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1.
Eur Arch Otorhinolaryngol ; 279(3): 1453-1460, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1265494

ABSTRACT

BACKGROUND: In the present study, we have shared our experience in managing head neck cancers, especially the oral malignancies, during the crisis of COVID 19. MATERIALS AND METHODS: Patients with oral cancers underwent pedicle/local flaps and free flaps reconstruction based on the availability of intensive care unit and comorbidities of the patients. The clinical outcomes were compared at the end of one week, one month, and three months after the primary surgery. RESULTS: Pedicle/local flaps were used in 25 cases and radial/fibular free flaps were used in 8 cases for the reconstruction of soft tissue defects. Patients with pedicle flap reconstruction had better clinical outcomes, including lesser ICU stay as compared to free flaps. CONCLUSION: Pedicle flap can be a valid alternative to the free flap for the soft tissue reconstruction in advanced oral malignancies during the COVID pandemic period in the Indian subcontinent, especially with limited infrastructure of the hospitals.


Subject(s)
COVID-19 , Free Tissue Flaps , Head and Neck Neoplasms , Reconstructive Surgical Procedures , COVID-19/epidemiology , Head and Neck Neoplasms/surgery , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
2.
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
3.
Tumori ; 108(3): 240-249, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1183475

ABSTRACT

OBJECTIVE: To capture and monitor flu-like symptoms in relation to the clinical characteristics and the oncologic treatment of a large head and neck cancer (HNC) patient cohort during the Coronavirus disease 2019 (COVID-19) pandemic. METHODS: Patients were monitored through by 2 rounds of interviews. Clinical characteristics of patients with no symptoms (group 0) and of those reporting ⩾1 (group A), ⩾3 (group B), or ⩾5 symptoms (group C) were analyzed. Patients with ⩾1 symptom at both interviews were defined as group A2. RESULTS: Five hundred patients with HNC were analyzed. A higher frequency of patients with the following characteristics was observed in group A vs group 0: active treatment (40% vs 24%, p = 0.0002), gastrostomy (6% vs 2%, p = 0.027), recent active treatment (48% vs 29%, p < 0.0001), and higher number of concomitant medications (p = 0.01). A lower median age was observed in group B vs group no-B (patients with fewer than three symptoms) (59 vs 63.55 years, p = 0.016) and in group A2 vs group no-A2 (patients without at least one symptom at both interviews) (56 vs 63 years, p = 0.021); patients in group B received more recent active treatment than those in group no-B and in group A2 vs those in group no-A2 (p = 0.024 and 0.043, respectively); patients in group B had a lower body mass index than those in group no-B (22.4 vs 23.93 kg/m2, p = 0.0066). CONCLUSIONS: This work is based on patient-reported symptoms and signs independently of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. In the future, these results might serve as a a benchmark for clinicians triaging and managing patients with HNC during infectious outbreaks involving flu-like symptoms.


Subject(s)
COVID-19 , Head and Neck Neoplasms , COVID-19/epidemiology , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/therapy , Humans , Medical Oncology , Middle Aged , Pandemics , SARS-CoV-2
4.
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
5.
Eur Arch Otorhinolaryngol ; 278(11): 4441-4448, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1081343

ABSTRACT

PURPOSE: Head and neck cancer (HNC) patients may experience fears regarding cancer recurrence (FoR) and of catching COVID-19. There could be unease for attending hospital clinics for face to face (F2F) examination. F2F benefit in cancer surveillance has to be balanced against the risk of virus transmission. This study aimed to report perceptions of fear of cancer and fear of COVID-19 and to report patient preference for follow-up consultation in HNC survivors during the COVID-19 pandemic. METHODS: The study ran from lockdown in England on 24th March to 29th July 2020. Patients were offered preference to postpone their consultation, to have it by telephone, or F2F. A postal survey was undertaken in the 2 weeks post-consultation (actual or postponed). RESULTS: There were 103 patients. Initial action by consultant and patient resulted in 51 postponed consultations, 35 telephone consultations and 17 F2F meetings, with 10 F2F triggered by the patient. There were 58 responders to the survey and most (39) had a clear preference for one mode of follow-up consultation during the COVID-19 pandemic, with half (19) preferring F2F. A similar response was seen regarding their consultations in general to address unmet needs and concerns, with 38 having a preferred mode, 29 preferring F2F. Serious fears about recurrence and COVID-19 were at relatively low levels with a tendency to be more concerned about recurrence. CONCLUSION: Any redesign of mode and frequency of out-patient follow-up in light of COVID-19 should be undertaken in discussion with patient groups and with individual patients.


