Total Laryngectomy Volume During the COVID-19 Pandemic

Noel, Christopher W.; Li, Qing; Sutradhar, Rinku; Eskander, Antoine

doi:10.1001/jamaoto.2021.2019

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…In the secondary analysis of patients eligible for recruitment in an ongoing study, there was no evidence of an increase in diagnoses at advanced stage in the periods following the first pandemic wave. This is in line with a recent finding of no increased total laryngectomy volume, reserved for advanced cases, during the COVID-19 pandemic ( 30 ). Although these findings indicate no evident stage migration, it should be considered that the 10-month period after the start of the pandemic may still be limited to observe any change in the distribution of stages at diagnosis.…”

Section: Discussionsupporting

confidence: 92%

“…Several previous studies that reported COVID-19-related reductions in HNC admissions and diagnoses ( 12 – 16 , 31 , 32 ) were hospital-based studies, conducted on a relatively limited population, focused on the first pandemic wave only, and did not account for temporal trends in HNC detection. The reported reductions in HNC referrals and diagnoses in the first pandemic months varied from 12% to up to 60% in different contexts and populations ( 13 , 15 , 16 , 30 , 31 ). In this study, accounting for temporal trends over a relatively long period and seasonal (likely holiday-related) fluctuations in HNC admissions, we found a decline of 28% in incident HNC admissions during the first pandemic wave, which was almost completely recovered in 2020.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis

Popović

Fiano

Moirano

et al. 2022

Front. Public Health

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BackgroundThe COVID-19 pandemic has likely affected the most vulnerable groups of patients and those requiring time-critical access to healthcare services, such as patients with cancer. The aim of this study was to use time trend data to assess the impact of COVID-19 on timely diagnosis and treatment of head and neck cancer (HNC) in the Italian Piedmont region.MethodsThis study was based on two different data sources. First, regional hospital discharge register data were used to identify incident HNC in patients ≥18 years old during the period from January 1, 2015, to December 31, 2020. Interrupted time-series analysis was used to model the long-time trends in monthly incident HNC before COVID-19 while accounting for holiday-related seasonal fluctuations in the HNC admissions. Second, in a population of incident HNC patients eligible for recruitment in an ongoing clinical cohort study (HEADSpAcE) that started before the COVID-19 pandemic, we compared the distribution of early-stage and late-stage diagnoses between the pre-COVID-19 and the COVID-19 period.ResultsThere were 4,811 incident HNC admissions in the 5-year period before the COVID-19 outbreak and 832 admissions in 2020, of which 689 occurred after the COVID-19 outbreak in Italy. An initial reduction of 28% in admissions during the first wave of the COVID-19 pandemic (RR 0.72, 95% CI 0.62–0.84) was largely addressed by the end of 2020 (RR 0.96, 95% CI 0.89–1.03) when considering the whole population, although there were some heterogeneities. The gap between observed and expected admissions was particularly evident and had not completely recovered by the end of the year in older (≥75 years) patients (RR: 0.88, 0.76–1.01), patients with a Romano-Charlson comorbidity index below 2 (RR 0.91, 95% CI: 0.84–1.00), and primary surgically treated patients (RR 0.88, 95% CI 0.80–0.97). In the subgroup of patients eligible for the ongoing active recruitment, we observed no evidence of a shift toward a more advanced stage at diagnosis in the periods following the first pandemic wave.ConclusionsThe COVID-19 pandemic has affected differentially the management of certain groups of incident HNC patients, with more pronounced impact on older patients, those treated primarily surgically, and those with less comorbidities. The missed and delayed diagnoses may translate into worser oncological outcomes in these patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis

