What is the best treatment option for head and neck cancers in COVID-19 pandemic? A rapid review

Abstract

With the onset of the COVID-19 crisis in late 2019, the health care systems of different countries are experiencing stressful conditions. Many patients need care in hospital wards and intensive care units (ICU). Head & neck cancers (HNC) are in a special condition in this pandemic. The main treatment in these patients is surgery. Most of these patients need care in the ICU, which is reduced in capacity in pandemic conditions. It's important to note that delays in the surgery of these patients make them non-operable and on the other hand increase mortality and morbidity. Numerous non-surgical alternative therapies have been proposed in these conditions, but there are fundamental questions about these suggestions. 1 How long should we look for alternative therapies? Because many countries are facing a second wave of the disease. 2 What's the effect of these alternative therapies and the delay in starting standard treatments in patients' survival? Different countries have different financial resources; many countries, patients face restrictions on receiving alternative therapies to standard treatments, and in non-pandemic conditions, long queues are given for non-surgical treatments such as chemo-radiotherapy. There are numerous guidelines to guide head and neck surgeons to the best choice in this situation. It seems that different countries have to make individual decisions based on the prevalence of COVID-19 and the financial resources and facilities of the health care system. In this review article, we have collected the opinions of world-renowned guidelines and institutions on how to treat HNCs during the pandemic.

Impact of the COVID-19 pandemic on head and neck cancer diagnosis: data from a single referral center, South Tyrol, northern Italy

“…Surgery is the main course of treatment for most HNCs, and after the outbreak, waiting lists were inevitably prolonged as a result of reallocation of anesthesiologists and reassignment of intensive care units (ICUs) into COVID-19 wards for treatment of the most severe COVID 19 cases. As a result, the delay in diagnosis and treatment could lead to more aggressive surgical procedures, with increasing morbidity and increased risk of recurrence, or to a tumor shift to a non-resectable disease, with an associated increase in mortality [6].…”

“…In most HNC cases, early diagnosis represents the boundary between less and more aggressive surgery, or between resectability and non-resectability of the disease, with a consequent increase in morbidity and mortality [6].…”

Outcomes of head and neck cancer management from two cancer centres in Southern and Northern Europe during the first wave of COVID-19

“…33,35 However, this strategy may have caused some drawbacks, because it has been found that patients with cancer contracting SARS-CoV-2 may have worse oncologic outcomes due to both a possible delay of treatments while waiting to become seronegative and a worsening of the patients' already fragile Performance Status. 32,36,37 The prevalence of COVID-19 among patients with cancer is unclear. Lai et al reported that 1% of patients with COVID-19 had a history of cancer, 36 whereas Yu et al estimated an 0.79% infection rate of SARS-CoV-2 in patients with cancer.…”

Strategic planning for maxillofacial trauma and head and neck cancers during COVID-19 pandemic– December 2020 updated from Germany

“…We read with great interest the review on otorhinolaryngology/head and neck surgery (ORL-HNS) practice during the COVID-19 pandemic recently published in this journal by Salari [ 1 ]. We would like to share our current protocol for organizing ORL-HNS patient care in Germany (updated in December 2020) ( Fig.…”