Route ​

Mermaid diagram

Key Results and Findings ​

  1. Risk Factors: Patients with both cancer and CVD are at heightened risk for severe COVID-19 outcomes. Key risk factors include older age, male sex, and the presence of comorbidities.
  2. Cardiac Injury: Studies indicate that a significant percentage of COVID-19 patients experience myocardial injury, with elevated troponin levels correlating with worse outcomes.
  3. Telehealth Utilization: The pandemic has necessitated a shift toward telehealth for routine consultations and follow-ups, reducing the need for in-person visits.
  4. Biomarker Monitoring: Increased reliance on cardiac biomarkers (e.g., troponins, natriuretic peptides) for monitoring cardiac function in lieu of traditional imaging techniques has been recommended to minimize infection risk.

Main Conclusions/Significance/Innovation ​

The consensus document underscores the necessity of adapting cardio-oncology practices in light of the COVID-19 pandemic. It highlights the need for a collaborative approach between cardiology and oncology to ensure the safety and efficacy of cancer treatments while addressing cardiovascular health. The emphasis on remote monitoring and biomarker utilization represents a significant innovation in managing high-risk patients during this public health crisis.

Research Limitations and Future Directions ​

  1. Evidence Gaps: The rapidly evolving nature of COVID-19 research presents challenges in maintaining updated clinical guidelines.
  2. Long-Term Impacts: The long-term cardiovascular effects of COVID-19 on cancer patients remain largely unknown and warrant further investigation.
  3. Adaptation of Guidelines: Continuous adaptation of treatment guidelines is essential as new data emerges regarding COVID-19 and its interaction with cancer therapies.

In summary, the document provides critical guidance for managing patients with cancer and cardiovascular disease during the COVID-19 pandemic, emphasizing the importance of integrating care across specialties to optimize outcomes while minimizing risks associated with the virus.

References ​

  1. SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China. - Jing Yu;Wen Ouyang;Melvin L K Chua;Conghua Xie - JAMA oncology (2020)
  2. Exploratory analysis of cardiac biomarkers in women with normal cardiac function receiving trastuzumab for breast cancer. - Shom Goel;R John Simes;Jane M Beith - Asia-Pacific journal of clinical oncology (2011)
  3. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19. - Dominic Wichmann - Annals of internal medicine (2020)
  4. COVID-19: consider cytokine storm syndromes and immunosuppression. - Puja Mehta;Daniel F McAuley;Michael Brown;Emilie Sanchez;Rachel S Tattersall;Jessica J Manson; - Lancet (London, England) (2020)
  5. A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group. - Humaid O Al-Shamsi;Waleed Alhazzani;Ahmad Alhuraiji;Eric A Coomes;Roy F Chemaly;Meshari Almuhanna;Robert A Wolff;Nuhad K Ibrahim;Melvin L K Chua;Sebastien J Hotte;Brandon M Meyers;Tarek Elfiki;Giuseppe Curigliano;Cathy Eng;Axel Grothey;Conghua Xie - The oncologist (2020)
  6. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. - Zunyou Wu;Jennifer M McGoogan - JAMA (2020)
  7. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). - Riccardo M Inciardi;Laura Lupi;Gregorio Zaccone;Leonardo Italia;Michela Raffo;Daniela Tomasoni;Dario S Cani;Manuel Cerini;Davide Farina;Emanuele Gavazzi;Roberto Maroldi;Marianna Adamo;Enrico Ammirati;Gianfranco Sinagra;Carlo M Lombardi;Marco Metra - JAMA cardiology (2020)
  8. Guidance for Cardiac Electrophysiology During the COVID-19 Pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association. - Dhanunjaya R Lakkireddy;Mina K Chung;Rakesh Gopinathannair;Kristen K Patton;Ty J Gluckman;Mohit Turagam;Jim Cheung;Parin Patel;Juan Sotomonte;Rachel Lampert;Janet K Han;Bharath Rajagopalan;Lee Eckhardt;Jose Joglar;Kristin Sandau;Brian Olshansky;Elaine Wan;Peter A Noseworthy;Miguel Leal;Elizabeth Kaufman;Alejandra Gutierrez;Joseph E Marine;Paul J Wang;Andrea M Russo - Circulation (2020)
  9. Myocarditis in Patients Treated With Immune Checkpoint Inhibitors. - Syed S Mahmood;Michael G Fradley;Justine V Cohen;Anju Nohria;Kerry L Reynolds;Lucie M Heinzerling;Ryan J Sullivan;Rongras Damrongwatanasuk;Carol L Chen;Dipti Gupta;Michael C Kirchberger;Magid Awadalla;Malek Z O Hassan;Javid J Moslehi;Sachin P Shah;Sarju Ganatra;Paaladinesh Thavendiranathan;Donald P Lawrence;John D Groarke;Tomas G Neilan - Journal of the American College of Cardiology (2018)
  10. Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China. - L Zhang;F Zhu;L Xie;C Wang;J Wang;R Chen;P Jia;H Q Guan;L Peng;Y Chen;P Peng;P Zhang;Q Chu;Q Shen;Y Wang;S Y Xu;J P Zhao;M Zhou - Annals of oncology : official journal of the European Society for Medical Oncology (2020)

