Head and neck oncological ablation and reconstruction in the COVID-19 era – our experience to date

Abstract

The COVID-19 pandemic has caused unprecedented disruption to the routine operations of healthcare services across the world. As the potential duration of the pandemic remains uncertain, the need to develop strategies to continue urgent elective services has received increasing attention. A solution adopted in the Kent, Sussex and Surrey area of England has been to create COVID-19-protected cancer hubs. The Queen Victoria Hospital is the designated hub for head and neck cancer services in the area. We report on the evolution of the head and neck cancer care pathway and standard operating protocols put in place and how these have combined both national guidelines and local problem solving. It is hoped that our experience can help guide other centres as they re-establish head and neck cancer services during the ongoing pandemic.

The Effects of COVID-19 on Cancer Care Provision: A Systematic Review

“…Testing played a huge role in various studies, with many hospitals enabling patient screening for COVID-19 symptoms upon hospital entry or pre-operatively. 3 , 7 - 38 This involved recording body temperature, checking respiratory symptoms, and taking blood tests and nasal swabs. 3 , 10 , 11 , 22 , 33 , 34 , 36 , 39 If the tests results were positive, patients were either disallowed treatment, asked to isolate/quarantine or were directed to COVID-19 outpatient clinics/admitted in to dedicated COVID-19 wards.…”

“…Many studies reported the use of telehealth through videoconferencing, telephone, email, mobile phone apps and text message as a means to monitor and counsel patients. 3 , 7 - 8 , 11 - 12 , 15 - 19 , 20 - 22 , 24 , 29 , 30 , 33 - 37 , 39 - 41 , 43 , 45 , 46 , 48 - 65 , 78 This included screening, symptom checking and side effect monitoring and outpatient care. 8 , 22 , 29 , 39 , 45 , 52 - 54 These modalities of communication were significant in enabling better evaluation and follow-up of patients, as well as facilitating patient triaging and contact tracing.…”

“…This large-scale surveillance system was informative for high-risk patients as they could make the decision to shield themselves if residing in a high-risk area. 43 The benefits of tracking were also evident in a study conducted by Ning et al who reported that active tracking reduced adverse effects that can occur from treatment delay and workforce incapacitation 46 (2) Outreach and Communication One of the most prominent strategies to ensure the maintenance of care continuity was regular communication between 77 P Brody et al 38 P P Butler et al 19 P P P P P P Casella et al 11 P P P P P P Chiang et al 14 P P P P P P Cinelli et al 53 P P Civantos et al 9 P P Civantos et al 49 P P P Collins et al 17 P P P P Curigliano et al 55 P P P Czernin et al 36 P P P P P de Marinis et al 39 P P P P Dharmarajan et al 51 P Elkaddoum et al 59 P P P Elkin et al 31 P Flannigan et al 57 P P Fosker 26 P P Frey et al 66 P Giuliani et al 58 P Gupta et al 48 P P P Grenda et al 54 P P Guven et al 12 P P P P Harky et al 61 P P P Indini et al 33 P P P P P P Jiang et al 60 P P Lee et al 15 P P P P P Lee et al 27 P P Lee et al 47 P P P Lobascio et al 56 P P Lombe et al 68 P P P Mei et al 21 P P P P P P Mendoza et al 23 P P P Millar et al 65 P Mirnezami et al 73 P P Morrison et al 69 P P Moss et al 32 P Mulvey et al 62 P...…”

“…40 Similar practice has been adopted in the UK, where doctors have openly educated patients on COVID-19 related risks before and during surgical treatment. 19 Videoconferencing was also frequently utilized between healthcare staff and multidisciplinary teams in order to streamline healthcare provision, continue staff training and maintain timely diagnosis and treatment. 7,11,17,19,30,33,35,36,40,41,45,49,51 Silvestris et al 35 P P P P P Tagliamento et al 25 P P Tan et al 7 P P P P P Tey et al 10 P P P P Valenza et al 37 P P P P Van de Haar et al 3 P P P P P van der Lee et al 64 P Vanderpuye et al 40 P P P P P Wahed et a 28 P P P Wang et al 34 P P P P P Wakefield et al 20 P P P P Wei et al 71 P Weisel et al 8 P P P P P Wilkinson 42 P P P P P Wilson 30 P P P P P Wu et al 44 P P P P Yusuf 13 P P P P P Agyapong et al 52 Report Canada 1.…”

“…Surgeons were willing to change their standard practice and recommend radiotherapy instead of surgery 3. Most surgeons were not willing to delay treatment beyond 4-6 weeks (Due to known risk of mortality/morbidity resulting from treatment delays) Butler et al 19 Article Patient education sessions were given on exercising, nutritional and psychological support. Extra attention was given to identity those who demonstrate signs of depression from isolation 3.…”