Evaluation of patient navigation and delivery of head and neck cancer therapy during COVID-19 pandemic: A single institution experience.
Authors: Sherri Rauenzahn Cervantez, Ruben A. Mesa, Jeremy Viles, Mary Salazar, Leslie Villarreal, Mark Bonnen, Joshua Asper
Journal: Journal of Clinical Oncology (2021)

e13510 Background: The COVID-19 (COVID) pandemic presents many challenges to cancer patient treatment. Care coordination pathways are more complex to ensure safe screening and monitoring for COVID while reducing person-to-person interaction. The oncologic management of head and neck cancer (HNC) involves an interdisciplinary workflow. Time from diagnosis/specialized oncologic referral to initiation of treatment is critical for optimal outcomes. The insertion of any additional rate limiting factor could drastically increase the timeliness to care. Our study evaluates the effectiveness of patient navigation and the impact of institutional COVID process on timeliness to treatment. Methods: Operational workflow changes were set in place with goal of obtaining COVID testing prior to initiation of therapy. Patients with COVID symptoms after initial clearance were subjected to additional COVID testing. COVID screening was obtained in a single location when feasible. COVID positive or patients with pending results were triaged to determine risk/benefits of delaying treatment initiation and CDC guidelines for safe administration of therapy were considered. Patients with pending or positive results, but acute situation, were treated after hours in full PPE gear in order to reduce exposure risks. Results: Navigation information for 88 HNC patients were collected from 1/1/20 to 1/1/21. All patients were treated with curative intent. COVID testing data were collected contemporaneously with the pandemic from 4/1/20 to 1/31/21. Thirty patients with HNC required coordination of CMT and completed COVID screening test an average of 19 days prior to the start of therapy (29 negative; 1 positive). Two (6%) patients received their screening results after therapy initiation. Four patients did not complete therapy (13%); 26 completed (86%). Patients treated with radiation averaged 31 treatments (range 30-35) each treatment indicative of an aerosolized risk exposure. Each infusion representing and aerosolized and IV risk exposure. During the course of care we experienced zero patient-to-staff contracted COVID positives. Five staff members tested positive for COVID however contact tracing indicated outside source. Prior to the pandemic, average time from referral to appointment (TRA) with oncology specialist was 14.62 days, time from first appointment with oncology specialist to first treatment modality (TAT) was 46.29 days, and time from referral to our center and initiation of first treatment (TRT) was 60.91 days. During the pandemic, from March 2020 to May 2020, average TRA was 10.51 days, TAT was 24.09 days, and TRT was 34.6 days. Conclusions: Appropriate navigation, protocols and team vigilance resulted in improved timeliness to treatment. Continued delivery of oncologic care to HNC patients can be achieved without increased patient or staff risk for contraction of COVID.