Subject(s)
COVID-19 , Communicable Disease Control , Fear , Humans , Neoplasm Recurrence, Local/epidemiology , Pandemics , Referral and Consultation , SARS-CoV-2
7.
Oral Oncol ; 112: 105043, 2021 01.
Article in English | MEDLINE | ID: covidwho-857053

ABSTRACT

BACKGROUND: Preoperative screening had a key role in planning elective surgical activity for head and neck cancer (HNC) during the COVID-19 pandemic. METHODS: All patients undergoing surgery for HNC at two Italian referral hospitals (University of Padua and National Cancer Institute [NCI]) during the peak of the COVID-19 epidemic in Italy were included. Accuracy of screening protocols was assessed. RESULTS: In the Padua protocol, 41 patients were screened by pharyngeal swab. The entire sample (100%) was admitted to surgery, diagnostic accuracy was 100%. In the NCI protocol, 23 patients underwent a telephone interview, blood test, and chest CT. Twenty patients (87%) were negative and were directly admitted to surgery. In the remaining 3 (13%), pharyngeal swab was performed. The screening was repeated until a negative chest CT was found. Diagnostic accuracy was 85%. CONCLUSIONS: Dedicated screening protocols for COVID-19 allow to safely perform elective HNC surgery.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Head and Neck Neoplasms/surgery , Preoperative Care , SARS-CoV-2 , Aged , COVID-19/epidemiology , Clinical Protocols , Elective Surgical Procedures , Female , Humans , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray Computed
8.
Am J Otolaryngol ; 41(6): 102738, 2020.
Article in English | MEDLINE | ID: covidwho-778356

ABSTRACT

With the onset of the COVID-19 crisis in late 2019, the health care systems of different countries are experiencing stressful conditions. Many patients need care in hospital wards and intensive care units (ICU). Head & neck cancers (HNC) are in a special condition in this pandemic. The main treatment in these patients is surgery. Most of these patients need care in the ICU, which is reduced in capacity in pandemic conditions. It's important to note that delays in the surgery of these patients make them non-operable and on the other hand increase mortality and morbidity. Numerous non-surgical alternative therapies have been proposed in these conditions, but there are fundamental questions about these suggestions. 1 How long should we look for alternative therapies? Because many countries are facing a second wave of the disease. 2 What's the effect of these alternative therapies and the delay in starting standard treatments in patients' survival? Different countries have different financial resources; many countries, patients face restrictions on receiving alternative therapies to standard treatments, and in non-pandemic conditions, long queues are given for non-surgical treatments such as chemo-radiotherapy. There are numerous guidelines to guide head and neck surgeons to the best choice in this situation. It seems that different countries have to make individual decisions based on the prevalence of COVID-19 and the financial resources and facilities of the health care system. In this review article, we have collected the opinions of world-renowned guidelines and institutions on how to treat HNCs during the pandemic.


Subject(s)
Clinical Decision-Making , Coronavirus Infections/epidemiology , Head and Neck Neoplasms/therapy , Patient Selection , Pneumonia, Viral/epidemiology , Resource Allocation , Betacoronavirus , COVID-19 , Humans , Pandemics , SARS-CoV-2 , Triage
9.
Head Neck ; 42(7): 1466-1470, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-457435

ABSTRACT

INTRODUCTION: For the EARs NOSE AND THROAT (ENT) surgeon, there are many challenges that show-up in the clinical management of a patient affected by a head and neck cancer during COVID-19 pandemic, especially in the postoperative period. METHODS: During the acute COVID-19 emergency phase in Italy, we analyzed the management of a patient affected by a head and neck cancer. We reported several clinical data about the hospitalization period, pointing out the difficulties encountered both from clinical and management point of view. RESULTS: During pandemic, we admitted 27 oncological patients at our ENT Department. Delays in surgical procedures, complications of hospitalizations, need for radiological studies, and possible transfer to other hospital ward, due to suspect SARS-CoV-2 infection, were registered. CONCLUSIONS: The changes in the whole health care system during the COVID-19 pandemic have impacted the management of patients with head and neck cancer, generating several clinical challenges for the ENT surgeon.


