Patterns of Technology Use Among Patients With Head and Neck Cancer and Implications for Telehealth.

OBJECTIVE: To describe baseline technology use within the head and neck cancer (HNC) population prior to the COVID-19 pandemic. STUDY DESIGN: Cross-sectional analysis of National Health Interview Survey (NHIS) data. SETTING: The NHIS is a survey of population health administered in person annually to a nationally representative sample of noninstitutionalized US residents via a complex clustered sampling design. METHODS: Data regarding technology use, cancer history, and demographics were extracted from the NHIS. The study population comprised individuals who completed the NHIS Sample Adult survey from 2012 to 2018 and self-reported a cancer diagnosis. Poisson regression was used to evaluate associations between demographics and general or health-related technology use and prevalence ratios reported. RESULTS: Patients with HNC were less likely to use general technology (computers, internet, or email) when compared with other patients with cancer (60% vs 73%, P < .001), although this difference was not statistically significant after controlling for sociodemographic factors. Among patients with HNC, older age, lower education, and lower income were negatively associated with general technology use (adjusted prevalence ratio [aPR], 0.71 [95% CI, 0.59-0.87] for age 65-79 years vs <50 years; aPR, 0.66 [95% CI, 0.51-0.85] for high school vs master; aPR, 0.66 [95% CI, 0.48-0.91] for income 100%-200% vs >400% federal poverty level). Older age and lower education were negatively associated with health-related technology use (aPR, 0.46 [95% CI, 0.32-0.67] for age 65-79 years vs <50 years; aPR, 0.47 [95% CI, 0.30-0.74] for high school vs master). CONCLUSION: Socioeconomic disparities exist in technology use rates among patients with HNC. Access to technology may pose a barrier to telehealth visits for many patients with HNC due to the unique socioeconomic demographics of this patient population.

Hospitalization rates and 30-day all-cause mortality among head and neck cancer patients and survivors with COVID-19.

BACKGROUND: The impact of COVID-19 on patients with cancer is emerging, but data are urgently needed for head and neck cancer (HNC) patients or survivors who are inherently high-risk for severe illness and mortality with SARS-CoV-2 infection. METHODS: This multi-institution, academic cohort study collected comprehensive data on clinical risk factors, COVID-19 symptoms and viral testing patterns, information about hospitalization rates, and predictors of survival among HNC patients with active disease or in remission. The primary endpoint was 30-day all-cause mortality from the date of confirmed COVID-19. We performed multivariate analysis to understand the prognostic value of clinical and laboratory parameters on outcomes. RESULTS: Thirty-two patients with COVID-19 and HNC were included. Median age was 70 (range: 38-91) with 38% aged 75+, and 34% resided in long-term care facilities (LTCF). Thirteen (41%) had active cancer, with 6 (19%) on cancer therapy within 4 weeks of COVID-19 diagnosis. New or worsening cough and fatigue were the most commonly reported presenting symptoms. More than 30% required >1 SARS-CoV-2 test before confirming a positive result. Twenty (63%) required hospitalization. At data cutoff, 7 (22%) had died (1 on active cancer treatment), with a 30-day all-cause mortality of 18.9% (95%CI: 11.4-33.6) among all patients, and 71.5% (95%CI: 38.2-92.3) among those requiring intensive care unit (ICU) admission. ICU admission and residing in a LTCF predicted worse outcomes (p < 0.01), while age, gender, and recent treatment did not. CONCLUSIONS: We observed high 30-day all-cause mortality among HNC patients with COVID-19, but most were not on active cancer therapy.