Impact of COVID-19 Pandemic on Patterns of Care and Outcome of Head and Neck Cancer: Real-World Experience From a Tertiary Care Cancer Center in India

Abstract

PURPOSE The COVID-19 pandemic has caused unprecedented health, social, and economic unrest globally, particularly affecting resource-limited low-middle–income countries. The resultant curfew had made the access to and delivery of cancer care services an arduous task. We have reported the patterns of care and 1-year outcome of head and neck squamous cell carcinoma (HNSCC) treatment before and during COVID-19 lockdown at our institution. MATERIALS AND METHODS Patients who underwent radiation therapy (RT) for nonmetastatic HNSCC between March 1, 2020, and July 31, 2020, were included in the COVID-RT group, and those who were treated between October 1, 2019, and February 29, 2020, were included in the preCOVID-RT group. RESULTS A total of 25 patients were in the COVID-RT group, and 51 patients were in the preCOVID-RT group. An increase in the incidence of locally advanced cancers across all subsites was observed in the COVID-RT group. There was a steep increase in the median overall RT treatment duration (52 v 44) and median break days during RT (10 v 2) in the COVID-RT group. The median follow-up period of all patients was 18 months. The progression-free survival at 1 year in the COVID-RT group and preCOVID-RT group was 84% and 90%, respectively ( P = .08), and overall survival at 1 year was 86% and 96%, respectively ( P = .06). CONCLUSION Our study elucidates the adverse impact of the COVID-19 curfew on cancer care and has demonstrated safe delivery of RT for HNSCC without major acute adverse effects. Despite a significant increase in treatment breaks, early outcome data also suggest that 1-year progression-free survival and overall survival are comparable with that of the pre–COVID-19 times; however, longer follow-up is warranted.

The COVID‐19 pandemic has not changed stage at presentation nor treatment patterns of head and neck cancer: A retrospective cohort study

“…However, our cancer network serves 2.4 million people or 46% of the national population, meaning that our data is likely to be representative of national trends. The immediate impact of the reallocation of healthcare provision and COVID‐19 public health measures internationally on HNC stage at diagnosis is remarkably consistent, with the studies comparing the 2019 and 2020 cohorts described above being carried out in 13 different countries from North America, Europe, Australia and Asia 5,10–21 . The time periods evaluated in our study coincide with the most severe COVID‐19 public health measures being eased in many countries, not just our own 25 .…”

“…Of these studies, 16 (70%) reported that patients did not present with more advanced disease during the pandemic in 2020. 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Furthermore, analysis of national cancer registry data showed that the incidence of HNC during 2020 was similar to what was observed in 2019, was in line with long term trends, and that patients were not presenting with more advanced disease during the pandemic. 22 Our study reinforces these findings but also indicates that the pandemic is unlikely to have caused longer‐term changes to disease stage or treatment.…”

“…The immediate impact of the reallocation of healthcare provision and COVID‐19 public health measures internationally on HNC stage at diagnosis is remarkably consistent, with the studies comparing the 2019 and 2020 cohorts described above being carried out in 13 different countries from North America, Europe, Australia and Asia. 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 The time periods evaluated in our study coincide with the most severe COVID‐19 public health measures being eased in many countries, not just our own. 25 It is likely therefore, that our study, the first to evaluate the impact of the pandemic on HNC diagnosis and treatment patterns at this later time point, is reflective of the situation internationally.…”

“…We identified 23 published observational studies comparing the stage of HNC cases of a 2019 cohort to a 2020 cohort. Of these studies, 16 (70%) reported that patients did not present with more advanced disease during the pandemic in 2020 5,10–21 . Furthermore, analysis of national cancer registry data showed that the incidence of HNC during 2020 was similar to what was observed in 2019, was in line with long term trends, and that patients were not presenting with more advanced disease during the pandemic 22 .…”

Impact of COVID-19 on Disease Progression and Postoperative Complications in Patients with Head and Neck Cancer

“…The doubling time of squamous cell carcinoma of the head and neck is short, so delays in diagnosis and treatment increase the risk of upstaging, inoperability, and more complex reconstructive procedures [ 5 , 6 ]. Optimal survival and functional outcomes are achieved with timely multidisciplinary intervention for head and neck cancer (HNC) patients [ 7 ].…”