Ethical Dilemmas in the Management of Head and Neck Cancers in the Era of the COVID-19 Pandemic

Abstract

Coronavirus disease 2019 (COVID-19) has emerged as an unforeseen challenge for head and neck cancer care providers. A similar challenge is also faced by other oncological fields, but the severity of this challenge is highest in otolaryngology because of the need for additional precautionary measures and curbs on the possibility of aerosol forming interventions related to the upper aerodigestive tract. In this narrative review, provision of ethical and consistent care on moral and professional grounds to head and neck cancer patients during the pandemic are discussed for professionals who provide head and neck oncology care.

Social, Ethical and Treatment Related Problems Faced by Healthcare Workers in the Care of Head and Neck Cancer Patients: A Narrative Review from the Bioethics Consortium from India

“…The outbreak of coronavirus pandemic [COVID-19] was an unanticipated issue and presented severe dilemmas for healthcare specialities across the streams but with more severity to otolaryngology and oncologists [ 82 – 85 ]. The COVID-19 virus was a major problem for the medical professionals caring for patients with HNC principally because of the need for extra safety measures and to limit the possibility of aerosol-forming procedures like while doing biopsies, endoscopic examination and surgery involving the upper aerodigestive tract safeguarding the patient, the medical team, and the community from COVID-19 [ 84 , 85 ].…”

“…In the early days of Covid, all surgical interventions were put on hold and alternative modalities like radiation and chemotherapy was preferred [ 84 , 85 ]. The delays in diagnosis, surveillance or treatment all had serious implications thereby affecting prognosis and survival [ 82 – 85 ].…”

“…During Covid pandemics “Public Health Ethics” superseded the “Clinical Ethics” and emphasis was predominately on safety of the population than individuals [ 86 ]. For professionals who cared for HNC, to observe and accept this paradigm change was challenging and dilemmatic [ 82 – 85 ]. Also unlike in the past, lack of accessibility (due to lock down), healthcare or financial resources had a major role in preventing the patients choose the course of care and physicians at providing them and this discrepancy was severe in the developing countries [ 82 – 85 ].…”

“…The Covid pandemic presented an extra layer of difficulty for both people affected with cancer and for cancer healthcare professionals. The total block on transportation and shutdown impacted patients from reaching for hospital services [ 82 – 85 ]. During peak pandemics, to accommodate COVID-19-related situations, oncological treatments had to be requisitioned at numerous general and medical college hospitals, and complex medical operations had to be scaled back [ 82 , 83 ].…”

“…The total block on transportation and shutdown impacted patients from reaching for hospital services [ 82 – 85 ]. During peak pandemics, to accommodate COVID-19-related situations, oncological treatments had to be requisitioned at numerous general and medical college hospitals, and complex medical operations had to be scaled back [ 82 , 83 ]. All these events impacted cancer patients the most, and the interruption of care combined with delaying the start of treatment and its continuance led to rapid progression and accelerated death from cancer.…”