ABSTRACT
PURPOSE: The coronavirus pandemic has redefined the practice of head and neck surgeons in the management of oncology patients. Several countries have issued practice recommendations in that context. This review is a collaboration of the YO-IFOS (Young Otolaryngologists of the International Federation of Otolaryngological Societies) group in order to summarize, in a systematic way, all available guidelines and provide clear guidelines for the management of head and neck cancer patients in the COVID-19 pandemic. METHODS: This systematic review was performed according to the PRISMA statements. Inclusion criteria for the systematic review were based on the population, intervention, comparison, and outcomes according to (PICO) framework. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to assess quality of all practice guidelines included in this review. RESULTS: Recommendations include adjustments regarding new patients' referral such as performing a pre-appointment triage and working in telemedicine when possible. Surgical prioritization must be adjusted in order to respect pandemic requirements. High-grade malignancies should, howeve,r not be delayed, due to potential serious consequences. Many head and neck interventions being aerosol-generating procedures, COVID-19 testing prior to a surgery and adequate PPE precautions are essential in operating rooms. CONCLUSION: These recommendations for head and neck oncology patients serve as a guide for physicians in the pandemic. Adjustments and updates are necessary as the pandemic evolves.
Subject(s)
COVID-19 , Head and Neck Neoplasms , COVID-19 Testing , Head and Neck Neoplasms/therapy , Humans , Pandemics , SARS-CoV-2ABSTRACT
PURPOSE: SARS-CoV-2 vaccines are a key step in fighting the pandemic. Nevertheless, their rapid development did not allow for testing among specific population subgroups such as pregnant and breastfeeding women, or elaborating specific guidelines for healthcare personnel working in high infection risk specialties, such as otolaryngology (ORL). This clinical consensus statement (CCS) aims to offer guidance for SARS-CoV-2 vaccination to this high-risk population based on the best evidence available. METHODS: A multidisciplinary international panel of 33 specialists judged statements through a two-round modified Delphi method survey. Statements were designed to encompass the following topics: risk of SARS-Cov-2 infection and use of protective equipment in ORL; SARS-Cov-2 infection and vaccines and respective risks for the mother/child dyad; and counseling for SARS-CoV-2 vaccination in pregnant, breastfeeding, or fertile healthcare workers (PBFHW). All ORL PBFHW were considered as the target audience. RESULTS: Of the 13 statements, 7 reached consensus or strong consensus, 2 reached no consensus, and 2 reached near-consensus. According to the statements with strong consensus otorhinolaryngologists-head and neck surgeons who are pregnant, breastfeeding, or with childbearing potential should have the opportunity to receive SARS-Cov-2 vaccination. Moreover, personal protective equipment (PPE) should still be used even after the vaccination. CONCLUSION: Until prospective evaluations on these topics are available, ORL-HNS must be considered a high infection risk specialty. While the use of PPE remains pivotal, ORL PBFHW should be allowed access to SARS-CoV-2 vaccination provided they receive up-to-date information.