Popović

Fiano

Moirano

et al. 2022

Front. Public Health

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“…This highlights how much breast cancer diagnosis relies on screening programmes which have suffered badly as a result of the pandemic in England36 and internationally 39. In England, head and neck cancers (HNC) saw a 10.2% (95% CI 7.6% to 12.7%) reduction in diagnosis, while studies in other geographies showed wide differences in the measures’ impact of the pandemic on HNC: a study in Ontario, Canada, found no evidence of a reduction in HNC diagnosis following an initial drop in the 6 weeks following lockdown,40 a clinic in Italy had just a 3.7% reduction in HNC,41 a 14% reduction in Belgium,29 a clinic in California showed a 22% reduction42 and a Cancer Centre in the North of England reported a 33% reduction in HNC cases 43. There is further international evidence of the impact of COVID-19 on interventions down the pathway, with reductions in radical cancer surgeries in two major cancer hubs in England and Italy 44…”

Section: Discussionmentioning

confidence: 99%

Primary care and cancer: an analysis of the impact and inequalities of the COVID-19 pandemic on patient pathways

2022

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ObjectivesWe explore the routes to cancer diagnosis to further undertanding of the inequality in the reduction in detection of new cancers since the start of the pandemic. We use different data sets to assess stages in the cancer pathway: primary care data for primary care consultations, routine and urgent referrals and published analysis of cancer registry data for appointments and first treatments.SettingPrimary and cancer care.ParticipantsIn this study we combine multiple data sets to perform a population-based cohort study on different areas of the cancer pathway. For primary care analysis, we use a random sample of 5 00 000 patients from the Clinical Practice Research Datalink. Postreferral we perform a secondary data analysis on the Cancer Wait Times data and the National Cancer Registry Analysis Service COVID-19 data equity pack.Outcome measuresPrimary care: consultation, urgent cancer referral and routine referral rates, then appointments following an urgent cancer referral, and first treatments for new cancer, for all and by quintile of patient’s local area index of multiple deprivation.ResultsPrimary care contacts and urgent cancer referrals in England fell by 11.6% (95% CI 11.4% to 11.7%) and 20.2% (95% CI 18.1% to 22.3%) respectively between the start of the first non-pharmaceutical intervention in March 2020 and the end of January 2021, while routine referrals had not recovered to prepandemic levels. Reductions in first treatments for newly diagnosed cancers are down 16.3% (95% CI 15.9% to 16.6%). The reduction in the number of 2-week wait referrals and first treatments for all cancer has been largest for those living in poorer areas, despite having a smaller reduction in primary care contact.ConclusionsOur results further evidence the strain on primary care and the presence of the inverse care law, and the dire need to address the inequalities so sharply brought into focus by the pandemic. We need to address the disconnect between the importance we place on the role of primary care and the resources we devote to it.

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An Artificial Intelligence-Based Algorithm for the Assessment of Substitution Voicing

et al. 2022

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The purpose of this research was to develop an artificial intelligence-based method for evaluating substitution voicing (SV) and speech following laryngeal oncosurgery. Convolutional neural networks were used to analyze spoken audio sources. A Mel-frequency spectrogram was employed as input to the deep neural network architecture. The program was trained using a collection of 309 digitized speech recordings. The acoustic substitution voicing index (ASVI) model was elaborated using regression analysis. This model was then tested with speech samples that were unknown to the algorithm, and the results were compared to the auditory-perceptual SV evaluation provided by the medical professionals. A statistically significant, strong correlation with rs = 0.863 (p = 0.001) was observed between the ASVI and the SV evaluation performed by the trained laryngologists. The one-way ANOVA showed statistically significant ASVI differences in control, cordectomy, partial laryngectomy, and total laryngectomy patient groups (p < 0.001). The elaborated lightweight ASVI algorithm reached rapid response rates of 3.56 ms. The ASVI provides a fast and efficient option for SV and speech in patients after laryngeal oncosurgery. The ASVI results are comparable to the auditory-perceptual SV evaluation performed by medical professionals.

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Total Laryngectomy Volume During the COVID-19 Pandemic

Abstract: 4.Graboyes EM, Halbert CH, Li H, et al. Barriers to the delivery of timely, guideline-adherent adjuvant therapy among patients with head and neck cancer.

Cited by 4 publications

References 9 publications

The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis

The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis

Primary care and cancer: an analysis of the impact and inequalities of the COVID-19 pandemic on patient pathways

An Artificial Intelligence-Based Algorithm for the Assessment of Substitution Voicing

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