The impact of COVID‐19 on head and neck cancer diagnosis and disease extent

Abstract

Background Due to COVID‐19, diagnostic delays and a surge of advanced head and neck cancer (HNC) is anticipated. We hereby evaluate patient and tumor characteristics before and during the early COVID‐19 period. Methods Retrospective review of patients with HNC presented at a multidisciplinary tumor conference from May 14, 2020 to June 18, 2020 was performed and compared to a similar 6‐week period a year before. Demographics, time to diagnosis, and tumor characteristics were analyzed. Results There was a 25% reduction in newly diagnosed malignancies. Groups were similar in baseline characteristics, duration of symptoms, and time to diagnosis. However, median primary tumor size was significantly larger ( p = 0.042) and T stage more advanced for mucosal subsites ( p = 0.025) in the COVID‐19 group. Conclusion Our findings suggest increased tumor burden in patients with HNC presenting during the pandemic, despite a similar time to diagnosis. This may become more pronounced as the pandemic duration is extended.

Impact of COVID-19 on presentation, staging, and treatment of head and neck mucosal squamous cell carcinoma

“…Consistent with previous reports [3] , overall number of patient encounters decreased during the initial stages of the pandemic. Contrary to what has been previously reported [7] , we report stability in number of patients presenting with new head and neck malignancies. The proportional increase in patients with malignant diseases, decrease in benign patient visits, and decrease in time from referral to initial clinic visit for mucosal SCC patients suggests that there were more available head and neck surgical oncology clinic appointments, likely due to less patients with benign pathology seeking medical care during the early months of the pandemic.…”

“…Despite more advanced clinical nodal staging for our cohort, T staging was not significantly more advanced during the pandemic. This is in contrast to a prior study by Kiong et al which used similar methods over only a six-week period during the pandemic and found that in a smaller cohort, mucosal SCC patient's median primary tumor size was greater and T stage was more advanced during the pandemic [7] . It is important to note that our cohort consists of a higher proportion of oral cavity and larynx subsite patients compared to the paper by Kiong et al of which nearly half the mucosal SCC patients were oropharynx.…”

“…For many solid malignancies, treatment delays have been reported and patient encounters for cancer treatment have decreased during the pandemic [4] , [5] , [6] . There have been reports of delays associated with head and neck cancer care [7] , [8] , although there is minimal evidence around how delays impact oncologic care. Patients themselves acknowledge delaying cancer care due to pandemic-related concerns [9] .…”

Urgent call to prevent late stage presentation of head and neck cancer

“…Access to both primary medical and dental services is currently limited and patients with head and neck cancer will be missing lifesaving opportunities for detection. One US study in May 2020 reported a 25% reduction in newly diagnosed head and neck malignancy and the median primary tumour size was statistically significantly larger 5. Similar evidence was observed in Turin, Italy, during their March 2020 lockdown when they received significantly fewer urgent referrals and diagnosed only 12% of predicted head and neck oncology caseload 6…”

Impact of COVID-19 on Head and Neck Cancer Advancement Measured by the Increasing Numbers of Acute Dyspnea Cases. What Can be Improved for the Future?

“…In developed countries, the use of inpatient care and subsequent hospitalization de cit in oncology was estimated to be 7%-35% [19][20][21][22]. All oncological subspecialties in the US experienced signi cant decreases in new patient visits and surgery capacity during COVID-19 [23], with a 25% reduction in newly diagnosed head and neck malignancies [24].…”