Reduction in healthcare services during the COVID-19 pandemic: Patient screening based on symptoms is an effective strategy for avoiding delayed laryngeal cancer diagnosis

Abstract

Objective Restriction in healthcare services during the COVID-19 pandemic caused delays in the diagnosis and treatment of several diseases. To overcome the risk of missed diagnosis of head and neck cancers, before deleting the scheduled appointments, we have introduced a selection of the patients by examining the clinical presenting issue and previous medical history. The aim of this study is to show the effects of the abovementioned strategy on the diagnosis and management of laryngeal cancer. Methods Data were extracted from the Hospital software regarding the new diagnosis of laryngeal SCC in the periods from March 2020 to December 2020 during the pandemic (study group) and from March 2019 to December 2019 (control group) were collected. Data were compared regarding: TNM stage, time from first medical examination to histological diagnosis ( Time-1 ), and time form histological diagnosis to beginning of treatments ( Time-2 ). Results The final study group was composed by 19 laryngeal cancers, the control group by 25 cases. No significant differences were found in the tumour stage between the groups. In the study group, Time-1 was shorter (24 days versus 43 days, p = 0.012), while Time-2 in surgically-treated patients was longer (20 days versus 9 days, p = 0.012). Conclusion During the pandemic, there was a dramatic lack of medical and nurse staff needed for surgical procedures. As consequence, the time between the diagnosis of malignancy and surgical treatment increased. In our unit, an efficient patient selection strategy to reschedule medical appointments avoided a dangerous shift toward higher laryngeal cancer stages.

Impact of the COVID-19 Pandemic on Access to Cancer Surgery: Analysis of Surgical Wait Times in British Columbia, Canada

“…The virus was initially underestimated in Italy, which led to an emotional efficiency to overcome the outbreak, diverting attention away from cancer patients. 4,6,28…”

The effect of COVID-19 pandemic on laryngeal cancer in a tertiary referral center

“…Murri et al evaluated the numbers of laryngeal SCC patients during the pandemic and compared them with the patients attended before the pandemic [ 11 ]. The authors concluded that there were 19 laryngeal cancers in the post-pandemic group and 25 patients in the before the pandemic group.…”

“…No significant differences were observed regarding the tumor stage between the study groups. However, they reported an increase in the time between cancer diagnosis and surgical treatment [ 11 ].…”

Risk of SARS-CoV-2 contagion in otolaryngology specialists

“…The drastic reduction of the routine activity of otolaryngology units had a dramatic impact on the services offered to patients during the pandemic. Scheduled visits and elective surgeries were postponed; this situation, associated with the patients’ fear to contract the infection inside the hospital, led to a delay in the diagnosis and treatment of several diseases, including head and neck cancer, with a dangerous shift toward more advanced cancer stages and potential upstaging of TNM classification 26 , 27 .…”

“…To reduce the risk of missing or delayed oncological diagnosis, oncology centres began performing a selection of scheduled visits by examining the symptoms reported and previous medical history 26 . The most frequent criteria found in the literature to select patients were history of malignant cancer, dysphonia and persistent dysphagia, cervical masses of new onset, dyspnoea, recent body weight loss and bleeding from the upper aerodigestive tract.…”