Times to Diagnosis, Staging, and Treatment of Head and Neck Cancer Before and During COVID‐19

Abstract

Objective The coronavirus disease 2019 (COVID-19) pandemic has reduced the demand for, and supply of, head and neck cancer services. This study compares the times to diagnosis, staging, and treatment of head and neck cancers before and during the COVID-19 pandemic. Study Design Retrospective cohort study. Setting Tertiary academic medical center in New York City (NYC). Methods The times to diagnosis, staging, and treatment of head and neck cancer for patients presenting to the clinics of 4 head and neck oncology surgeons with newly diagnosed head and neck cancers were compared between pre–COVID-19 and COVID-19 periods. Results Sixty-eight patients in the pre–COVID-19 period and 26 patients in the COVID-19 period presented with newly diagnosed head and neck cancer. Patients in the COVID-19 group had a significantly longer time to diagnosis than the pre–COVID-19 group after adjustment for age and cancer diagnosis ( P = .02; hazard ratio [HR], 0.54; 95% CI, 0.32-0.92). Patients in the pre–COVID-19 and COVID-19 groups had no statistically significant differences in time to staging ( P > .9; HR, 1.01; 95% CI, 0.58-1.74) or time to treatment ( P = .12; HR, 1.55; 95% CI, 0.89-2.72). Conclusion This study found that time to diagnosis for head and neck cancers was delayed during a COVID-19 period compared to a pre–COVID-19 period. However, there was no evidence of delays in time to staging and time to treatment during the COVID-19 period. Our results prompt further investigations into the factors contributing to diagnostic delays but provide reassurance that despite COVID-19, patients were receiving timely staging and treatment for head and neck cancers.

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

“…In the United States, only a small retrospective cohort study has been published to address time to diagnosis and treatment of head and neck cancer. 14 In this study by Yao et al, time from suspicion of cancer to diagnosis and time from diagnosis to treatment were similar between COVID and pre‐COVID cohorts. Our study corroborates these findings, indicating that concerns regarding potential delays in cancer care during the COVID era have generally not materialized.…”

“…They also found that time from diagnosis to treatment was shorter in the COVID pandemic when compared with pre‐COVID years. In the United States, only a small retrospective cohort study has been published to address time to diagnosis and treatment of head and neck cancer 14 . In this study by Yao et al, time from suspicion of cancer to diagnosis and time from diagnosis to treatment were similar between COVID and pre‐COVID cohorts.…”

COVID-19 and head and neck cancer management. Experience of an oncological hub comprehensive cancer centre and literature review

“…However, an extension of the time to diagnosis was not significant in two studies 8 , 9 , while Yao et al reported a longer time to diagnosis (p = 0.02) but not to staging 11 . Four studies showed a significant increase in tumour size (p = 0.042) 8 and in T stage 9 , 10 , 12 at presentation in the COVID group.…”

“…In 2021, Teveteglu et al reported a significantly higher (p = 0.02) mean time from the beginning of the first symptom to hospital admission in patients treated in 2020 compared to those treated in 2019 10 . Similarly, Yao et al found that patients in the COVID-19 group had a significantly longer time to diagnosis than the pre-COVID-19 group after adjustment for age and cancer diagnosis (p = 0.02; HR, 0.54; 95% CI, 0.32-0.92) 11 .…”

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

“…It must be considered, however, that, although there was no difference in the time between the diagnosis and the start of treatment, the mean time interval veri ed in the present study was high, mainly considering the results of other studies, which demonstrated a mean time of 20 to 28 days between the rst patient visit and initiation of treatment during the COVID-19 period. [10,22] The impact of delayed diagnosis and initiation of HNSCC treatment on patient survival has been studied. [23] Previous studies that investigated the association between the time interval between diagnosis and treatment initiation and the overall survival of patients with HNSCC found that the time elapsed between diagnosis and initiation of treatment independently affects patient survival, increasing the 5-year mortality risk.…”