Analysis of Early Impact of COVID-19 on Presentation and Management of Oral Cancers – an Experience from a Tertiary Care Hospital in South India

Abstract

Oral cancers are the leading cause of cancer-related death in Indian men. Currently steps to contain the transmission and treatment of COVID-19 pandemic have crippled the entire health care system. With hospitals running short of resources, the oncological practice became standstill, especially during the initial phase. This is a retrospective study among patients who presented to our tertiary care hospital in early 3 months of COVID-19 era(ECE) with respect to pre-COVID-19 era(PCE). The study includes patients discussed in multidisciplinary tumor board(MDT)(421 in ECE Vs 31 in PCE) and those who underwent surgery(192 in ECE Vs 26 in PCE). The presentation and outcomes of oral carcinoma were compared between the two eras. There was a significant drop in the number of patients who presented during ECE. Though mean age and gender remained comparable between groups, there was a statistical difference in relation to demographic profile of patient ( p value < 0.001). Among operated during ECE, 80% had a significantly advanced tumor stage ( p value < 0.034) and advanced composite stage ( p value < 0.049). Among patients discussed in MDT during ECE, 38.7% were deemed inoperable which is double the number when compared with PCE ( p value < 0.009). Results of our study showed a higher incidence of advanced stage disease during ECE, with many patient turning inoperable. Thus, the survival of newly diagnosed oral carcinoma patients will be worser. In the management of oral cancer both early stage and advanced stage should have the same priority. Immediate resumption of safe oncology services is mandatory to curtail the current issues.

The Effects of the COVID-19 Pandemic on Cancer Staging in Patients Diagnosed With Head and Neck Cancer

“…Similar findings were seen in patients presenting at a major cancer center in the United States; there was a statistically significant increase in tumor size and T stage seen in the early months of the pandemic (May-June 2020) compared to the same period from 2019 [12]. In addition, in a study specific to oral cancers, an analysis of patients at a tertiary care hospital in South India found a statistically significant increase in advanced T stage from April 2020 through June 2020 compared to the same period from 2019 [9]. The same was also true in a series of oral cavity cancer patients treated at Heidelberg University Hospital in Germany in 2020 when compared to patients from 2010-2019 [8].…”

“…The number of diagnostic procedures for detecting cancer and patients diagnosed with several different types of cancer, including breast, colorectal, lung, pancreatic, and gastric cancers, was lower than the numbers prior to the pandemic [11]. Specifically for head and neck cancers, two studies demonstrated a decrease in the number of patients presenting for care of head and neck cancers in the early months of the pandemic [9,12]. Our study showed similar findings; there was a decrease in the number of consults per month between January 2020 and May 2020, decreasing from 12 consults per month to 1 consult per month.…”

“…With fewer consults and diagnoses throughout the pandemic, patients may present initially with more advanced-stage cancers and higher rates of more advanced-stage cancer might ultimately lead to higher morbidity and mortality rates for these patients. Multiple studies have suggested a higher rate of advanced-stage cancers [6][7][8][9][10], but overall impacts and survival rates have not yet been studied [3].…”

Effects of the COVID-19 Pandemic on Head and Neck Cancer Stage and Treatment Duration

“…In our cohort, we noticed a slight prolongation (median 15 weeks, not statistically significant) from the first symptom related to the oncologic disease till diagnosis, reflecting limitations in primary care or a change in patients’ behaviour [ 3 ]. Significant delays in cancer diagnosis have been observed in Turkey [ 18 ] and India [ 19 ], indicating compromised accessibility to health services (Table 3 ). On the other hand, in the USA [ 20 ], the median duration of the first visit remained constant at 12 weeks.…”

“…Five out of seven published studies reported more advanced T-and N-stages of HNC patients during the pandemic [18][19][20]22,24]. Despite severe pressure on health services in northern Italy during the beginning of the virus spread, D'Ascanio et al [25] did not notice any shift to more advanced cancer stages during this period.…”