Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA.
UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA.
Curr Oncol Rep. 2020 May 28;22(6):60. doi: 10.1007/s11912-020-00945-4.
The novel Coronavirus (2019-nCoV, COVID-19) is historically one of the most severe acute respiratory syndromes and pandemics to affect the globe in the twenty-first century. Originating in Wuhan, the virus rapidly spread and impacted subsets of populations with initial unclear risk factors contributing to worsening morbidity and mortality. Patients with diagnosis of cancer and undergoing treatment further represent a population at risk for worsening cardiopulmonary outcomes. This review explores specific risk factors, diagnoses, and treatment options that impact cardio-oncologic patients with COVID-19.
Multiple studies globally, including Italy, China, and the USA, have documented severe outcomes. Cancer patients are at increased risk of cardiac injury which itself is a risk factor for mortality. Additionally, elderly cancer patients undergoing recent anti-cancer treatment may be at greater risk for sustaining worse outcomes, although data remains suboptimal in this population. Major gaps remain regarding risk associated with type of cancer and type of anti-cancer treatment, as well as the layered risk of cardiovascular disease and cancer. Immunomodulatory therapies used to treat cytokine release syndrome secondary to anti-cancer therapies, as well as other agents being traditionally used to treat cardiovascular and cancer disease states, are being investigated for treatment of COVID-19. Hypertension, cardiovascular disease, diabetes, and cancer have been associated with more severe COVID-19 infection and worse outcomes. Patients undergoing anti-cancer therapy or those who have suffered from coronavirus infection may develop long-standing changes, not limited to pulmonary fibrosis, hyperlipidemia, and worsening atherosclerosis. Those undergoing anti-cancer therapy are at theoretically increased susceptibility for infection, with type of cancer not necessarily dictating outcome. A review of the literature of patients with cardiovascular and/or cancer disease is presented, as well as proposed strategies to attenuate risk regarding treatment, management, and surveillance in this vulnerable population.
新型冠状病毒（2019-nCoV，COVID-19）是 21 世纪以来全球历史上最严重的急性呼吸系统综合征和大流行之一。该病毒起源于武汉，迅速传播，影响了具有初始不明确致病因素的人群亚组，导致发病率和死亡率恶化。诊断为癌症并正在接受治疗的患者进一步代表了心肺预后恶化风险较高的人群。本综述探讨了影响 COVID-19 心肿瘤患者的具体风险因素、诊断和治疗选择。
包括意大利、中国和美国在内的全球多项研究都记录了严重的结果。癌症患者发生心脏损伤的风险增加，而心脏损伤本身就是死亡的一个风险因素。此外，接受近期抗癌治疗的老年癌症患者可能面临更大的恶化结局风险，尽管该人群的数据仍不理想。与癌症类型和抗癌治疗类型相关的风险、心血管疾病和癌症的分层风险以及与 COVID-19 相关的风险仍存在较大差距。用于治疗抗癌治疗引起的细胞因子释放综合征的免疫调节疗法，以及用于治疗心血管和癌症疾病状态的其他药物，正在被研究用于 COVID-19 的治疗。高血压、心血管疾病、糖尿病和癌症与 COVID-19 感染的严重程度和结局恶化有关。正在接受抗癌治疗或曾感染过冠状病毒的患者可能会出现持久的变化，不仅限于肺纤维化、高脂血症和动脉粥样硬化恶化。接受抗癌治疗的患者理论上更容易受到感染，而癌症的类型不一定决定结局。本文对患有心血管和/或癌症疾病的患者的文献进行了综述，并提出了在这一脆弱人群中减少治疗、管理和监测风险的策略。
