Follow-up arrangements in head and neck cancer clinics during the COVID-19 pandemic: results from two tertiary UK head and neck cancer centres

Abstract

Introduction The aim of this paper is to report the pattern of follow-up that occurred for a cohort of head and neck cancer (HNC) patients across two large centres in the UK (Aintree and Leeds), as a consequence of the COVID-19 pandemic. Methods Patients had been treated for HNC with curative intent between April 2017 and October 2019 by 14 oral and maxillofacial (OMFS) and ear nose and throat (ENT) oncology surgeons in the Patient Concerns Inventory intervention trial. In October 2020, hospital records were reviewed, and information collected on the timing and mode (face-to-face/telephone/video) of follow-up consultations. In addition, recurrence, second primary tumours and deaths were recorded. Results At the start of ‘lockdown’, 212 members of the cohort were known to be alive. During the post-lockdown period (follow-up appointment data comprised 5 months in Aintree and 7 months in Leeds) 7 died and 13 were identified as palliative/recurrence/new primary/metastases (‘new event’). In Aintree, the first ENT/OMFS consultations after lockdown were 51 (67%) telephone and 25 (33%) face-to-face appointments. In Leeds, 46 (78%) consultations were by telephone and 13 (22%) were face-to-face. The second ENT/OMFS consultations post lockdown included 11 (44%) telephone and 14 (56%) face-to-face in Aintree, and 21 (75%) telephone and 7 (25%) face-to-face in Leeds. Conclusions These data suggest that clinicians favoured remote consultations. Variations in practice were observed but reached a point of a ‘hybrid follow-up approach’ that included both face-to-face and remote consultations. With the emergence of telemedicine, clinicians may consider a follow-up model tailored to risk stratification. The development of the mode of such a consultation model needs further evaluation.

Telehealth adoption in cancer clinical trials: An Australian perspective

“…From these themes, our research team developed a list of action- Our results are consistent with other published studies, which have emphasized the importance of integrating telehealth into trials on a case-by-case basis-according to patient needs and trial protocol. 37,38 Telehealth in such instances was widely reported as being used as a follow-up approach and for patient monitoring (symptom management, medication changes, and adherence) via videoconferencing and/or telephone. 33,37,38 Parallel to our findings, studies regarding rare cancer trials found telehealth was mostly employed in the followup arm of trials, as preliminary interventions were invasive, protocol driven, and required physical examination.…”

“…37,38 Telehealth in such instances was widely reported as being used as a follow-up approach and for patient monitoring (symptom management, medication changes, and adherence) via videoconferencing and/or telephone. 33,37,38 Parallel to our findings, studies regarding rare cancer trials found telehealth was mostly employed in the followup arm of trials, as preliminary interventions were invasive, protocol driven, and required physical examination. 17,34 Telehealth was also perceived as more successful for behavioral interventions, and considered unsuitable for radiotherapy interventions, new diagnoses, and end-of-life discussions.…”