Subject(s)
Coronavirus Infections/epidemiology , Elective Surgical Procedures/statistics & numerical data , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/surgery , Infection Control/methods , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Aged , Aged, 80 and over , COVID-19 , Cohort Studies , Coronavirus Infections/prevention & control , Databases, Factual , Disease Management , Elective Surgical Procedures/methods , Female , Hospitalization/statistics & numerical data , Hospitals, University , Humans , Italy , Male , Medical Oncology/trends , Middle Aged , Otolaryngology/trends , Outcome Assessment, Health Care , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/prevention & control , Prospective Studies , Surgical Oncology/trends , Time-to-Treatment
10.
Cancer ; 126(15): 3426-3437, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-457377

ABSTRACT

BACKGROUND: The objective of this study was to identify a subgroup of patients with head and neck squamous cell carcinoma (HNSCC) who might be suitable for hypofractionated radiotherapy (RT-hypo) during the COVID-19 pandemic. METHODS: HNSCC cases (oropharynx/larynx/hypopharynx) treated with definitive RT-hypo (60 Gy in 25 fractions over 5 weeks), moderately accelerated radiotherapy (RT-acc) alone (70 Gy in 35 fractions over 6 weeks), or concurrent chemoradiotherapy (CCRT) during 2005-2017 were included. Locoregional control (LRC) and distant control (DC) after RT-hypo, RT-acc, and CCRT were compared for various subgroups. RESULTS: The study identified 994 human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma cases (with 61, 254, and 679 receiving RT-hypo, RT-acc, and CCRT, respectively) and 1045 HPV- HNSCC cases (with 263, 451, and 331 receiving RT-hypo, RT-acc, and CCRT, respectively). The CCRT cohort had higher T/N categories, whereas the radiotherapy-alone patients were older. The median follow-up was 4.6 years. RT-hypo, RT-acc, and CCRT produced comparable 3-year LRC and DC for HPV+ T1-2N0-N2a disease (seventh edition of the TNM system [TNM-7]; LRC, 94%, 100%, and 94%; P = .769; DC, 94%, 100%, and 94%; P = .272), T1-T2N2b disease (LRC, 90%, 94%, and 97%; P = .445; DC, 100%, 96%, and 95%; P = .697), and T1-2N2c/T3N0-N2c disease (LRC, 89%, 93%, and 95%; P = .494; DC, 89%, 90%, and 87%; P = .838). Although LRC was also similar for T4/N3 disease (78%, 84%, and 88%; P = .677), DC was significantly lower with RT-hypo or RT-acc versus CCRT (67%, 65%, and 87%; P = .005). For HPV- HNSCC, 3-year LRC and DC were similar with RT-hypo, RT-acc, and CCRT in stages I and II (LRC, 85%, 89%, and 100%; P = .320; DC, 99%, 98%, and 100%; P = .446); however, RT-hypo and RT-acc had significantly lower LRC in stage III (76%, 69%, and 91%; P = .006), whereas DC rates were similar (92%, 85%, and 90%; P = .410). Lower LRC in stage III predominated in patients with laryngeal squamous cell carcinoma receiving RT-acc (62%) but not RT-hypo (80%) or CCRT (92%; RT-hypo vs CCRT: P = .270; RT-acc vs CCRT: P = .004). CCRT had numerically higher LRC in comparison with RT-hypo or RT-acc in stage IV (73%, 65%, and 66%; P = .336). CONCLUSIONS: It is proposed that RT-hypo be considered in place of CCRT for HPV+ T1-T3N0-N2c (TNM-7) HNSCCs, HPV- T1-T2N0 HNSCCs, and select stage III HNSCCs during the COVID-19 outbreak.


