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1.
Curr Oncol ; 29(2): 1062-1068, 2022 02 13.
Article in English | MEDLINE | ID: covidwho-1686628

ABSTRACT

The COVID-19 pandemic has fundamentally changed healthcare access, delivery, and treatment paradigms throughout oncology. Patients with head and neck cancer comprise an especially vulnerable population due to the nature of their disease and the transmission mechanism of the SARS-CoV-2 virus. The consequences of triage decisions and delays in care have serious psychosocial implications for patients. The development of structured psychosocial support programs, coupled with clear and consistent communication from treating physicians, can help mitigate perceptions of abandonment and distress that may accompany delays in care. As the unpredictability of the pandemic's course continues to burden both providers and patients, we must be proactive in addressing the psychosocial implications of these delays in care.


Subject(s)
COVID-19 , Head and Neck Neoplasms , Head and Neck Neoplasms/therapy , Humans , Medical Oncology , Pandemics , SARS-CoV-2
2.
Support Care Cancer ; 30(5): 4337-4344, 2022 May.
Article in English | MEDLINE | ID: covidwho-1653504

ABSTRACT

PURPOSE: The COVID-19 pandemic has drastically changed cancer care delivery strategies. Patients with locally advanced head and neck cancer (LA-HNC) may be particularly affected by the COVID-19 pandemic, as they often undergo treatments that require daily clinic visits (e.g., radiation therapy). The goal of this study was to characterize the lived experience of LA-HNC patients and their healthcare providers during the COVID-19 pandemic. METHODS: LA-HNC patients who completed a full course of chemotherapy and radiation therapy during the COVID19 pandemic (N = 20) and LA-HNC healthcare providers (N = 13) participated in semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed for qualitative themes. RESULTS: The COVID-19 pandemic had a significant impact on patients' overall quality of life and health care. Results were organized in four main themes: (1) increased psychological distress; (2) exacerbated social isolation; (3) added stress in clinic for patients and providers; and (4) delays in health care. CONCLUSIONS: Findings highlight myriad ways LA-HNC patients and providers have been affected by the COVID-19 pandemic. Results can inform the development of supportive interventions to assist LA-HNC in managing COVID-19-related stress and unmet needs related to social isolation and in-clinic support.


Subject(s)
COVID-19 , Head and Neck Neoplasms , Head and Neck Neoplasms/therapy , Humans , Pandemics , Qualitative Research , Quality of Life/psychology
3.
Eur Rev Med Pharmacol Sci ; 26(1): 284-290, 2022 01.
Article in English | MEDLINE | ID: covidwho-1630130

ABSTRACT

OBJECTIVE: The COVID-19 pandemic and the measures accompanying it have been accused of having a negative influence on the frequency and methods of treatment of various diseases including head and neck cancer (HNSCC). To go further into this assumption, the diagnoses made, and treatments performed at one of Germany's largest head and neck cancer centres were evaluated. PATIENTS AND METHODS: This study consisted of one single centre and involved a retrospective review of all patients with newly diagnosed or recurrent HNSCC. The diagnosis and treatment methods used in the pre-COVID-19 time period between March 1st, 2019, and March 1st, 2020, were analysed and compared with the COVID-19 time period from April 1st, 2020, until April 1st, 2021. The primary objective was defined as the number of malignant diagnoses and the secondary objectives as the disease stage and the time to therapy. RESULTS: A total of 612 patients (160♀; mean 63 yrs.) were included. 319 patients (52%) were treated in the pre-COVID-19 time. The two groups did not differ in terms of age (p=0.304), gender (p=0.941), presence of recurrent disease (p=0.866), tumour subsite (p=0.194) or the duration from presentation to the multidisciplinary tumour board until start of therapy (p=0.202). There were no significant differences in the T stage (p=0.777), N stage (p=0.067) or UICC stage (p=0.922). During the pre-COVID-19 period more patients presented with distant metastases (n= 23 vs. n=8; p=0.011). CONCLUSIONS: This study shows that there was no significant change in either the number and severity of HNSCC diagnoses or the time until start of therapy at this large head and neck cancer centre as a result of the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/epidemiology , Pandemics , Adolescent , Adult , Aged , Aged, 80 and over , Cancer Care Facilities , Delayed Diagnosis/trends , Female , Germany , Head and Neck Neoplasms/therapy , Humans , Male , Middle Aged , Neoplasm Staging , Retrospective Studies , Squamous Cell Carcinoma of Head and Neck , Young Adult
4.
Radiother Oncol ; 167: 42-48, 2022 02.
Article in English | MEDLINE | ID: covidwho-1569002

