Cardio-Oncology in the COVID Era (Co & Co): The Never Ending Story

Abstract

The pathophysiology of some non-communicable diseases (NCDs) such as hypertension, cardiovascular disease (CVD), diabetes, and cancer includes an alteration of the endothelial function. COVID-19 is a pulmonary and vascular disease with a negative impact on patients whose damaged endothelium is particularly vulnerable. The peculiar SARS-CoV-2-induced “endothelitis” triggers an intriguing immune-thrombosis that affects both the venous and arterial vascular beds. An increased liability for infection and an increased likelihood of a worse outcome have been observed during the pandemic in patients with active cancer and in cancer survivors. “Overlapping commonalities” between COVID-19 and Cardio-Oncology have been described that include shared phenotypes of cardiovascular toxicities such as left ventricular dysfunction, ischemic syndromes, conduction disturbances, myocarditis, pericarditis and right ventricular failure; shared pathophysiologic mechanisms such as inflammation, release of cytokines, the renin-angiotensin-aldosterone-pathway, coagulation abnormalities, microthrombosis and endothelial dysfunction. For these features and for the catalyst role of NCDs (mainly CVD and cancer), we should refer to COVID-19 as a “syndemic.” Another challenging issue is the persistence of the symptoms, the so-called “long COVID” whose pathogenesis is still uncertain: it may be due to persistent multi-organ viral attacks or to an abnormal immune response. An intensive vaccination campaign is the most successful pharmacological weapon against SARS-CoV-2, but the increasing number of variants has reduced the efficacy of the vaccines in controlling SARS-CoV-2 infections. After a year of vaccinations we have also learned more about efficacy and side-effects of COVID-19 vaccines. An important byproduct of the COVID-19 pandemic has been the rapid expansion of telemedicine platforms across different care settings; this new modality of monitoring cancer patients may be useful even in a post pandemic era. In this paper we analyze the problems that the cardio-oncologists are facing in a pandemic scenario modified by the extensive vaccination campaign and add actionable recommendations derived from the ongoing studies and from the syndemic nature of the infection.

Reopening the “CANCER MOONSHOT” in the United States: A great task in the COVID-19 era

“…During the pandemic or post-Covid-19 era, patients with active cancer and in cancer survivors have a worse outcome due to persistent multi-organ viral attacks or an abnormal immune response 14 . There are both more adverse cardiac outcomes and significantly increased cardiac biomarkers as well as a high in-hospital mortality in Covid-19 patients with cancer 15 due to mainly driven by gender, advancing age, smoking, socioeconomic deprivation, and other comorbidities 16,17 , such as cardiovascular disease (CVD), diabetes.…”

Innovations in Cardio-oncology Resulting from the COVID-19 Pandemic

“…In our cardio-oncology patients who were infected with COVID-19, the use of biomarkers was complicated due to similar CV side effects of COVID-19 and cardiotoxicity from chemotherapy medications. A strong collaboration among oncology and cardiology services to co-manage this group of high-risk patients is essential to find the right balance to provide appropriate care with the limited and restricted use of resources during pandemic [ 19 ].…”

Cardio-Oncology and the COVID-19 Pandemic

“…Increasing cardiovascular disease due to cancer treatment led to the development of cardio-oncology field of research with the aim of monitoring, detecting, and treating cardiovascular diseases caused due to chemotherapy or radiotherapy side effects. The aim of this research is to study the effects of cardio-oncology and COVID-19 on each other in different perspectives which can suggest strategies for future similar phases [8][9][10][11].…”