Cancer and Cardiovascular Diseases during the COVID-19 Pandemic

Kawahara, Lucas Tokio; Costa, Isabela Bispo Santos da Silva; Barros, Cecília Chie Sakaguchi; Almeida, Gabriel Coelho de; Bittar, Cristina Salvadori; Rizk, Stephanie Itala; Testa, Laura; Moniz, Camila Motta Venchiarutti; Pereira, Juliana; Oliveira, Gláucia Maria Moraes de; Diz, Maria Del Pilar Estevez; Guimarães, Patricia Oliveira; Pinto, Ibraim Masciarelli; Kalil Filho, Roberto; Hajjar, Ludhmila Abrahão; Hoff, Paulo M.

doi:10.36660/abc.20200405

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Review Article • Arq. Bras. Cardiol. 115 (3) • Sept 2020 • https://doi.org/10.36660/abc.20200405 copy

Cancer and Cardiovascular Diseases during the COVID-19 Pandemic

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The challenges that the COVID-19 pandemic cretead to the healthcare system have made it necessary to adapt routines and services, with the objectives of controlling the spread of the virus and preserving health. Safe and correct management of patients in risks groups, such as elderly patients, patients with cardiovascular diseases, and patients with cancer, has become even more important. Thus, cardio-oncology has gained a new dimension, with the aim of adapting to patients’ needs during the pandemic by restructuring the system of care in a manner that offers quality and safety in healthcare.

Coronavirus; COVID-19; Betacoronavirus/complications; Cardiovascular Diseases/complications; Severe Acute Respiratory Syndrome/complications; Neoplasms/complications; Pandemics; SARS-CoV-19

Period	Procedures	Recommendations
Pre-diagnostic	Oncological screening	- Routine procedures in asymptomatic patients that require visits to health centers, such as mammograms and colonoscopies, should be postponed. - Patients with suspected disease should be investigated. - Biopsies and imaging exams should be performed in patients with suspected neoplasm.
Active oncological diagnosis	Staging	- Comprehensive evaluation of postponement, considering diseases with indolent behavior.
	Radiotherapy	- In patients with rapidly progressing tumors or patients for whom curative radiotherapy has a clear benefit, radiotherapy should be maintained; - Some patients may have radiotherapy postponed safely; however, multidisciplinary discussion is fundamental in making individual decisions.
	Immunotherapy	- The clinical decision to postpone immunosuppressive therapies should be made in an individualized manner, taking the following factors into consideration: • Risk of recurrence of cancer in the event that there are changes to the therapy routine; • Number of therapy cycles completed; • Patient tolerance to treatment. - In patients with unstable tumors, suspending chemotherapy is not recommended.
	Chemotherapy
	Oncological surgery	- It is necessary to routinely perform analysis of the risks of damage due to postponing surgery and the benefits of the surgery, in the midst of the COVID-19 pandemic.
	Stem cell transplant	- High-risk patients for COVID-19 whose neoplasms can be temporarily controlled with conventional therapy may have their stem cell transplant postponed. - Notwithstanding the lack of evidence regarding the transmission of SARS-CoV-2 through blood transfusion, it is prudent to test potential donors for COVID-19.
Oncological diagnosis in remission	Follow-up routine	- In cases of patients with low risk of recurrence who are asymptomatic during the period of follow-up, it is possible to postpone the follow-up routine in order to avoid clinical visits and possible exposure; - Telemedicine is a useful tool for evaluating patients, provided that it is carried out in a safe and regular manner; - In cases where there are recommendations regarding frequency of intervention in patients, it is prudent to postpone the intervention routine to the lowest recommended frequency.

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[1] Mailing Address: Isabela Bispo Santos da Silva Costa • Universidade de São Paulo Instituto do Câncer do Estado de São Paulo – Av. Dr. Arnaldo, 251. Postal Code 01246-000, São Paulo, SP – Brazil. E-mail: Isabela.bispo@hc.fm.usp.br