ABSTRACT

BACKGROUND: Inevitably, the emergence of COVID-19 has impacted non-COVID care. Because timely diagnosis and treatment are essential, especially for patients with head and neck cancer (HNC) with fast-growing tumours in a functionally and aesthetically important area, we wished to quantify the impact of the COVID-19 pandemic on HNC care in the Netherlands. MATERIAL AND METHODS: This population-based study covered all, in total 8468, newly diagnosed primary HNC cases in the Netherlands in 2018, 2019 and 2020. We compared incidence, patient and tumour characteristics, primary treatment characteristics, and time-to-treatment in the first COVID-19 year 2020 with corresponding periods in 2018 and 2019 (i.e. pre-COVID). RESULTS: The incidence of HNC was nearly 25% less during the first wave (n = 433) than in 2019 (n = 595) and 2018 (n = 598). In April and May 2020, the incidence of oral cavity and laryngeal carcinomas was significantly lower than in pre-COVID years. There were no shifts in tumour stage or alterations in initial treatment modalities. Regardless of the first treatment modality and specific period, the median number of days between first visit to a HNC centre and start of treatment was significantly shorter during the COVID-19 year (26-28 days) than pre-COVID (31-32 days, p < 0.001). CONCLUSION: The incidence of HNC during the Netherlands' first COVID-19 wave was significantly lower than expected. The expected increase in incidence during the remainder of 2020 was not observed. Despite the overloaded healthcare system, the standard treatment for HNC patients could be delivered within a shorter time interval.


Subject(s)
COVID-19 , Head and Neck Neoplasms , Laryngeal Neoplasms , COVID-19/epidemiology , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/therapy , Humans , Incidence , Pandemics
6.
Eur Arch Otorhinolaryngol ; 279(2): 1111-1115, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1474004

ABSTRACT

PURPOSE: In response to the coronavirus disease 2019 (COVID-19) pandemic, otolaryngology departments across the United Kingdom have adopted non-face-to-face clinics with consultations being carried out remotely, via telephone or video calls. By reducing footfall on hospital sites, the aim of this strategy was to limit direct contact and curb the spread of infection. This report outlines our experience of conducting a telephone triage clinic in the assessment of urgent suspected head and neck cancer referrals during the first wave of the COVID-19 pandemic. METHODS: New patients who were referred on the urgent suspected head and neck cancer pathway were prospectively identified between 1 May 2020 and 31 August 2020. Patients were triaged remotely using telephone consultations. Risk stratification was performed using the 'Head and Neck Cancer Risk Calculator' (HaNC-RC v.2). RESULTS: Four-hundred and twelve patients were triaged remotely during the 4-month study period. Of these, 248 patients were deemed 'low risk' (60.2%), 78 were classed as 'moderate risk' (18.9%) and 86 were considered 'high risk' (20.9%) according to the HaNC-RC v.2 risk score. Twenty-four patients who were assessed during the study period were diagnosed with head and neck cancer (5.82%). CONCLUSION: The use of teleconsultation, supported by a validated, symptom-based risk calculator, has the potential to provide a viable and effective adjunct in the assessment and management of new suspected head and neck cancer patients and should be considered as part of the inherent re-shaping of clinical service delivery following the ongoing pandemic.


Subject(s)
COVID-19 , Head and Neck Neoplasms , Remote Consultation , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/therapy , Humans , Pandemics , Referral and Consultation , SARS-CoV-2 , Triage
9.
JPEN J Parenter Enteral Nutr ; 45(7): 1397-1399, 2021 09.
Article in English | MEDLINE | ID: covidwho-1453614

ABSTRACT

The current article details new upgrades to the guideline methodology, including the publication of "a priori" protocols, methods for assuring agreement between reviewers, adoption of Covidence software for tracking reasons for article exclusion, the establishment of a separate bias panel to improve study quality assessment, an algorithm for study design inclusion, and Delphi technique implementation for the management and external validation of expert opinion. These methodologic additions will provide greater transparency and accountability for the choices made during the guideline development process.


