Evaluating the impact of the coronavirus(COVID-19) pandemic on treatment paradigms in headand neck cancer at a tertiary care hospital
Authors: Joshua A. Thompson, Reju Joy, Joshua E. Lubek, Ranee Mehra, Jason K. Molitoris, Rodney J. Taylor, Jeffrey S. Wolf, Matthew E. Witek, Kyle M. Hatten
Journal: Clinical Cancer Research (2020)

Objective: The study aimed to assess the impact of the coronavirus (COVID-19) pandemic on head and neckoncologic care at a tertiary care hospital  The pandemic caused by the novel severe acute respiratory syndromecoronavirus (SARS-CoV-2) has led to policies designed to limit its spread  Policies including eliminating routineappointments, statewide stay-at-home orders, and restricting surgical cases to emergent surgeries have limitedaccess to care  Therefore, we hypothesized that treatment modifications would be implemented for patients andcancer consultations would decrease compared to historical data  Methods: Information regarding treatment modifications was collected prospectively during interdepartmental tumorconferences from March 18, 2020 to May 20, 2020  Information regarding patient demographics, tumorcharacteristics, and incidence of new cancer consultations was collected via chart review  Treatment modifications were categorized as follows: Elimination of Systemic Therapy, Treatment Delay, Change to Non-SurgicalManagement, or Alteration in Adjuvant Therapy  Rationales for modification were similarly grouped as follows:Operating Room Limitations, Medical Co-Morbidities, COVID-19 positive, Patient concern, or System limitations  Wedetermined the rate of treatment modifications and the frequencies of rationales and modification types  Demographic and tumor characteristics were compared between this population and a retrospectively collectedcohort from 2019  Results: 117 patients were presented during the review period in 2020  There were 69 patients presented acrossthe same time period in 2019  There were no differences in demographic characteristics between the groups  There was no difference between the tumor or nodal stages of the presented cases year over year  During the 2020 timeperiod there were more total case presentations and new cancer cases compared to the 2019 time period  Of the117 cases presented during the study period, there were 10/117 (8 4%) treatment modifications  The most commonreason for modification was limited PPE supply  The most common modification was treatment delay  The secondmost common modification was change from primary surgical management to nonsurgical management  Treatmentmodifications occurred most commonly early in the review period and declined subsequently  Conclusions: Despite the ongoing pandemic and resulting state and institutional restrictions, there was noappreciable reduction in new cancer consultations for head and neck cancer  There were a small number oftreatment modifications, particularly early in the course of our state and institutional response to the virus  However, over the 2-month period examined, patient care for these patients remained largely unaffected  While the restrictionin elective surgical care was implemented across the state of Maryland, the oncologic triage and emergency surgeryprioritization sustained the volume of oncologic practice