Subject(s)
Head and Neck Neoplasms/radiotherapy , Radiation Dose Hypofractionation , Squamous Cell Carcinoma of Head and Neck/radiotherapy , Adult , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/epidemiology , Female , Follow-Up Studies , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/virology , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Oropharyngeal Neoplasms/drug therapy , Oropharyngeal Neoplasms/radiotherapy , Oropharyngeal Neoplasms/virology , Pandemics , Papillomavirus Infections/complications , Pneumonia, Viral/epidemiology , Radiotherapy, Intensity-Modulated , Risk Factors , Squamous Cell Carcinoma of Head and Neck/drug therapy , Squamous Cell Carcinoma of Head and Neck/mortality , Squamous Cell Carcinoma of Head and Neck/virology , Treatment Outcome
11.
Head Neck ; 42(7): 1674-1680, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-291714

ABSTRACT

BACKGROUND: Outpatient telemedicine consultations are being adopted to triage patients for head and neck cancer. However, there is currently no established structure to frame this consultation. METHODS: For suspected referrals with cancer, we adapted the Head and Neck Cancer Risk Calculator (HaNC-RC)-V.2, generated from 10 244 referrals with the following diagnostic efficacy metrics: 85% sensitivity, 98.6% negative predictive value, and area under the curve of 0.89. For follow-up patients, a symptom inventory generated from 5123 follow-up consultations was used. A customized Excel Data Tool was created, trialed across professional groups and made freely available for download at www.entintegrate.co.uk/entuk2wwtt, alongside a user guide, protocol, and registration link for the project. Stakeholder support was obtained from national bodies. RESULTS: No remote consultations were refused by patients. Preliminary data from 511 triaging episodes at 13 centers show that 77.1% of patients were discharged directly or have had their appointments deferred. DISCUSSION: Significant reduction in footfall can be achieved using a structured triaging system. Further refinement of HaNC-RC-V.2 is feasible and the authors welcome international collaboration.


Subject(s)
Continuity of Patient Care , Coronavirus Infections/epidemiology , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/epidemiology , Pneumonia, Viral/epidemiology , Referral and Consultation , Risk Assessment/methods , Triage/organization & administration , Betacoronavirus , COVID-19 , Clinical Decision-Making , Evidence-Based Practice , Humans , Medical Oncology/methods , Pandemics , Predictive Value of Tests , Remote Consultation , SARS-CoV-2 , Symptom Assessment , United Kingdom/epidemiology
13.
Head Neck ; 42(7): 1423-1447, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-155350

ABSTRACT

BACKGROUND: Coronavirus has serially overtaken our metropolitan hospitals. At peak, patients with acute respiratory distress syndrome may outnumber mechanical ventilators. In our Miami Hospital System, COVID-19 cases have multiplied for 4 weeks and elective surgery has been suspended. METHODS: An Otolaryngologic Triage Committee was created to appropriately allocate resources to patients. Hospital ethicists provided support. Our tumor conference screened patients for nonsurgical options. Patients were tested twice for coronavirus before performing urgent contaminated operations. N95 masks and protective equipment were conserved when possible. Patients with low-grade cancers were advised to delay surgery, and other difficult decisions were made. RESULTS: Hundreds of surgeries were canceled. Sixty-five cases screened over 3 weeks are tabulated. Physicians and patients expressed discomfort regarding perceived deviations from standards, but risk of COVID-19 exposure tempered these discussions. CONCLUSIONS: We describe the use of actively managed surgical triage to fairly balance our patient's health with public health concerns.


Subject(s)
Coronavirus Infections/epidemiology , Elective Surgical Procedures/ethics , Head and Neck Neoplasms/surgery , Pandemics/statistics & numerical data , Patient Selection/ethics , Pneumonia, Viral/epidemiology , Triage/ethics , COVID-19 , Coronavirus Infections/prevention & control , Elective Surgical Procedures/statistics & numerical data , Female , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/epidemiology , Hospitals, Urban , Humans , Infection Control/methods , Male , Occupational Health , Otolaryngology/organization & administration , Pandemics/prevention & control , Patient Safety , Pneumonia, Viral/prevention & control , Risk Assessment , United States
14.
Head Neck ; 42(7): 1460-1465, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-155347

ABSTRACT

In India, oral cancer is the most common head and neck cancer (HNC) in men, mainly caused by the consumption of smoked and smokeless tobacco. During the current pandemic, delaying surgery for even 1 or 2 months may lead to more extensive surgery or inoperability, where only supportive care can be provided. Being semi-emergent in nature, treatment for these patients is currently on hold or delayed in most centers across the country. This study was conducted to assess the impact of COVID-19 pandemic and inability of the health system to treat HNC in a timely fashion and how surgeons are coping to this emergent situation. This article highlights the situation in India, a country burdened with one of the highest incidence rates of HNC.