Subject(s)
Head and Neck Neoplasms , Adult , Head and Neck Neoplasms/therapy , Humans , Nutrition Policy , Research Design
10.
Cancer ; 127(22): 4177-4189, 2021 11 15.
Article in English | MEDLINE | ID: covidwho-1363649

ABSTRACT

BACKGROUND: Remote triage for suspected head and neck cancer (HNC) referrals was adopted by many institutions during the initial peak of the coronavirus disease 2019 pandemic. Its safety in this population has not been established. METHODS: A 16-week, prospective, multicenter national service evaluation was started on March 23, 2020. Suspected HNC referrals undergoing remote triage in UK secondary care centers were identified and followed up for a minimum of 6 months to record the cancer status. Triage was supported by risk stratification using a validated calculator. RESULTS: Data for 4568 cases were submitted by 41 centers serving a population of approximately 26 million. These represented 14.1% of the predicted maximum referrals for this population outside of pandemic times, and this gave the study a margin of error of 1.34% at 95% confidence. Completed 6-month follow-up data were available for 99.8% with an overall cancer rate of 5.6% (254 of 4557). The rates of triage were as follows: urgent imaging investigation, 25.4% (n = 1156); urgent face-to-face review, 27.8%; (n = 1268); assessment deferral, 30.3% (n = 1382); and discharge, 16.4% (n = 749). The corresponding missed cancers rates were 0.5% (5 of 1048), 0.3% (3 of 1149), 0.9% (12 of 1382), and 0.9% (7 of 747; P = .15). The negative predictive value for a nonurgent triage outcome and no cancer diagnosis was 99.1%. Overall harm was reported in 0.24% (11 of 4557) and was highest for deferred assessments (0.58%; 8 of 1382). CONCLUSIONS: Remote triage, incorporating risk stratification, may facilitate targeted investigations for higher risk patients and prevent unnecessary hospital attendance for lower risk patients. The risk of harm is low and may be reduced further with appropriate safety netting of deferred appointments. LAY SUMMARY: This large national study observed the widespread adoption of telephone assessment (supported by a risk calculator) of patients referred to hospital specialists with suspected head and neck cancer during the initial peak of the coronavirus disease 2019 pandemic. The authors identified 4568 patients from 41 UK centers (serving a population of more than 26 million people) who were followed up for a minimum of 6 months. Late cancers were identified, whether reviewed or investigated urgently (0.4%) or nonurgently (0.9%), but the overall rate of harm was low (0.2%), with the highest rate being seen with deferred appointments (0.6%).


Subject(s)
COVID-19/prevention & control , Head and Neck Neoplasms/diagnosis , Remote Consultation/methods , Triage/methods , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/transmission , Child , Child, Preschool , Communicable Disease Control/standards , Female , Follow-Up Studies , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/therapy , Humans , Infant , Male , Middle Aged , Pandemics/prevention & control , Prospective Studies , Remote Consultation/standards , Risk Assessment/methods , Triage/standards , United Kingdom/epidemiology , Young Adult
11.
J Laryngol Otol ; 135(9): 815-819, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1333849

ABSTRACT

OBJECTIVE: To review patient satisfaction with the change in practice towards telephone consultations during and after the coronavirus disease 2019 pandemic for head and neck cancer follow up. METHOD: A retrospective analysis was conducted of head and neck cancer telephone appointments during a six-month period in a tertiary referral centre. RESULTS: Patients found the telephone consultations beneficial (98 per cent), with 30 per cent stating they were relieved to not have to attend hospital. Patients who travelled further, those with lower stage disease and patients with a greater interval from initial treatment were most satisfied with the telephone consultations. Sixty-eight per cent of patients stated they would be happy to have telephone consultations as part of their regular follow up after the pandemic. CONCLUSION: Patients found the telephone consultations beneficial and 30 per cent considered them preferable to face-to-face appointments. This study demonstrates that telephone consultations can be used as an adjunct to face-to-face appointments in an effort to reduce hospital attendances whilst maintaining close follow up.


