Impact of COVID-19 on Head and Neck Cancer Advancement Measured by Increasing Numbers of Urgent Dyspnea Cases—What Could Be Improved in the Event of Subsequent Pandemics?

Abstract

The COVID-19 pandemic has altered all aspects of the healthcare system’s organization and impacted patients with head and neck cancer (HNC) who have experienced delayed diagnosis and treatment. The pandemic resulted in the admission of patients with severe dyspnea and a need for tracheotomy due to extremely advanced HNC. This study’s objective was to evaluate the clinical characteristics of two multi-center cohorts, “pre-COVID-19” and “COVID-19”, of HNC patients admitted as emergencies for dyspnea. The therapeutic activity of HNC patients in four University Departments of Otolaryngology was studied over two time periods: September–February 2019/2020 and 2020/2021. A group of 136 HNC patients who underwent a tracheotomy in two-time cohorts, pre-COVID-19 (N = 59) and COVID-19 (N = 77), was analyzed. The mean tracheotomies incidence proportion was 1.82 (SD: 1.12) for the pre-COVID-19 and 3.79 (SD: 2.76) for COVID-19 period. A rise in the occurrence of emergency dyspnea was observed in the COVID-19 cohort, and the greatest increase was seen in the centers with the highest limitations on planned surgeries. In the pre-COVID-19 period, 66% of patients presented with symptoms for more than a month in comparison to 78% of patients in the COVID-19 period (p = 0.04). There was a higher incidence of laryngeal and laryngopharyngeal cancer in the COVID-19 period (63% vs. 75%, respectively). The number of tracheotomies performed under general anesthesia dropped in favor of local anesthesia during COVID-19 (64% vs. 56%, respectively) due to extremely advanced HNC. In the COVID-19 cohort, most patients received a telemedicine consultation (N = 55, 71%) in comparison to the pre-COVID-19 period (N = 14, 24%). Reorganization of the referral system, adjustment of treatment capacity for an increased number of HNC, and a reserve for more extensive resection and reconstruction surgeries should be made in the profile of otorhinolaryngological departments, ensuring future HNC treatment is not hampered in case of a new pandemic wave.

Stage shift and relative survival for head and neck cancer during the 2020 COVID-19 pandemic: a population-based study of temporal trends

“…Delayed diagnosis of HNC is particularly concerning given that these tumors can double in volume and show nodal progression in as little as one month ( 5 ). Single- and multi-center studies from around the world have reported increases in more advanced HNC stage, tumor size, node involvement and/or metastatic disease among these patients as well as increases in emergency presentation during the COVID-19 pandemic ( 6 – 12 ). Population-based analyses have found conflicting results.…”

Risk Factors for Transient Hypoparathyroidism after Total Thyroidectomy: Insights from a Cohort Analysis

“…Furthermore, the short duration of the study (three years) allowed for uniformity in the main patient evaluation criteria. The sample size was also negatively affected by its significant overlap with the pandemic period, during which strict limitations were placed on the performance of non-urgent surgical procedures [ 34 ], despite the fact that these choices led to a general worsening of disease stages, particularly in neoplastic diseases [ 35 ]. Nevertheless, we believe that limiting the study to the evaluation of only TH, excluding the definitive form, allowed us to analyze a complication that has unique characteristics and causative mechanisms, which we thus aimed to emphasize.…”

Treatment Patterns and Outcomes of Patients with Grade 4 Glioma Treated with Radiation during the COVID-19 Pandemic

“…The COVID-19 pandemic caused significant strain on healthcare resources globally and influenced the care of all patients, including those with cancer [ 13 , 14 , 15 ]. In the field of neuro-oncology, numerous guidelines recommended the prioritization of high-grade gliomas in the face of potential severe strains on neurosurgical resources and recommended appropriate adjuvant therapy while trying to minimize the risk of COVID for both patients and healthcare providers [ 7 , 16 ].…”

“…Similar trends were observed for patients with other cancers during the COVID pandemic. One study reported a substantial increase in breast cancer patients presenting at an advanced stage compared to a pre-pandemic cohort in Brazil [ 17 ], while another showed increased morbidity from larger tumor size in patients with head and neck cancers [ 15 ]. These trends are thought to represent a delay in presentation to hospitals during COVID, perhaps due to fear of contracting COVID or general recommendations to avoid hospital visits when possible [ 18 ].…”