Subject(s)
Coronavirus Infections/epidemiology , Elective Surgical Procedures/statistics & numerical data , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/surgery , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Surveys and Questionnaires , Academic Medical Centers , Adult , COVID-19 , Cancer Care Facilities/organization & administration , Coronavirus Infections/prevention & control , Disease Management , Female , Humans , India , Male , Middle Aged , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/prevention & control , Safety Management/methods , Surgical Oncology/organization & administration , Tertiary Care Centers
15.
Head Neck ; 42(6): 1273-1277, 2020 06.
Article in English | MEDLINE | ID: covidwho-143443

ABSTRACT

BACKGROUND: This case highlights challenges in the assessment and management of the "difficult airway" patient in the SARS-CoV-2 (COVID-19) pandemic era. METHODS: A 60-year-old male with history of recent transoral robotic surgery resection, free flap reconstruction, and tracheostomy for p16+ squamous cell carcinoma presented with stridor and dyspnea 1 month after decannulation. Careful planning by a multidisciplinary team allowed for appropriate staffing and personal protective equipment, preparations for emergency airway management, evaluation via nasopharyngolaryngoscopy, and COVID testing. The patient was found to be COVID negative and underwent imaging which revealed new pulmonary nodules and a tracheal lesion. RESULTS: The patient was safely transorally intubated in the operating room. The tracheal lesion was removed endoscopically and tracheostomy was avoided. CONCLUSIONS: This case highlights the importance of careful and collaborative decision making for the management of head and neck cancer and other "difficult airway" patients during the COVID-19 epidemic.


Subject(s)
Betacoronavirus , Carcinoma, Squamous Cell/surgery , Coronavirus Infections/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Tonsillar Neoplasms/pathology , Tracheal Neoplasms/surgery , COVID-19 , COVID-19 Testing , Carcinoma, Squamous Cell/secondary , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Humans , Male , Middle Aged , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , SARS-CoV-2 , Tracheal Neoplasms/secondary
16.
Head Neck ; 42(6): 1147-1149, 2020 06.
Article in English | MEDLINE | ID: covidwho-133526

ABSTRACT

Elderly patients with head and neck cancer are at increased risk of adverse outcomes during and after treatment of head and neck cancer. COVID-19 severity and mortality can be expected to be significantly greater in elderly patients with head and neck cancer, given that increased age, comorbidities, and presence of malignancy are known risk factors for disease severity and mortality in patients with COVID-19. Therefore, their management requires multidisciplinary consensus and patient input. A thorough geriatric assessment, which has been shown to be beneficial prior to the COVID-19 pandemic, could be particularly helpful in this patient population with the added dimension of COVID-19 risk. In many cases, prudent treatment plan modification may allow for overall best outcomes. Furthermore, recruitment of social services and, when appropriate, palliative care, may allow for optimal management of these patients.


Subject(s)
Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Geriatric Assessment/methods , Head and Neck Neoplasms/therapy , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Communicable Disease Control/methods , Coronavirus Infections/prevention & control , Disease Management , Female , Follow-Up Studies , Head and Neck Neoplasms/epidemiology , Humans , Male , Patient Safety , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Treatment Outcome , World Health Organization
17.
Head Neck ; 42(6): 1194-1201, 2020 06.
Article in English | MEDLINE | ID: covidwho-133336

ABSTRACT

BACKGROUND: COVID-19 pandemic has strained human and material resources around the world. Practices in surgical oncology had to change in response to these resource limitations, triaging based on acuity, expected oncologic outcomes, availability of supportive resources, and safety of health care personnel. METHODS: The MD Anderson Head and Neck Surgery Treatment Guidelines Consortium devised the following to provide guidance on triaging head and neck cancer (HNC) surgeries based on multidisciplinary consensus. HNC subsites considered included aerodigestive tract mucosa, sinonasal, salivary, endocrine, cutaneous, and ocular. RECOMMENDATIONS: Each subsite is presented separately with disease-specific recommendations. Options for alternative treatment modalities are provided if surgical treatment needs to be deferred. CONCLUSION: These guidelines are intended to help clinicians caring for patients with HNC appropriately allocate resources during a health care crisis, such as the COVID-19 pandemic. We continue to advocate for individual consideration of cases in a multidisciplinary fashion based on individual patient circumstances and resource availability.