Subject(s)
Aftercare , Head and Neck Neoplasms/therapy , Patient Satisfaction , Referral and Consultation , Adult , Aftercare/methods , Aftercare/psychology , Aftercare/standards , Aged , Aged, 80 and over , Humans , Middle Aged , Patient Satisfaction/statistics & numerical data , Retrospective Studies , Telephone , Tertiary Care Centers
12.
ANZ J Surg ; 91(7-8): 1364-1368, 2021 07.
Article in English | MEDLINE | ID: covidwho-1286653

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had widespread impacts on health services, particularly regarding the provision of urgent elective surgical services. It has influenced the evaluation of surgical patients, patient willingness to consult with medical services, and the ability to provide timely care to these patients. The aim of this study is to assess the impact of the COVID-19 pandemic on the time to definitive management for head and neck cancer in a regional setting. METHODS: A retrospective review was performed through the University Hospital Geelong Head and Neck Unit records and electronic medical records. Ethics approval for quality assurance was attained. The primary outcome was time from the first clinic appointment to commencement of definitive management. Statistical analysis was performed using Prism (version 8.0, GraphPad). RESULTS: A total of 127 patients were identified, 64 in the pre-COVID and 63 in the post-COVID period. In the post-COVID period, more patients (14.3%) had their first clinic appointment with telehealth compared to the pre-COVID period (1.6%). There was also no significant difference in time from referral to first clinic appointment or time from first clinic appointment to date of definitive treatment decision or multidisciplinary meeting. There was no significant difference in definitive treatment modality between groups. CONCLUSION: Despite increased adoption of telemedicine and increased public health considerations, there was no increase in time to definitive treatment from the time of referral to a regional head and neck cancer service.


Subject(s)
COVID-19 , Head and Neck Neoplasms , Telemedicine , Head and Neck Neoplasms/therapy , Humans , Pandemics , Referral and Consultation , Retrospective Studies , SARS-CoV-2
13.
J Laryngol Otol ; 136(3): 248-251, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1279750

ABSTRACT

BACKGROUND: The impact of coronavirus disease 2019 extends far beyond the immediate burden on healthcare systems caused by hospitalisation of patients with the disease itself. OBJECTIVE: To investigate the impact of the coronavirus disease 2019 pandemic on the referral rate of patients to the suspected head and neck cancer two-week-wait clinic. METHODS: A multicentre retrospective study was performed investigating data collected for all patients attending the suspected head and neck cancer two-week-wait clinic in ENT departments in the West Midlands. RESULTS: A total of 509 fast-track referrals were received from February to April in 2019, compared to 399 referrals in 2020. April 2020 saw a 62.4 per cent reduction in referral rate compared to April 2019. CONCLUSION: The coronavirus disease 2019 pandemic has resulted in changes to health-seeking behaviours, and healthcare provision and delivery. Urgent policy interventions may be required to compensate for the hidden impact that the coronavirus disease 2019 pandemic has had on those with cancer.


Subject(s)
COVID-19/epidemiology , Head and Neck Neoplasms/diagnosis , Referral and Consultation/statistics & numerical data , Waiting Lists , Adult , COVID-19/prevention & control , COVID-19/transmission , Communicable Disease Control , Delayed Diagnosis , Female , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/therapy , Humans , Male , Middle Aged , Patient Acceptance of Health Care , Retrospective Studies , Time Factors , United Kingdom
14.
J Surg Oncol ; 124(4): 476-482, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1263111

ABSTRACT

BACKGROUND: Considering the pandemic's mode of transmission, the impact on quality of life (QOL) is likely to be exaggerated among healthcare workers (HCWs) who treat head and neck diseases (hHCWs). METHODS: A cross-sectional self-reported QOL assessment was undertaken between July and September 2020 using the World Health Organization Quality of Life instrument sent out to hHCWs. Factors that predicted a poorer QOL were identified using regression models and mediation analysis. RESULTS: Responses from 979 individuals across 53 countries were analyzed with 62.4% participation from low- and middle-income countries. The physical domain had the highest mean scores of 15 ± 2.51, while the environmental domain was the lowest (14.17 ± 2.42). Participants from low- and middle-income countries had a significantly worse physical (p < 0.001) and environmental (p < 0.001) domains, while a low coronavirus disease 2019-related mortality significantly impacted the environmental domain (p-0.034). CONCLUSION: QOL-related issues among hHCWs are a vexing problem and need intervention at an individual and systems level in all parts of the world.


