Surgical voice restoration service provision varies within and between cancer networks. There is a need for a national management and care protocol, an educational programme for out of hours service providers, and a review of current speech and language therapist staffing levels in England.
Objectives
The aim of this study was to evaluate the differences in surgical capacity for head and neck cancer in the UK between the first wave (March‐June 2020) and the current wave (Jan‐Feb 2021) of the COVID‐19 pandemic.
Design
REDcap online‐based survey of hospital capacity.
Setting
UK secondary and tertiary hospitals providing head and neck cancer surgery.
Participants
One representative per hospital was asked to report the capacity for head and neck cancer surgery in that institution.
Main outcome measures
The principal measures of interests were new patient referrals, capacity in outpatients, theatres and critical care; therapeutic compromises constituting delay to surgery, de‐escalated surgery and therapeutic migration to non‐surgical primary modality.
Results
Data were returned from approximately 95% of UK hospitals with a head and neck cancer surgery specialist service. 50% of UK head and neck cancer patients requiring surgery have significantly compromised treatments during the second wave: 28% delayed, 10% have received radiotherapy‐based treatment instead of surgery, and 12% have received de‐escalated surgery. Surgical capacity has been more severely constrained in the second wave (58% of pre‐pandemic level) compared with the first wave (62%) despite the time to prepare.
Conclusions
Some hospitals are overwhelmed by COVID‐19 and unable to offer essential cancer surgery, but all have neighbouring hospitals in their region retaining good (or even normal) capacity. It is noteworthy that very few patients have been appropriately redirected away from the hospitals most constrained by their burden of COVID‐19. The paucity of an effective central or regional strategic response to this evident mismatch between demand and surgical capacity is to the detriment of our head and neck cancer patients.
The importance of providing patients with adequate additional information prior to the consenting process for a surgical procedure has long been established. This information is intended to provide sufficient detail to allow the patient to make an informed decision about the proposed surgical intervention. indeed, the general Medical Council states this in Good Medical Practice: patients must be given sufficient information, in a way that they can understand, in order to enable them to exercise their right to make informed decisions about their care.
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