Important questions include the following: 1) Which patients need attention, and by what means? 2) Is there a need to modify published algorithms and protocols? 3) Should there be a switch from CV imaging to serum biomarkers? 4) Which innovative approaches for remote monitoring can be quickly and effectively used? The answers to many of these questions may vary, depending on the local impact of COVID-19 or any other pandemic at the time, and these questions should be approached with vibrant and ongoing communication between oncology, hematology, and C-O providers alike

Important questions include the following: 1) Which patients need attention, and by what means? 2) Is there a need to modify published algorithms and protocols? 3) Should there be a switch from CV imaging to serum biomarkers? 4) Which innovative approaches for remote monitoring can be quickly and effectively used? The answers to many of these questions may vary, depending on the local impact of COVID-19 or any other pandemic at the time, and these questions should be approached with vibrant and ongoing communication between oncology, hematology, and C-O providers alike. typical practice pathways. The goal of this strategic adjustment is to minimize the risk of SARSCCoV-2 infection (or other future viral outbreaks) while not becoming negligent of CVD and its important impact on PK68 the overall outcomes of patients who are being treated for cancer. < .001)For severe events:Cancer (OR, 5.39; 95% Cl, 1.8C16.2; = .003) COPD (OR, 3.4; 95% Cl, 1.4C8.4; = .008) DM (OR, 2.2; 95% Cl, 1.3C3.7; = .002) HTN (OR, 1.9, 95% 1.2C2.9; = .004) Age (OR, 1.1, 95% 1.0C1.1;<.001) Women (OR, 0.6, 95% 0.4C0.9; = .02) Zhang 202024Hubei, ChinaSolid cancer only; 6 received anticancer therapy within 14 d (1 radiation, 5 drug)282.2% of all admitted patients21.4%35.7%28.6%53.6%For severe events:Anticancer therapy within 14 d (OR, 4.1; 95% Cl, 1.1C15.3; = .04) Patchy consolidation (OR, 5.4; 95% Cl, 1.5C19.8; = .01) Dai 202025Hubei, China96 Solid cancers, 9 hematologic malignancies; 48 with cancer therapy within 40 d (8 surgery, 13 radiation therapy)105 Patients with cancer; 536 matched patients without cancerNA19.05%9.52%11.43%34.3%Death:Age (OR, 30.1; = .003) DM (OR, 2.99; = .03) Severe symptoms:Cancer (OR, 1.99; = .006) HTN (OR, 1.8; = .02) ICU:Cancer (OR, 3.1; = .001) Age (OR, 11.2; = .008) MV:Cancer (OR, 2.7; = .04) For severe symptoms:Cancer (HR 2.5; 95% Cl, 1.7C3.8; < .01) Hem. malignancy (HR 6.3; 95% Cl, 2.7C14.9; <.01) Lung cancer (HR 2.6; 95% Cl, 1.3C5.0; < .01) Met. cancer (HR 2.5; 95% Cl, 1.2C5.1; = Rabbit Polyclonal to Dyskerin .01) Immunotherapy (HR 4.8, 95% 1.7C13.5; < .01) Surgery (HR, 6.2; 95% Cl, 2.4C15.8; < .01) Yang 202026Hubei, China183 Solid tumors, 22 hematologic malignancies; PK68 54 with cancer therapies in the 4 wk prior (31 chemotherapy, 12 targeted therapy, 4 immunotherapy, 9 radiation, 2 surgery)205NA15%10%20%Mortality:On chemotherapy (OR, 3.5; 95% Cl, 1.2C10.6; = .03) Men (OR, 3.9; 95% Cl, 1.6C9.5; = .003) Cancer type, stage, and time since diagnosis not predictiveRogado 202027Madrid, Spain45 Solid cancers; 71.1% on active treatment454.2% (vs 0.6% in the overall population)0%42.2% (vs 13.2% in the overall population)64%Mortality:Age (OR, 1.1; 95% Cl, 1C1.1; = .03) Cancer type, stage, and treatment not predictiveMehta 202028New York City, USA164 Solid cancers, 54 hem. malignancies; 92 with active cancer <1 y (49 on radiation therapy, 47 on drug therapy)218 With cancer; 1090 age-matched and sex-matched controlsNA10.5%20.6%28% (14% in control group)Mortality:Cancer (OR, 2.45; <.001) Disease characteristics significantly more common in patients with cancer who died:= .006) Age (OR, 9.4; 95% Cl, 6.6C10.0; = .002) HTN (OR, 1.95; 95% Cl 1.4C2.8; = .002) No association with cancer type, stage, or therapy Open in a separate window Abbreviations: CAD, coronary artery disease; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disorder; CVC, cardiovascular disease; DM, diabetes mellitus; ECOG, Eastern Cooperative Oncology Group; Hem. malignancy, hematologic malignancy; HR, hazard ratio; HTN, hypertension; ICU, intensive care unit; Met. cancer, metastatic cancer; MV, mechanical ventilation; NA, not available; NSCLC, nonsmall cell lung cancer; OR, odds ratio; SCLC, small PK68 cell lung cancer. Interestingly, calls to prepare for the care of patients with cancer in times of a pandemic were issued over a decade ago and were updated more recently.32 These include preparation for a change in the delivery of cancer care, including type, timing, and setting. Such an approach may shift away from surgery, radiation therapy, and conventional infusion chemotherapy toward therapies that can be given as a tablet or injection. More recently, specific recommendations for the care of patients with cancer in times of COVID-19 have emerged. A key concept is the designation of patients with cancer as high-risk or low-risk for disease progression without cancer therapy and thus at high need or low need for urgent treatment.33,34 This concept of prioritization is depicted in Figure 2. Open in a separate window FIGURE 2. Workflow Outline for Cardio-Oncology in Times of a Viral Pandemic. PK68 Initial triage should take cardiovascular (CV) disease (CVD) acuity into consideration as well as the broader scope of the patients cancer care and the specific viral pandemic practice environment. COVID-19 indicates coronavirus disease 2019. Impact of COVID-19 on the Patient With Cancer and CV Disease Contemporary cancer therapy has expanded beyond traditional chemotherapeutics, radiation therapy, and surgery to include targeted therapies as well as immunotherapy, resulting in a range of potential CV toxicities that require more complex CV monitoring.11,35C37 Specific cancer therapies are associated with worsening CV risk factors, such as hypertension and dyslipidemia, as well as the development of CVD, including heart failure,.