Head and neck virtual medicine in a pandemic era: Lessons from COVID-19

Head and neck cancer surveillance: The value of computed tomography and clinical exam

PURPOSE

The recurrence of head and neck cancer (HNC) is most prevalent during the initial two years following curative treatment, underscoring the criticality of regular surveillance for HNC survivors. This study aims to evaluate the effectiveness of computed tomography (CT) imaging and clinical physical examination (CE) in HNC surveillance, assessing whether these imaging protocols meet the current treatment limitations confronting HNC specialists.

METHODS

Retrospective chart review of a 9-year experience with head and neck cancer patients at a single, academic tertiary care center. Demographic data was collected along with data regarding whether the recurrences were detected primarily through CE, flexible endoscopic exam (scope exam), or CT or CT/PET scan. Subsets of the data were analyzed and compared by sensitivity, specificity, and negative predictive values.

RESULTS

264 HNC patients were identified. 72 total recurrences (27 %) were noted. The method of initial detection spurring further investigation was imaging in 42 (58.3 %) patients, CE (33.3 %) in 24 patients, scope exam in 6 (8.4 %) patients. Overall, 65 (90.3 %) patients had imaging that showed recurrence regardless of method of initial detection. Sensitivity, (87.1 % vs 70.5 %), and specificity (93.95 % vs 96.9 %) were noted for CT and CE respectively. Combined sensitivity and specificity for CT and CE was 96.2 % and 91.05 % respectively.

CONCLUSION

The data suggests that imaging could provide sufficient methods of HNC surveillance despite limitations the COVID-19 pandemic presents.

Outcomes of remote versus face-to-face ear, nose and throat outpatient consultation on patient pathways

INTRODUCTION

Remote consultation has potential benefits in increasing patient pathway efficiency and has been found to reduce costs and carbon emissions. Previous studies of remote consultation in ear, nose and throat (ENT) practice have reported mixed results and used relatively small sample sizes. The aim of this article is to study the impact of remote telephone consultation on ENT clinic outcomes and pathway efficiency, compared with in-person review, within new and follow-up patient cohorts and subspeciality, where previous studies demonstrate mixed and inconclusive results.

METHODS

This was a comparison of remote clinic appointment outcomes over a 2-month period from a single ENT referral centre (426) with an equivalent data set of face-to-face clinic appointments over a similar time frame (1,533). Statistical analysis included chi-squared test for clinic outcomes and two-sample t-squared test for mean hand-off between both cohorts (p < 0.05).

RESULTS

For new referrals, remote consultation was associated with statistically significantly greater rates of follow-up (p < 0.00001), investigation (p = 0.00251) and hand-off (p < 0.00013) than patients seen face-to-face - particularly where presenting with head and neck symptoms. For follow-up patients, remote consultation had similar rates of investigation (p = 0.11071) or further follow-up (p = 0.08) and mean hand-off (p < 0.11764) to those seen face-to-face.

CONCLUSIONS

Remote consultation in ENT could become the norm for follow-up patients, but should be used with caution in the initial consultation of new patients.

Impact of the COVID-19 Pandemic Period on Patients with Head and Neck Carcinoma: A Systematic Review

INTRODUCTION

The COVID-19 pandemic has significantly impacted all public life and the global economy. Since its discovery, the disease has spread rapidly, which led to an unprecedented public health crisis and the adoption of extreme measures to limit community and hospital spread. As a result of a confluence of extraordinary circumstances caused by this pandemic, the doctrines of treatment for patients with head and neck carcinoma had to be reanalyzed, guaranteeing the well-being of both patients and health professionals as well as society itself.

OBJECTIVE

The aim of our systematic review was to study the impact of the COVID-19 pandemic period on head and neck cancer patients, the effects on the health care provided and on patient health.

MATERIALS AND METHODS

This systematic review was based on the PRISMA guidelines and PICO strategy, with the focus question, "How has the COVID-19 pandemic period conditioned the treatment of patients with head and neck carcinoma?" Thus, electronic research was carried out on six databases: LILACS, PubMed/MedLine, Web of Science, the Cochrane COVID-19 Study Register, Scielo, and Scopus, aiming to answer the research question by considering the objective and defined criteria. The following information was extracted: author and year of the publication, patients' age, gender, time until the first appointment, time from the first appointment to the surgery, the period in the hospital, time in intensive care, TNM, general stage of cancer, diagnostic procedures, oncological procedures, reconstructive surgery, and postoperative complications.

RESULTS

Initially, 837 articles were found. After removing duplicates, we obtained 471 studies. After screening by title and abstract, 67 articles were selected for full-text reading (k = 92) in order to assess their eligibility. Thus, nine articles were included (k = 1.0). All data and statistical results were obtained and contrasted. The included studies made it possible to reveal distinct impacts felt in different institutions of several countries, not allowing generalizable conclusions to be drawn. However, some of the variables analyzed are worrying, namely, the limitations that occurred in some types of oncological surgeries, as well as the increase in the number of patients admitted with higher TNM classifications and more debilitated general conditions.

