Impact of the COVID‐19 Pandemic on the Management of Head and Neck Malignancies

Werner, Matthew E.; Carey, Ryan M.; Albergotti, William Greer; Lukens, John N.; Brody, Robert M.

doi:10.1177/0194599820921413

Cited by 46 publications

(58 citation statements)

References 7 publications

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“…These risks must be balanced with the risk of cancer progression by delaying therapy as well as the psychological impact on patients of delayed or altered plans of care. [10][11][12] It has been established in the literature that increases in the duration of time between diagnosis and definitive therapy is associated with decreased overall and disease-free survival. 7,8 In addition, delays in surgery may result in increased morbidity due to disease progression necessitating more extensive tumor resection.…”

Section: Accepted Articlementioning

confidence: 99%

Changes in head and neck oncologic practice during the COVID‐19 pandemic

et al. 2020

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Introduction: The COVID-19 pandemic has raised controversies regarding safe and effective care of head and neck cancer patients. It is unknown how much the pandemic has changed surgeon practice.Methods: A questionnaire was distributed to head and neck surgeons assessing opinions related to treatment and concerns for the safety of patients, self, family, and staff.Results: A total of 67 head and neck surgeons responded during the study period. Surgeons continued to recommend primary surgical treatment for oral cavity cancers. Respondents were more likely to consider non-surgical therapy for patients with early glottic cancers and HPVmediated oropharynx cancer. Surgeons were least likely to be concerned for their own health and safety and had the greatest concern for their resident trainees.Conclusions: This study highlights differences in the willingness of head and neck surgeons to delay surgery or alter plans during times when hospital resources are scarce and risk is high.

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Section: Accepted Articlementioning

confidence: 99%

Changes in head and neck oncologic practice during the COVID‐19 pandemic

et al. 2020

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“…Recently, Werner et al suggested that low-grade cancers of the head and neck could potentially be delayed by 1-3 months, as the benefit of minimizing SARS-Cov-2 transmission and preserving PPE may outweigh delay in diagnosis and treatment. 11 The authors also suggested consideration of alternatives to surgery, such as chemoradiation for human papillomavirus-positive oropharyngeal cancers, to prevent aerosolization. In our case, the patient had imminent airway compromise and did not yet have tissue diagnosis of his transglottic mass.…”

Section: Discussionmentioning

confidence: 99%

Surgical Considerations for an Awake Tracheotomy During the COVID-19 Pandemic

Crossley

Clark

Brody³

et al. 2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: The current global COVID-19 pandemic is caused by the novel coronavirus Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Given that SARS-CoV-2 is highly transmissible, surgical societies have recommended that procedures with a high risk of aerosolization be avoided or delayed. However, some high-risk procedures, such as those related to head and neck malignancies, cannot always be delayed. Care must be taken during aerosol-generating procedures to minimize viral transmission as much as possible. Preoperative testing for COVID-19, limited operating room personnel, adequate personal protective equipment, and surgical technique are factors to consider for high-risk procedures. Methods: This article presents the case of an awake tracheotomy performed for a transglottic mass causing airway obstruction. Results: With detailed planning and specific techniques, the amount of aerosolization was reduced, and the procedure was performed as safely as possible. Conclusion: This case provides a template for future aerosol-generating procedures during respiratory pandemics.

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“…32,46,47 Tracheostomy increases risk of aerosolization because of the shorter distance from the high-viral density alveolar surface to the stoma. 3 The amount of care that patients with a tracheostomy require increases the duration of exposure, and accumulation of secretions around the stoma places clinicians at close contact with infected fluids, increasing risk of transmission. 4,48 Precautions must be taken to prevent exposure to aerosolized particles by streamlining care and increasing efficiency via timeouts and checklists ( Table 2).…”

Section: Aerosol-generating Proceduresmentioning

confidence: 99%

Multidisciplinary Safety Recommendations After Tracheostomy During COVID‐19 Pandemic: State of the Art Review

Meister

Pandian

Hillel

et al. 2020

Otolaryngol.--head neck surg.

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Objective In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. Data Sources PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents. Review Methods Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. Conclusions Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel. Implications for Practice Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.

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Impact of the COVID‐19 Pandemic on the Management of Head and Neck Malignancies

Cited by 46 publications

References 7 publications

Changes in head and neck oncologic practice during the COVID‐19 pandemic

Changes in head and neck oncologic practice during the COVID‐19 pandemic

Surgical Considerations for an Awake Tracheotomy During the COVID-19 Pandemic

Multidisciplinary Safety Recommendations After Tracheostomy During COVID‐19 Pandemic: State of the Art Review

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