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Strategies for Cardio-Oncology Care During the COVID-19 Pandemic
Sonu Abraham1, Shamitha Alisa Manohar2, Rushin Patel1
1Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA.
Insights
Patients with cancer and cardiovascular disease face higher COVID-19 risks. Strategies for cardio-oncology care involve innovation, equity, and inclusion to improve outcomes.
Area of Science:
- Cardio-oncology
- Infectious Diseases
- Public Health
Background:
- COVID-19 disproportionately affects marginalized populations, particularly those with comorbid cancer and cardiovascular disease (cardio-oncology).
- Evidence indicates increased morbidity and mortality from COVID-19 in this vulnerable group.
- De novo cardiovascular complications, such as myocarditis and myocardial infarction, have emerged due to exacerbated immune responses.
Purpose of the Study:
- To review current data on COVID-19 vulnerability and outcomes in cardio-oncology patients.
- To discuss strategies for optimizing cardio-oncology care during the pandemic.
- To focus on healthcare innovation, health equity, and inclusion in managing these patients.
Main Methods:
- Review of current literature and data on COVID-19 in cancer and cardiovascular disease patients.
- Analysis of emerging cardiovascular complications and their potential mechanisms.
- Exploration of patient-centric policies and innovative care strategies, including remote monitoring and virtual care.
- Examination of challenges related to vaccine administration and treatment repurposing.
Main Results:
- Increased COVID-19 morbidity and mortality observed in cardio-oncology patients.
- Emergence of de novo cardiovascular complications possibly linked to cytokine release syndrome.
- Repurposed cancer therapies (corticosteroids, IL-6 inhibitors) show utility in COVID-19 treatment.
- COVID-19 vaccine timing and dosing pose challenges due to overlapping toxicities and immune cell depletion.
Conclusions:
- Patient-centric policies, including remote monitoring and advanced imaging, are crucial for high-risk cardio-oncology patients.
- Healthcare innovation, particularly virtual care, is essential for patient outreach and managing disparities.
- Addressing the backlog in cardio-oncology care, therapy side effects, and long COVID-19 are critical in the recovery phase.
Purpose Of Review:
The COVID-19 pandemic has disrupted healthcare and has disproportionately affected the marginalized populations. Patients with cancer and cardiovascular disease (cardio-oncology population) are uniquely affected. In this review, we explore the current data on COVID-19 vulnerability and outcomes in these patients and discuss strategies for cardio-oncology care with a focus on healthcare innovation, health equity, and inclusion.
Recent Findings:
The growing evidence suggest increased morbidity and mortality from COVID-19 in patients with comorbid cancer and cardiovascular disease. Additionally, de novo cardiovascular complications such as myocarditis, myocardial infarction, arrhythmia, heart failure, and thromboembolic events have increasingly emerged, possibly due to an accentuated host immune response and cytokine release syndrome.
Summary:
Patient-centric policies are helpful for cardio-oncology surveillance like remote monitoring, increased use of biomarker-based surveillance, imaging modalities like CT scan, and point-of-care ultrasound to minimize the exposure for high-risk patients. Abundant prior experience in cancer therapy scaffolded the repurposed use of corticosteroids, IL-6 inhibitors, and Janus kinase inhibitors in the treatment of COVID-19 infection. COVID-19 vaccine timing and dose frequency present a challenge due to overlapping toxicities and immune cell depletion in patients receiving cancer therapies. The SARS-CoV-2 pandemic laid bare social and ethnic disparities in healthcare but also steered in innovation to combat problems of patient outreach, particularly with virtual care. In the recovery phase, the backlog in cardio-oncology care, interplay of cancer therapy-related side effects, and long COVID-19 syndrome are crucial issues to address.
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