The Effects of the COVID-19 Pandemic on Cancer Staging in Patients Diagnosed With Head and Neck Cancer at an Academic Health Center

ABSTRACT

Purpose/Objective(s) The healthcare system across the world was forced to implement new policies, guidelines, and procedures due to the COVID-19 pandemic and led many patients to make an impossible choice about their health. For various reasons, many patients chose to remain at home and delay any interaction at medical facilities to protect themselves or others from the virus. Patients managing chronic diseases faced unprecedented challenges during this period and the long-term effects on these patient populations remain unclear. Oncology patients, specifically those diagnosed with head and neck cancers, require prompt diagnosis and initiation of treatment for better outcomes. While the overall impact of how the pandemic has affected oncology patients is unknown, this retrospective study examined how the staging of head and neck tumors at our institution has been impacted since the beginning of the pandemic. Materials/Methods Available patient data (from August 2019 through June 2021) was collected from medical records and compared to determine statistical significance. Patients were categorized into a Pre-pandemic group, a Pandemic group, and a Vaccine-approved group based on date of consultation and patient and treatment characteristics were analyzed to look for patterns. The Pre-pandemic period was defined as the period from August 2019 to March 2020, the Pandemic period was defined as the period from March 2020 to December 2020, and the Vaccine approved period was defined as the period from January 2021 to June 2021. Results Fisher's exact tests were used to compare TNM staging distributions between the three groups using the eight edition of the American Joint Committee on Cancer staging system. In the Pre-pandemic group, out of 67 patients, 33 patients (55.0%) were diagnosed with a T stage of 0-2 and 27 patients (45.0%) were diagnosed with a T stage of 3-4. In the Pandemic and Vaccine approved groups, out of 139 patients, 50 patients (39.1%) were diagnosed with a T stage of 0-2 and 78 patients (60.9%) were diagnosed with a T stage of 3-4;these differences were statistically significant (P-value = 0.0426). The Pre-pandemic group had 25 patients (41.7%) diagnosed with a Group stage of 0-2 and 35 patients (58.3%) diagnosed with a Group stage of 3-4. The Pandemic and Vaccine approved groups had 36 patients (28.1%) diagnosed with a Group stage of 0-2 and 92 patients (71.9%) diagnosed with a Group stage of 3-4;these results trended to statistical significance (P-value = 0.0688). Conclusion Our findings demonstrate that there have been a higher number of patients with head and neck cancer diagnosed with a T stage of 3 or 4 at our institution since the start of the COVID-19 pandemic. The effects of the COVID-19 pandemic are ongoing and will need further evaluation to determine the overall effects on oncology patients. Increased morbidity and mortality rates may be a potential result in the years to come.