Respiratory and pulmonary complications in head and neck cancer patients: Evidence‐based review for the COVID‐19 era

Abstract

Background: Pulmonary complications and infections frequently affect patients with head and neck squamous cell carcinoma (HNSCC). Common characteristics can predispose these patients to the development of severe respiratory illness, which may be particularly relevant during the 2019 coronavirus disease (COVID-19) pandemic. Methods: A scoping review was performed to assess the impact of pulmonary comorbidities and adverse respiratory outcomes in HNSCC patients. Results: Advanced age, history of tobacco and alcohol abuse, and cardiopulmonary comorbidities are significant risk factors for the development of adverse respiratory outcomes. Treatment toxicities from radiation or chemoradiation therapy significantly increase these risks.Conclusion: Respiratory complications are a frequent cause of morbidity and mortality among HNSCC patients, and the COVID-19 pandemic may disproportionately affect this population. Interventions designed to decrease smoking and alcohol use, improve oral hygiene, and aggressively manage medical comorbidities are important to the long-term management and health of these patients. K E Y W O R D Sadverse respiratory outcomes, COVID-19, head and neck squamous cell carcinoma (HNSCC), pulmonary comorbidities, respiratory infections and complications

Coronavirus Disease-19

“…Head and neck cancer patients are an at-risk group for several reasons. Silverman and colleagues 39 point out that head and neck cancer patients tend to present with advanced age, history of tobacco and alcohol abuse, and cardiac and pulmonary comorbidities, which are similarly found in COVID-19. Risk of respiratory sequelae in patients who have received chemotherapy and/or radiation therapy are high, with increased rates of dysphagia, aspiration, and pneumonia.…”

“…Additionally, head and neck cancer patients have an increased risk of respiratory infections and aspiration pneumonitis. 39 These factors may expedite deterioration to severe adverse events in patients with COVID-19. Additionally, head and neck patients who are actively receiving chemotherapy or immunotherapy may have depressed immune function, malnutrition, and older age.…”

Recommendations for head and neck surgical procedures during the COVID-19 pandemic

“…The highest rate of pulmonary complications and mortality from COVID-19 is in patients with the following characteristics: male, more than 70 years old, and with a history or current diagnosis of cancer and pneumopathy. Patients with head and neck cancer often have some, if not all, of these conditions: they usually have a history of smoking and drinking, impaired lung reserve, and greater susceptibility to infections, including aspiration pneumonia (64). Thus, the presence of fever and respiratory problems becomes a diagnostic challenge, as it is difficult to distinguish between pulmonary atelectasis and viral pneumonia (60).…”

Besonderheiten in der Behandlung von Patienten mit Kopf-Hals-Karzinomen in Zeiten der COVID-19-Pandemie

“…Schließlich ist die Neoadjuvanz im Sinne des klassischen TPF-Schemas aufgrund des immunsuppressiven Charakters nur mit Zurückhaltung und in ausgesuchten Szenarien einzusetzen [2]. Prinzipiell gilt, dass Patienten mit Kopf-Hals-Karzinomen aufgrund ihres immunkompromittierten Status besonders vulnerabel für einen fatalen Verlauf von COVID-19 sind [15,18,19].…”