A multi-centre survey reveals variations in the standard treatments and treatment modifications for head and neck cancer patients during Covid-19 pandemic

Abstract

Background The onset of the COVID-19 pandemic necessitated rapid changes to the practice of head and neck oncology. This survey was conducted to assess the pre-Covid-19 pandemic standard of practice for head and neck oncology patients and the treatment modifications introduced during the Covid-19 pandemic in UK. Methodology The UK National Cancer Research Institute (NCRI) Head and Neck Clinical Studies Group initiated a multi-centre survey using questionnaire to investigate the effect on feeding tube practice, radiotherapy (RT) fractionation and volumes, use of chemotherapy in the neo-adjuvant, adjuvant and palliative setting, the use of immunotherapy in the palliative setting, access to radiology and histopathology services, availability of surgical procedures. Results 30 centres were approached across UK; 23 (76.7%) centres responded and were included in the survey. There were differences in the standard practices in feeding tube policy, RT dose and fractionation as well as concurrent chemotherapy use. 21 (91%) participating centres had at least one treatment modification. 15 (65%) centres initiated a change in radical RT; changing to either a hypofractionation or acceleration schedule. For post-operative RT 10 centres (43.5%) changed to a hypofractionation schedule.12 (52.2%) centres stopped neo-adjuvant chemotherapy for all patients; 13 (56.5%) centres followed selective omission of chemotherapy in concurrent chemo-radiotherapy patients, 17 (73.9%) centres changed first-line chemotherapy treatment to pembrolizumab (following NHS England’s interim guidance) and 8 (34.8%) centres stopped the treatment early or offered delays for patients that have been already on systemic treatment. The majority of centres did not have significant changes associated with surgery, radiology, histopathology and dental screening. Conclusion There are variations in the standard of practice and treatment modifications for head and neck cancer patients during Covid-19 pandemic. A timely initiative is required to form a consensus on head and neck cancer management in the UK and other countries.

Effect of treatment interruptions and outcomes in cancer patients undergoing radiotherapy during the first wave of COVID-19 pandemic in a tertiary care institute

“…Manchester et al screened all asymptomatic patients twice a week with RT PCR from April 17, 2020, to May 8, 2020; 139 patients also showed a positivity rate of 0.7% [ 13 ]. Another multicenter survey by Vasiliadou et al on head and neck cancer patients during COVID-19 pandemic revealed that around 52.2% of centers performed pre-treatment swab tests, and about four centers were doing it weekly [ 14 ].…”

Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition

“…871 The standard primary radical RT fractionation used for head and neck cancer patients in the UK currently varies mainly between 70 Gy in 35 fractions over seven weeks and 65 Gy in 30 fractions over six weeks. 873 Radiotherapy should include neck levels IIa, III and IV. Prophylactic irradiation of retropharyngeal nodes also provides effective regional control.…”