Subject(s)
COVID-19/epidemiology , Head and Neck Neoplasms/therapy , Health Personnel/psychology , Internationality , Quality of Life , Surgical Oncology , Adult , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Self Report , Young Adult
15.
Eur Arch Otorhinolaryngol ; 279(2): 907-943, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1198430

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-2
16.
Am Soc Clin Oncol Educ Book ; 41: 1-11, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1166954

ABSTRACT

The overwhelming majority of head and neck cancers and related deaths occur in low- and middle-income countries, which have challenges related to burden of disease versus access to care. Yet the additional health care burden of the COVID-19 pandemic has also impacted access to care for patients with head and neck cancer in the United States. This article focuses on challenges and innovation in prioritizing head and neck cancer care in Sub-Saharan Africa, the Indian experience of value-added head and neck cancer care in busy and densely populated regions, and strategies to optimize the management of head and neck cancer in the United States during the COVID-19 pandemic.


Subject(s)
COVID-19 , Head and Neck Neoplasms/therapy , Health Services Accessibility , Medical Oncology , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/mortality , Health Priorities , Health Services Needs and Demand , Humans , Needs Assessment , Treatment Outcome
17.
Otolaryngol Head Neck Surg ; 166(1): 93-100, 2022 01.
Article in English | MEDLINE | ID: covidwho-1158179

ABSTRACT

OBJECTIVE: The study aimed to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on head and neck oncologic care at a tertiary care facility. STUDY DESIGN: This was a cross-sectional study conducted between March 18, 2020, and May 20, 2020. The primary planned outcome was the rate of treatment modifications during the study period. Secondary outcome measures were tumor conference volume, operative volume, and outpatient patient procedure and clinic volumes. SETTING: This single-center study was conducted at a tertiary care academic hospital in a large metropolitan area. METHODS: The study included a consecutive sample of adult subjects who were presented at a head and neck interdepartmental tumor conference during the study period. Patients were compared to historical controls based on review of operative data, outpatient procedures, and clinic volumes. RESULTS: In total, 117 patients were presented during the review period in 2020, compared to 69 in 2019. There was an 8.4% treatment modification rate among cases presented at the tumor conference. There was a 61.3% (347 from 898) reduction in outpatient clinic visits and a 63.4% (84 from 230) reduction in procedural volume compared to the prior year. Similarly, the operative volume decreased by 27.0% (224 from 307) compared to the previous year. CONCLUSION: Restrictions related to the COVID-19 pandemic resulted in limited treatment modifications. Transition to virtual tumor board format observed an increase in case presentations. While there were reductions in operative volume, there was a larger proportion of surgical cases for malignancy, reflecting the prioritization of oncologic care during the pandemic.


Subject(s)
COVID-19 , Head and Neck Neoplasms/surgery , Health Services Accessibility/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Aged , Baltimore , Clinical Protocols , Female , Head and Neck Neoplasms/therapy , Humans , Male , Middle Aged , Practice Patterns, Physicians'/trends , Prospective Studies , Surgical Oncology/statistics & numerical data , Tertiary Care Centers , Time-to-Treatment
20.
Head Neck ; 43(6): 1872-1880, 2021 06.
Article in English | MEDLINE | ID: covidwho-1116767

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic has led to increased telemedicine visits. This study examines current preferences and barriers for telemedicine among patients with head and neck cancer. METHODS: Single institution retrospective analysis of 64 patients scheduling visits with the head and neck surgical oncology clinic at a tertiary academic medical center. Data were collected detailing patient preferences and barriers regarding telemedicine appointments. Patients electing to participate in telemedicine were compared to those preferring in-person appointments. RESULTS: Most patients (68%) were not interested in telemedicine. Preference for in-person examination was the most common reason for rejecting telemedicine, followed by discomfort with or limited access to technology. Patients elected telemedicine visits to avoid infection and for convenience. CONCLUSIONS: When given a choice, patients with head and neck cancer preferred in-person visits over telemedicine. Although telemedicine may improve health care access, patient preferences, technology-related barriers, and limitations regarding cancer surveillance must be addressed moving forward.


Subject(s)
COVID-19 , Head and Neck Neoplasms , Telemedicine , Head and Neck Neoplasms/therapy , Humans , Retrospective Studies , SARS-CoV-2
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