CONCLUSION

Within the limitation of this review, the results showed efforts made to prevent the pandemic from affecting the healthcare provided. There were no significant differences in days inside the intensive care unit, postoperative complications, and, in most cases, length of stay in the hospital. There were no differences in the number of patients admitted with a history of recurrence or neoadjuvant treatment. However, some variables raise concerns, such as the increase in patients with more advanced stage and TNM classification and a decrease in certain oncological procedures.

Feasibility and efficacy of telerehabilitation in the management of patients with head and neck cancer during and after oncological treatment: A systematic review

PURPOSE

The aim in this review was to evaluate recent advances in telerehabilitation for the management of patients with head and neck cancer (HNC) during and after their oncological treatment.

METHODS

A systematic review was carried out in three databases (Medline, Web of Science and Scopus) in July 2022. The methodological quality of randomised clinical trials and quasi-experimental ones was assessed using the Cochrane tool (RoB 2.0) and the Critical Appraisal Checklists of the Joanna Briggs Institute, respectively.

RESULTS

14 out of 819 studies met the inclusion criteria: 6 studies were randomised clinical trials, 1 was a single-arm study with historical controls and 7 were feasibility studies. Most studies reported high participant satisfaction and efficacy of telerehabilitation used, in addition, no adverse effects were reported. None of the randomised clinical trials achieved a low overall risk of bias, whereas the methodological risk of bias of the quasi-experimental studies was low.

CONCLUSIONS

This systematic review demonstrates that telerehabilitation offers feasible and effective interventions for the patients with HNC follow-up, during and after their oncological treatment. It was observed that telerehabilitation interventions should be personalised according to the patient's characteristics and the stage of the disease. Further research on telerehabilitation to support caregivers as well as to carry out studies with a long-term follow-up of these patients are imperative.

The Effects of the COVID-19 Pandemic on Cancer Staging in Patients Diagnosed With Head and Neck Cancer

Purpose The healthcare system across the world was forced to implement new policies, guidelines, and procedures due to the coronavirus disease 2019 (COVID-19) pandemic, which led many patients to make an impossible choice about their health. For various reasons, many patients chose to remain at home and delay any interaction at medical facilities to protect themselves or others from the virus. Patients managing chronic diseases faced unprecedented challenges during this period, and the long-term effects on these patient populations remain unclear. Oncology patients, specifically those diagnosed with head and neck cancers, require prompt diagnosis and initiation of treatment for better outcomes. While the overall impact of how the pandemic has affected oncology patients is unknown, this retrospective study examined how the staging of head and neck tumors at our institution has been impacted since the beginning of the pandemic. Methods Available patient data (from August 1, 2019, through June 28, 2021) were collected from medical records and compared to determine statistical significance. Patients were categorized into a Pre-pandemic group, Pandemic group, and Vaccine-approved group, and patient and treatment characteristics were analyzed to look for patterns. The pre-pandemic period was defined as the period from August 1, 2019, to March 16, 2020, the pandemic period was defined as the period from March 17, 2020, to December 31, 2020, and the vaccine-approved period was defined as the period from January 1, 2021, to June 28, 2021.  Results Fisher's exact tests were used to compare tumor, node, metastasis (TNM) staging distributions between the three groups. In the Pre-pandemic group, out of 67 patients, 33 patients (55.0%) were diagnosed with a T stage of 0-2 and 27 patients (45.0%) were diagnosed with a T stage of 3-4. In the Pandemic and Vaccine-approved groups, out of 139 patients, 50 patients (39.1%) were diagnosed with a T stage of 0-2 and 78 patients (60.9%) were diagnosed with a T stage of 3-4; these differences were statistically significant (P-value = 0.0426). The Pre-pandemic group had 25 patients (41.7%) diagnosed with a group stage of 0-2 and 35 patients (58.3%) diagnosed with a group stage of 3-4. The Pandemic and Vaccine-approved groups had 36 patients (28.1%) diagnosed with a group stage of 0-2 and 92 patients (71.9%) diagnosed with a group stage of 3-4; these results trended to statistically significant (P-value = 0.0688). Conclusions Our findings suggest that there have been a higher number of patients with head and neck cancer diagnosed with a T stage of 3 or 4 since the start of the COVID-19 pandemic. The effects of the COVID-19 pandemic are ongoing and will need further evaluation to determine the overall effects on oncology patients. Increased morbidity and mortality rates may be a potential result in the years to come.

