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Development and validation of a Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN-HN) in a scarce resource setting: Response to the COVID-19 pandemic.
de Almeida, John R; Noel, Christopher W; Forner, David; Zhang, Han; Nichols, Anthony C; Cohen, Marc A; Wong, Richard J; McMullen, Caitlin; Graboyes, Evan M; Divi, Vasu; Shuman, Andrew G; Rosko, Andrew J; Lewis, Carol M; Hanna, Ehab Y; Myers, Jeffrey; Paleri, Vinidh; Miles, Brett; Genden, Eric; Eskander, Antoine; Enepekides, Danny J; Higgins, Kevin M; Brown, Dale; Chepeha, Douglas B; Witterick, Ian J; Gullane, Patrick J; Irish, Jonathan C; Monteiro, Eric; Goldstein, David P; Gilbert, Ralph.
  • de Almeida JR; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
  • Noel CW; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
  • Forner D; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
  • Zhang H; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
  • Nichols AC; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
  • Cohen MA; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
  • Wong RJ; Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
  • McMullen C; Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada.
  • Graboyes EM; Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.
  • Divi V; Department of Otolaryngology-Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
  • Shuman AG; Department of Otolaryngology-Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
  • Rosko AJ; Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida.
  • Lewis CM; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
  • Hanna EY; Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California.
  • Myers J; Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.
  • Paleri V; Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.
  • Miles B; Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
  • Genden E; Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
  • Eskander A; Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
  • Enepekides DJ; Head and Neck Unit, The Royal Marsden Hospital, London, United Kingdom.
  • Higgins KM; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Brown D; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Chepeha DB; Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
  • Witterick IJ; Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
  • Gullane PJ; Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
  • Irish JC; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
  • Monteiro E; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
  • Goldstein DP; Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada.
  • Gilbert R; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Cancer ; 126(22): 4895-4904, 2020 11 15.
Article in English | MEDLINE | ID: covidwho-704955
ABSTRACT

BACKGROUND:

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, access to surgical care for patients with head and neck cancer (HNC) is limited and unpredictable. Determining which patients should be prioritized is inherently subjective and difficult to assess. The authors have proposed an algorithm to fairly and consistently triage patients and mitigate the risk of adverse outcomes.

METHODS:

Two separate expert panels, a consensus panel (11 participants) and a validation panel (15 participants), were constructed among international HNC surgeons. Using a modified Delphi process and RAND Corporation/University of California at Los Angeles methodology with 4 consensus rounds and 2 meetings, groupings of high-priority, intermediate-priority, and low-priority indications for surgery were established and subdivided. A point-based scoring algorithm was developed, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN-HN). Agreement was measured during consensus and for algorithm scoring using the Krippendorff alpha. Rankings from the algorithm were compared with expert rankings of 12 case vignettes using the Spearman rank correlation coefficient.

RESULTS:

A total of 62 indications for surgical priority were rated. Weights for each indication ranged from -4 to +4 (scale range; -17 to 20). The response rate for the validation exercise was 100%. The SPARTAN-HN demonstrated excellent agreement and correlation with expert rankings (Krippendorff alpha, .91 [95% CI, 0.88-0.93]; and rho, 0.81 [95% CI, 0.45-0.95]).

CONCLUSIONS:

The SPARTAN-HN surgical prioritization algorithm consistently stratifies patients requiring HNC surgical care in the COVID-19 era. Formal evaluation and implementation are required. LAY

SUMMARY:

Many countries have enacted strict rules regarding the use of hospital resources during the coronavirus disease 2019 (COVID-19) pandemic. Facing delays in surgery, patients may experience worse functional outcomes, stage migration, and eventual inoperability. Treatment prioritization tools have shown benefit in helping to triage patients equitably with minimal provider cognitive burden. The current study sought to develop what to the authors' knowledge is the first cancer-specific surgical prioritization tool for use in the COVID-19 era, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN-HN). This algorithm consistently stratifies patients requiring head and neck cancer surgery in the COVID-19 era and provides evidence for the initial uptake of the SPARTAN-HN.
Subject(s)
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Triage / Coronavirus Infections / Betacoronavirus / Head and Neck Neoplasms / Health Resources Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Cancer Year: 2020 Document Type: Article Affiliation country: Cncr.33114

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Triage / Coronavirus Infections / Betacoronavirus / Head and Neck Neoplasms / Health Resources Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Cancer Year: 2020 Document Type: Article Affiliation country: Cncr.33114