Literatures Citing This Work ​

  1. Editorial commentary: Cardiovascular imaging in COVID-19: Focus on safety, value, and clinical relevance. - Sourbha S Dani;Shiv Bagga;Sarju Ganatra - Trends in cardiovascular medicine (2021)
  2. Cardiotoxicity of Contemporary Anticancer Immunotherapy. - Natalie Dal'bo;Rushin Patel;Rohan Parikh;Sachin P Shah;Avirup Guha;Sourbha S Dani;Sarju Ganatra - Current treatment options in cardiovascular medicine (2020)
  3. Current status of treatment of cancer-associated venous thromboembolism. - Wei Xiong - Thrombosis journal (2021)
  4. Reaching Across the Aisle: Cardio-Oncology Advocacy and Program Building. - Diego Sadler;Anita Arnold;Joerg Herrmann;Andres Daniele;Carolina Maria Pinto Domingues Carvalho Silva;Arjun K Ghosh;Sebastian Szmit;Roohi Ismail Khan;Luis Raez;Anne Blaes;Sherry-Ann Brown - Current oncology reports (2021)
  5. Cardiotoxicity of Immune Checkpoint Inhibitors. - Rushin P Patel;Rohan Parikh;Krishna S Gunturu;Rana Zouveenoor Tariq;Sourbha S Dani;Sarju Ganatra;Anju Nohria - Current oncology reports (2021)
  6. Cardio-oncology Training in the COVID-19 Era. - Stephanie Feldman;Jennifer Liu;Richard Steingart;Dipti Gupta - Current treatment options in oncology (2021)
  7. Impact of Cancer and Cardiovascular Disease on In-Hospital Outcomes of COVID-19 Patients: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry. - David Tehrani;Xiaoyan Wang;Asim M Rafique;Salim S Hayek;Joerg Herrmann;Tomas G Neilan;Pooja Desai;Alicia Morgans;Juan Lopez-Mattei;Rushi V Parikh;Eric H Yang - Research square (2021)
  8. Clinical characteristics, risk factors, and cardiac manifestations of cancer patients with COVID-19. - Yan Huang;Zhenhong Hu;Dong Hu;Zhou Quan;Xiaoyang Zhou;Guohua Fan;Xiu Chen;Xiaoxiong Liu;Zhonghe Zhang;Ganxiao Chen;Yanwen Wu;Fangqi Zhang;Congzheng Mao;Hao Xia;Jinjun Liang;Bo Yang;Hong Jiang;Congxin Huang;Hector Barajas-Martínez;Dan Hu - Journal of applied physiology (Bethesda, Md. : 1985) (2021)
  9. The Role and Impact of Social Media in Cardio-oncology During the COVID-19 Pandemic. - Jennifer M Kwan;Mariana L Henry;Briana Christophers;Kamala Tamirisa;Ritu Thamman;Diego Sadler;Niti R Aggarwal;Richard Cheng;Purvi Parwani;Susan Dent;Roohi Ismail-Khan;Michael G Fradley;Sherry-Ann Brown - Current oncology reports (2021)
  10. Consumer Wearables and the Integration of New Objective Measures in Oncology: Patient and Provider Perspectives. - Lakshan N Fonseka;Benjamin Kp Woo - JMIR mHealth and uHealth (2021)

... (14 more literatures)

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