Ethical surgical triage of patients with head and neck cancer during the <scp>COVID</scp>‐19 pandemic

Civantos, Francisco; Leibowitz, Jason M.; Arnold, David; Stubbs, Vanessa C.; Gross, Jennifer; Thomas, Giovana R.; Sargi, Zoukaa; Casiano, Roy R.; Franzmann, Elizabeth; Weed, Donald T.; Perez, Cesar A.; Samuels, Michael Α.; Goodman, Kenneth W.; Goodwin, W. Jarrard

doi:10.1002/hed.26229

Cited by 22 publications

(47 citation statements)

References 31 publications

(46 reference statements)

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“…With 5000 new cancer diagnoses a day in the United States, 2 delivery of timely cancer care has been challenging in the wake of this pandemic. Many cancer care triaging algorithms have been proposed locally and by national organizations, 3‐5 yet it is unknown how these algorithms have affected outcomes.…”

Section: Introductionmentioning

confidence: 99%

Head and neck surgery during the coronavirus‐19 pandemic: The University of California San Francisco experience

Wai

Lee

et al. 2020

Head & Neck

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Section: Introductionmentioning

confidence: 99%

Head and neck surgery during the coronavirus‐19 pandemic: The University of California San Francisco experience

Wai

Lee

et al. 2020

Head & Neck

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“…Amid the current coronavirus disease 2019 (COVID-19) practice environment, 46 - 53 otolaryngologists have faced the challenge of making diagnoses without the typical reliance on concurrent fiberoptic exam. During telehealth encounters, we often need to proceed with medical decisions based on described symptoms and histories.…”

Section: Discussionmentioning

confidence: 99%

The Sinonasal Outcome Test–22 or European Position Paper: Which Is More Indicative of Imaging Results?

Zhou

Prince

Maxfield

et al. 2020

Otolaryngol.--head neck surg.

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Objective The 22-item Sinonasal Outcome Test (SNOT-22) is a trusted measure of symptom severity in chronic rhinosinusitis. The European Position Paper on Rhinosinusitis (EPOS) provides widely accepted diagnostic criteria, which include sinonasal symptoms, their duration, and imaging results. Our objective was to compare these approaches to assessing symptoms to determine if either was more indicative of radiologic findings, to support decisions in telehealth. Study Design Observational outcomes study. Setting Tertiary care center. Methods In total, 162 consecutive patients provided a structured sinonasal history, completed the SNOT-22, and underwent sinus computed tomography (CT) within 1 month. SNOT-22 scores, EPOS-defined symptom sets, and Lund-Mackay results were assessed. To facilitate direct comparisons, we performed stepwise evaluations of sinonasal symptoms alone and combined with duration. The discriminatory capacity for imaging results was determined through areas under the receiver operating characteristic curves (ROC-AUC) for dichotomous outcomes and ordinal regression for multilevel outcomes. Results In ROC-AUC analyses, SNOT-22 and EPOS-defined symptoms had similar discriminatory capacity for Lund-Mackay scores, regardless of duration. Within ordinal regression analyses, SNOT-22 nasal scores were significantly associated with Lund-Mackay scores, while EPOS-defined nasal symptoms were not statistically significantly related. Conclusions SNOT-22 nasal scores and EPOS-defined nasal symptoms may have similar associations with imaging results when assessed via ROC-AUC, while SNOT-22 may have more association within ordinal data. Understanding the implications of discrete patterns of symptoms may confer benefit, particularly when in-person and fiberoptic exams are limited.

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“…This is in contrast to the traditional paradigm and recent COVID-19 guidelines recommending MDT involvement only in cases of uncertainty regarding optimal management. 22,23 Virtual MDT meetings during the COVID-19 era have allowed providers as far as 200 miles away to participate. 24 Patients are often requested to meet face-to-face with the MDT following the tumor board to discuss their treatment options.…”

Section: Patient-centric Multidisciplinary Care Of Head and Neck Cancermentioning

confidence: 99%

Time for a Paradigm Shift in Head and Neck Cancer Management During the COVID‐19 Pandemic

Han

Miller

Long

et al. 2020

Otolaryngol.--head neck surg.

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Objective The coronavirus disease 2019 (COVID-19) pandemic has caused physicians and surgeons to consider restructuring traditional cancer management paradigms. We aim to review the current evidence regarding the diagnosis and management of head and neck cancer, with an emphasis on the role of the multidisciplinary team (MDT) during a pandemic. Data Sources COVID-19 resources from PubMed, Google Scholar, the American Academy of Otolaryngology–Head and Neck Surgery, and the American Head and Neck Society were examined. Review Methods Studies and guidelines related to the multidisciplinary management of head and neck cancer in the COVID-19 setting were reviewed. A total of 54 studies were included. Given the continuously evolving body of literature, the sources cited include the latest statements from medical and dental societies. Results The unpredictable fluctuation of hospital resources and the risk of the nosocomial spread of SARS-CoV-2 have direct effects on head and neck cancer management. Using an MDT approach to help define “essential surgery” for immediately life- or function-threatening disease processes in the context of available hospital resources will help to maximize outcomes. Early enrollment in an MDT is often critical for considering nonsurgical options to protect patients and health care workers. The role of the MDT continues after cancer treatment, if delivered, and the MDT plays an essential role in surveillance and survivorship programs in these challenging times. Conclusion Head and neck cancer management during the COVID-19 pandemic poses a unique challenge for all specialists involved. Early MDT involvement is important to maximize patient outcomes and satisfaction in the context of public and community safety.

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Ethical surgical triage of patients with head and neck cancer during the COVID‐19 pandemic

Cited by 22 publications

References 31 publications

Head and neck surgery during the coronavirus‐19 pandemic: The University of California San Francisco experience

Head and neck surgery during the coronavirus‐19 pandemic: The University of California San Francisco experience

The Sinonasal Outcome Test–22 or European Position Paper: Which Is More Indicative of Imaging Results?

Time for a Paradigm Shift in Head and Neck Cancer Management During the COVID‐19 Pandemic

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