Managing head and neck cancer patients during the COVID-19 pandemic: the experience of a tertiary referral center in southern Italy

Abstract

Background The medical community has been deeply involved in fighting the Coronavirus disease 2019 (COVID-19) pandemic and, as a consequence, the care of non-COVID-19 patients has been impacted. However, the treatment of head and neck cancer patients is not deferrable, and an integrated strategy is required. The aim of the current article is to present the experience in the management of head and neck patients during the COVID-19 pandemic at the research hospital “Casa Sollievo della Sofferenza”. This review contains replicable and widely usable instructions on how to avoid delays in the diagnosis and treatment of head and neck tumors and to ensure a gradual return to elective procedures. Main text The Head and Neck Department of the research hospital “Casa Sollievo della Sofferenza” includes an Otolaryngology and a Maxillofacial Surgery Unit, both of which deal with the diagnosis and treatment of benign and malignant pathologies of the head and neck, as well as urgent/emergent consultations and surgical procedures that necessitate time sensitive operative management, such as cochlear implantation (CI). Given these premises and the complexity of the Department, the “COVID-19 organizing protocol” of the research hospital “Casa Sollievo della Sofferenza” was divided into two phases in accordance with the different stages of the pandemic and the priority of treatment. Special attention was given to the medical surveillance of health care workers and hospitalized patients, to the organization of the outpatient clinic and the operating setting as well as to the implementation of telehealth systems. Conclusions The COVID-19 pandemic is going to be a long-term situation with lasting effects on the public health and the entire society. Therefore, an efficient health care system has to adopt a double strategy: always being ready for a “new wave” of the pandemic and not forgetting non-COVID-19 patients, among whom head and neck cancer patients represent a priority. More than 1 year since the first outbreak in Wuhan, this review offers a unique and helpful perspective that incorporates awareness of the disease.

The increasing need of salvage and palliative surgery with microvascular free flaps for advanced head and neck cancers during COVID19 era

“…In a COVID-dedicated center, as it was in our experience, modification in the prioritization of surgical procedures, redistribution of human and economic resources, reduction of non-COVID-19-related health care, were just some of the challenges that upset our everyday clinical practice, similarly to other experiences described in Italy (21,22) . All the health providers experienced clinical, managing and ethical issues that are still burdening their everyday activity.…”

Analysis of the characteristics of outpatient and emergency diseases in the department of otolaryngology during the “COVID-19” pandemic

“…They believe that the COVID-19 pandemic has undoubtedly accelerated the change for future health care systems. 37 Telemedicine, artificial intelligence, and mobile apps will be used more frequently.…”

Primary care and cancer: an analysis of the impact and inequalities of the COVID-19 pandemic on patient pathways

“…This highlights how much breast cancer diagnosis relies on screening programmes which have suffered badly as a result of the pandemic in England36 and internationally 39. In England, head and neck cancers (HNC) saw a 10.2% (95% CI 7.6% to 12.7%) reduction in diagnosis, while studies in other geographies showed wide differences in the measures’ impact of the pandemic on HNC: a study in Ontario, Canada, found no evidence of a reduction in HNC diagnosis following an initial drop in the 6 weeks following lockdown,40 a clinic in Italy had just a 3.7% reduction in HNC,41 a 14% reduction in Belgium,29 a clinic in California showed a 22% reduction42 and a Cancer Centre in the North of England reported a 33% reduction in HNC cases 43. There is further international evidence of the impact of COVID-19 on interventions down the pathway, with reductions in radical cancer surgeries in two major cancer hubs in England and Italy 44…”