Subject(s)
Coronavirus Infections/epidemiology , Head and Neck Neoplasms/surgery , Outcome Assessment, Health Care , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic/standards , Surgical Oncology/standards , Betacoronavirus , COVID-19 , Cancer Care Facilities , Communicable Disease Control/standards , Consensus , Coronavirus Infections/prevention & control , Female , Head and Neck Neoplasms/diagnosis , Humans , Male , Occupational Health , Pandemics/prevention & control , Patient Safety , Patient Selection , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Triage/standards , United States
18.
Head Neck ; 42(6): 1131-1136, 2020 06.
Article in English | MEDLINE | ID: covidwho-66373

ABSTRACT

BACKGROUND AND METHODS: There is an added level of complexity in the management of head and neck cancer patients with underlying immunosuppressive disorders during the COVID-19 pandemic. Head and neck oncologists are tasked with balancing the dual risks of cancer progression in the setting of impaired tumor immunity and increased susceptibility to life-threatening complications from exposure to viral infection for patients and providers. Through two cases of immunocompromised patients with newly diagnosed head and neck malignancies, we aim to provide guidance to clinicians struggling with how to best counsel and manage this unique subset of patients under these difficult circumstances. RESULTS: After careful consideration of the options, we took different approaches in the care of these two patients. CONCLUSIONS: Ultimately, there is no uniform set of rules to apply to this heterogeneous group of immunocompromised patients. We provide some general principles to help guide patient management during the current pandemic.


Subject(s)
Conservative Treatment/methods , Coronavirus Infections/epidemiology , Head and Neck Neoplasms/therapy , Immunocompromised Host , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Time-to-Treatment/organization & administration , Adult , COVID-19 , Clinical Decision-Making , Communicable Disease Control/methods , Disease Management , Female , Follow-Up Studies , Head and Neck Neoplasms/pathology , Humans , Interdisciplinary Communication , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Male , Middle Aged , Mouth Neoplasms/pathology , Mouth Neoplasms/surgery , Patient Safety , Risk Assessment , Sampling Studies , Time Factors , United States , Vocal Cords/pathology , Vocal Cords/surgery
19.
Oral Oncol ; 105: 104684, 2020 06.
Article in English | MEDLINE | ID: covidwho-35006

ABSTRACT

The COVID-19 pandemic demands reassessment of head and neck oncology treatment paradigms. Head and neck cancer (HNC) patients are generally at high-risk for COVID-19 infection and severe adverse outcomes. Further, there are new, multilevel COVID-19-specific risks to patients, surgeons, health care workers (HCWs), institutions and society. Urgent guidance in the delivery of safe, quality head and neck oncologic care is needed. Novel barriers to safe HNC surgery include: (1) imperfect presurgical screening for COVID-19; (2) prolonged SARS-CoV-2 aerosolization; (3) occurrence of multiple, potentially lengthy, aerosol generating procedures (AGPs) within a single surgery; (4) potential incompatibility of enhanced personal protective equipment (PPE) with routine operative equipment; (5) existential or anticipated PPE shortages. Additionally, novel, COVID-19-specific multilevel risks to HNC patients, HCWs and institutions, and society include: use of immunosuppressive therapy, nosocomial COVID-19 transmission, institutional COVID-19 outbreaks, and, at some locations, societal resource deficiencies requiring health care rationing. Traditional head and neck oncology doctrines require reassessment given the extraordinary COVID-19-specific risks of surgery. Emergent, comprehensive management of these novel, multilevel surgical risks are needed. Until these risks are managed, we temporarily favor nonsurgical therapy over surgery for most mucosal squamous cell carcinomas, wherein surgery and nonsurgical therapy are both first-line options. Where surgery is traditionally preferred, we recommend multidisciplinary evaluation of multilevel surgical-risks, discussion of possible alternative nonsurgical therapies and shared-decision-making with the patient. Where surgery remains indicated, we recommend judicious preoperative planning and development of COVID-19-specific perioperative protocols to maximize the safety and quality of surgical and oncologic care.


Subject(s)
Coronavirus Infections/epidemiology , Head and Neck Neoplasms/therapy , Medical Oncology/methods , Pneumonia, Viral/epidemiology , Aerosols , Betacoronavirus , COVID-19 , Head and Neck Neoplasms/surgery , Humans , Infection Control , Pandemics , Personal Protective Equipment , SARS-CoV-2 , Surgical Oncology
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