Treatment strategies for head and neck tumors in cancer-specialized hospital amid the novel coronavirus (COVID-19) pandemic: a report of 38 cases

ABSTRACT

Background and Aims: The novel coronavirus (COVID-19), discovered in December 2019, has now spread throughout the world. Studies have shown that patients with cancer have a higher risk of COVID-19 and are more likely to develop severe symptoms and progress to exacerbation. Head and neck tumors, as the major disease entities to be encountered in a cancer-specialized hospital, have a large number of cases of complex disorders, and some of them are highly malignant with rapid progress, for which the treatment cannot be delayed. Moreover, the operations involving the mouth, throat and airway are unavoidable during the diagnosis and treatment process of head and neck tumors, which may increase the risk of COVID-19 infection between doctors and patients. Therefore, this study was conducted to mainly investigate the appropriate diagnosis and treatment of head and neck tumors and prevention and control strategies of COVID-19 in a cancer-specialized hospital amid the COVID-19 pandemic. Methods: The clinical data of 38 patients with head and neck malignant tumors admitted for therapy by scheduled appointment in Zhejiang Cancer Hospital from February 1th, 2020 to February 22rd, 2020 were retrospectively analyzed. In our center, the time-phased appointments were implemented, patients were appropriately diverted based on the diagnosis and treatment guidelines and clinical practice, and the hospitalization indications were rigorously adhered to. All admitted patients received surgery or chemotherapy on the premise of exclusion of COVID-19 by detailed epidemiological investigation, nucleic acid detection and chest CT scan. During hospitalization, the epidemic prevention and control measures were strictly implemented, the treatment process was carefully observed, and the temperature monitoring and management were paid particular attention. After discharge, the outcomes of patients were followed up and the patients received medical advice and post-discharge treatment through internet-based hospitals or other online channels. Results: Among the 38 patients with head and neck tumors, 17 cases were males and 21 were females, with an average age of 49 years. There were 21 cases of thyroid cancer, 6 cases of oral malignancies, 3 cases of salivary gland cancer, 2 cases of laryngeal cancer, 2 cases of hypopharyngeal cancer, and 1 case each of cervical esophageal cancer, lymphoma, nasopharyngeal cancer and of angiosarcoma. COVID-19 was excluded in all 38 patients upon admission. Thirty-one patients underwent surgical treatment and the other 7 patients were subjected to chemotherapy. Fever occurred in 3 patients during the process of treatment, which included fever associated with agranulocytosis in 1 case, fever caused by tumor necrosis and infection in 1 case and fever caused by wound infection in 1 case. Patients generally had an uneventful treatment course and recovered well. No COVID-19 infection was found in patients and medical staff during hospitalization and at the end of 2 weeks after discharge from hospital. Conclusion: In the situation of COVID-19 pandemic, rational distribution of patients as well as scientific prevention and control based on the diagnosis and treatment guidelines and clinical practice, making full use of the advantages of "internet + medical service", to protect cancer patients from virus while engage in the fight against the epidemic, providing psychological support to the patients, and minimizing the impact of the epidemic on treatment and ensuring the continuity of treatment are feasible strategies for the clinical treatment of head and neck tumors. © 2020 by the Author(s).