Incidence of the Initial Diagnosis of Head and Neck Cancer in a University Emergency Department Pre- and Post-COVID-19

ABSTRACT

Introduction: The COVID-19 pandemic has led to an increased burden being placed on our health care system. In this study, we aim to expand upon the impact of COVID-19 on a head and neck cancer population by examining the number of patients presenting to a university emergency department with an initial presentation of head and neck cancer during the pandemic and immediately before it. Method(s) A retrospective analysis of medical records of patients presenting to the emergency department (ED) at Baylor University Medical Center (BUMC) who received a diagnosis of head and neck cancer (HNC) either in the ED or in the admission immediately after was performed for a 6-month pre- COVID-19 time period (September 2019-February 2020) and a 6-month post-COVID-19 time period (April 2020-September 2020). Data analysis of patient presentation and final diagnosis was performed. Analysis of total ED encounters at BUMC per month over both time periods was also performed. Result(s) A chart review of 892 patients found 217 HNCrelated admissions in the pre-COVID-19 period and 228 in the post. In the pre-COVID-19 period, 9 patients presented with a primary diagnosis of HNC either in the ED or upon subsequent admission, accounting for 4.1% of HNC-related admissions. In the post-COVID-19 period, 14 patients presented with a primary diagnosis of HNC either in the ED or upon subsequent admission, accounting for 6.1% of HNCrelated admissions. In the pre-COVID-19 period, 1.9 per 10,000 ED visits resulted in a diagnosis of HNC. Comparatively, in the post-COVID-19 period, 3.8 per 10,000 ED visits resulted in a diagnosis of HNC. There was a sharp increase in ED-related HNC diagnoses in May of 2020, with 6.9 per 10,000 ED visits resulting in a diagnosis of HNC. Of ED-related HNC diagnoses, 75% made in May of 2020 were stage IV at the time of diagnosis. Conclusion(s) There has been a significant increase in the amount of primary HNC diagnoses made in the ED or upon subsequent admission since the start of the COVID-19 pandemic. HNC diagnosed at ED presentation or upon subsequent admission are more likely to be late stage, highlighting delays in care secondary to the COVID-19 pandemic.