The impact of COVID‐19 on presentation and diagnosis of head and neck squamous cell carcinoma

Abstract

Objective To analyze how the COVID‐19 pandemic has influenced trends in head and neck squamous cell carcinoma (HNSCC) presentation and diagnosis—including referral patterns, stage at presentation, and time to diagnosis—over a longitudinal time course. Setting Multicenter tertiary care academic institution. Methods A retrospective review of patients with HNSCC presenting between January 1, 2019 and December 31, 2020 was performed. Patients were stratified into pre‐COVID and COVID cohorts based upon presentation date either before or after the COVID pandemic was declared a national emergency. Data was collected on demographics, referral site, symptoms, tumor characteristics, and time to diagnosis. Results Of 203 patients with HNSCC identified, 77.3% (157/203) were in the pre‐COVID cohort and 22.7% (46/203) were in the COVID cohort. Patients in the COVID cohort were more likely to present through inpatient or ER consultation (26% vs. 11%) than outpatient setting. There was a greater than 50% decrease in new tumor board case presentations per month in the COVID cohort (4.8) relative to the pre‐COVID (10.9) cohort. Cancer stage at presentation was similar between cohorts. Time from presentation to diagnosis was similar between the cohorts at approximately 30 days. Conclusions These results suggest that patients presenting during the COVID pandemic may have unique referral patterns. A significant decrease in tumor board presentations was noted, which may contribute to more delayed presentations that have yet to be observed. Further investigation with a larger sample size is warranted. Lay Summary The COVID‐19 pandemic may have changed where and how patients with head and neck cancer initially seek care. We found that patients with newly diagnosed head and neck cancer more often were initially seen in urgent settings than before the pandemic. Level of Evidence 3

Title: Impact of the COVID-19 pandemic on the severity of newly diagnosed cases of head and neck squamous cell carcinoma in southern Brazil

“…[19] Different from these results, other studies that evaluated the impact of the COVID-19 pandemic on the diagnosis of new cases of HNSCC demonstrated a reduction from 22% to more than 50% of new diagnoses during the pandemic, but the stage of the disease and the time of diagnosis were similar in the groups before and during the pandemic. [9,20] This suggests that, in our study, although the number of patients who received the diagnosis in both groups was similar, in the COVID-19 group, patients must have taken longer to seek care after the onset of the rst signs and/or symptoms, which may have impacted on the delay in diagnosis, and, consequently, the cases, when they were diagnosed, already had greater lymph node involvement.…”

“…[6][7][8] The restrictions imposed by the COVID-19 pandemic also had an impact on reducing the number of new diagnoses of head and neck cancer. [9,10] With the social distancing measures adopted to control the spread of the COVID-19 pandemic in Brazil, it is believed that, as in other countries, many patients stopped seeking care to evaluate head and neck injuries, resulting in a delay in the diagnosis and, consequently, a worse prognosis for the patient. [11] There is little evidence on the impact of COVID-19 on the diagnosis and extent of head and neck cancer in low-income countries, especially considering confounding variables.…”

Head and Neck Cancer Incidence in the United States Before and During the COVID-19 Pandemic

“…The COVID-19 pandemic affected both the diagnosis and treatment of many cancer sites, including HNC . Several studies have reported disparities associated with access to care during the COVID-19 pandemic, which may have affected stage at presentation and survival outcomes of patients with cancer, especially among individuals with limited access to care .…”

“…[4][5][6] The COVID-19 pandemic affected both the diagnosis and treatment of many cancer sites, including HNC . [7][8][9] Several studies have reported disparities associated with access to care dur-ing the COVID-19 pandemic, which may have affected stage at presentation and survival outcomes of patients with cancer, especially among individuals with limited access to care. [10][11][12] However, although studies have described the epidemiology and outcomes of HNC associated with the COVID-19 pandemic, the generalizability of these studies to the HNC population in the US has been limited, as most have been either from a single institution, aggregated data from multiple institutions, or studies with data outside of the US.…”

“…[10][11][12] However, although studies have described the epidemiology and outcomes of HNC associated with the COVID-19 pandemic, the generalizability of these studies to the HNC population in the US has been limited, as most have been either from a single institution, aggregated data from multiple institutions, or studies with data outside of the US. 7,9,[13][14][15][16][17][18][19] Thus, because of the lack of population-based data, whether or to what extent the COVID-19 pandemic affected diagnoses of HNC in the US is unclear. Also, the understanding of population-based changes in the stage of presentation of HNC during the COVID-19 pandemic is limited.…”