Head and neck cancer care in the COVID-19 pandemic: A brief update

Abstract

As the COVID-19 pandemic continues to unfold, guidelines related to the delivery of medical and cancer care are being disseminated in an effort to flatten the curve of transmission while continuing to provide appropriate guideline based care for cancer patients. Head and neck squamous cell carcinoma (HNSCC) is unique in its location in the upper aerodigestive tract, a known location that harbors SARS-Cov2, the causative virus in COVID-19. Otolaryngologists and associated multidisciplinary team members caring for head and neck cancer patients are at heightened risk of transmission through mucus, blood, and aerosolized particles. A high rate of transmission to otolaryngologists has been reported in China, Italy, and Iran, with reports of morbidity and death [1]. The limited availability of COVID-19 testing, personal protective equipment (PPE), disposable medical supplies, hospital and ICU beds, ventilators, and ancillary staff force clinicians to triage which procedures are "essential" and which can be safely delayed. Healthcare providers who contract the virus have generally been mandated to selfquarantine, thereby reducing the availability of the hospital workforce. In the midst of the ongoing pandemic, patients diagnosed with HNSCC now have the added stress in how COVID-19 will impact their care and treatment. The current evidence supports that cancer patients have a higher risk of infection and serious complications from COVID-19 relative to other patient subgroups [2]. Uncertainties such as whether treatment will continue and how these high risk patients will continue to access services, are being addressed as the situation continues to evolve. Patients, physicians, health care workers, health care systems, ethicists, and attorneys among others have become aware of the number of complex dilemmas and issues that have arisen during this pandemic that include but are not limited to the following:

Impact of the first month of Covid-19 lockdown on oncologic surgical activity in the Ile de France region university hospital otorhinolaryngology departments

“…In China, these findings led to guidelines advocating changing certain practices during the epidemic in digestive and lung cancer patients, with 2 main aims in view: to limit high-risk situations such as surgery, and to limit contact, especially with health-care establishments. At the same time, several societies, groups and associations specializing in head and neck cancer surgery put forward various advices [1,[8][9][10][11][12][13][14][15][16][17][18]. The first idea was a form of triage, adapting the interval to surgery according to the potential danger of the cancer.…”

The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020

“…The global COVID-19 pandemic, caused by the novel SARS-CoV-2, has led to over 387,000 deaths worldwide as of June 3rd, 2020 [160]. As a majority of HNCs arise in the mucous membranes of the upper aerodigestive tract, a primary site for SARS-CoV-2 to harbor, the safety of health care providers treating HNC may be jeopardized [161]. Additionally, the effects of COVID-19 on the healthcare system may cause delays in care, from diagnosis to workup to treatment.…”

Head and neck cancer surgery in COVID-19 pandemic in Northern Italy

“…The Coronavirus disease 2019 (COVID-2019) pandemic represents a great challenge both in itself and for time-sensitive diseases [1]. In particular, treatments for cancer patients could not be postponed.…”

“…Surgery for head and neck tumors consists of high risk procedures because surgeons operate on possible locations of SARS-CoV-2, such as the upper respiratory tract. Its mucous membranes could harbor the virus and/or be the entry point of the virus into the human body [1,2]. Therefore, personal protective equipment is mandatory for otorhinolaryngologists and other healthcare workers dealing with head and neck cancer patients.…”