The Effectiveness of Remote Consultations During the COVID-19 Pandemic: A Tool for Modernising the National Health Service (NHS)

Objective The coronavirus disease 2019 (COVID-19) pandemic prompted major changes to the delivery of care. There was a move towards remote consultations in order to mitigate the risk of viral exposure and the risk of delaying care. Remote consultations will play a prominent role within the National Health Service (NHS) in the future. This project aimed to evaluate the effectiveness of remote consultations relative to face-to-face (F2F) consultations. Methods A local retrospective audit of remote consultations in ENT was performed by comparing outcome data for video and telephone appointments during the first peak of the pandemic to outcomes for F2F consultations during the same months of the preceding year. Chi-square tests were employed to determine whether there was any statistically significant discrepancy between the two modalities. Results Outcomes from a total of 314 patient consultations were reviewed. One hundred and fifty-four patients were male, and 160 were female; 111 patient consultations were conducted F2F, and 203 remotely (101 via telephone and 102 via video). There was no statistically significant difference detected between remote and F2F groups for rates of investigation, listing for theatre, referral to other specialties, and initiating treatment. Patients reviewed remotely were less likely to be discharged than those reviewed F2F (p=<0.001). Comparing the two remote modalities, telephone patients were more likely to undergo investigation than patients reviewed over video (p = 0.031). Conclusions Remote consultations were an effective and reliable resource for maintaining a high standard of care during the COVID-19 pandemic. Our findings suggest that remote consultations will prove a valuable tool for clinicians in the remobilisation of health services in the post-pandemic era.

Virtual Behavioral Health Treatment Satisfaction and Outcomes Across Time

PURPOSE

The COVID-19 pandemic continues to have major and long-lasting impacts on health care delivery and mental health. As health care shifted to telehealth, legislation was adjusted to expand telehealth allowances, creating a unique opportunity to elucidate outcomes. The aim of this study was to assess long-term patient and clinician satisfaction and outcomes with virtual behavioral health.

METHODS

Data were obtained over 16 months from surveys to patients and clinicians receiving/providing virtual treatment. Outcomes data also were collected from medical records of adults receiving in-person and virtual behavioral health treatment. Data were summarized using descriptive statistics. Groups were compared using various chi-squared tests for categorical variables, Likert response trends over time, and conditional independence, with Wilcoxon rank-sum or Jonckheere trend test used to assess continuous variables. P-values of ≤0.05 were considered statistically significant.

RESULTS

Patients gave high ratings to virtual treatment and indicated a preference for virtual formats. Both patient and clinician preference for virtual visits increased significantly with time, and many clinicians perceived virtual services to be equally effective to in-person. Virtual programs had higher completion rates, attendance rates, and number of treatment visits, suggesting that virtual behavioral health had equivalent or better outcomes to in-person treatment and that attitudes toward telehealth changed over time.

CONCLUSIONS

If trends found in this study continue, telehealth may emerge as a preferred option long term This is important considering the increase in mental health needs associated with the COVID-19 pandemic and the eventuality that in-person restrictions ease as the pandemic subsides.

Emerging Disparities in Prevention and Survival Outcomes for Patients with Head and Neck Cancer and Recommendations for Health Equity

Purpose of Review

The aim of this review is to describe less known and emerging disparities found in the prevention and survival outcomes for patients with head and neck cancer (HNC) that are likely to play an increasingly important role in HNC outcomes and health inequities.

Recent Findings

The following factors contribute to HNC incidence and outcomes: (1) the effect of rurality on prevention and treatment of HNC, (2) dietary behavior and nutritional factors influencing the development of and survival from HNC, and (3) barriers and benefits of telehealth for patients with HNC.

Summary

Rurality, nutrition and diet, and telehealth usage and access are significant contributors to the existing health disparities associated with HNC. Population and culturally specific interventions are urgently needed as well as more research to further define the issues and develop appropriate population and individual level solutions.

Technology in the Era of COVID-19: A Systematic Review of Current Evidence

BACKGROUND

During the COVID-19 pandemic, the use of technology-based services has been incremental by the care providers for patients scheduling, regulatory considerations, resource allocation, thus enabling virus exposure prevention while maintaining effective patient care. This study aims to review the currently available evidence to identify available technology solutions in the era of COVID-19.

METHODS

A systematic review in July 2020 using the PubMed, Scopus, Embase, Science Direct, and Web of Science databases has been carried out. After evaluating the title and abstract to select the most relevant studies based on inclusion and exclusion criteria, the selected articles underwent quality assessment. The full text of selected articles was then thoroughly evaluated to extract the essential findings.

RESULTS

In this study, 20 technology-based approaches have been identified for provision of healthcare services to patients with COVID-19. These methods included telemedicine, virtual visits, e-consult, tele-consulting, video conference, virtual healthcare, mobile-based self-care, social media, tele ICU, 3D printing technology, telemonitoring, teleradiology, telesurgical, and cloud-based service.

CONCLUSION

Due to the rapid spread of the coronavirus, the use of technology-based methods for the provision of remote healthcare services can help control the disease. The effectiveness of each of these approaches can be investigated in future research.

Clinical Experiences of People With a Laryngectomy During the SARS COVID-19 Pandemic

Purpose This study described the clinical experiences of patients with a total laryngectomy (TL) during the COVID-19 pandemic and identified changes in communication, tracheostoma care, and heat-moisture exchange (HME) use that were recommended or self-implemented. Method An online survey addressing the study aims was completed by 173 people with a TL who live in the United States. The survey was open from July 5 to August 10, 2020. Results In-person clinic visits, appointment cancellations, and contact from their speech-language pathologists (SLPs) were reported by 42%, 19%, and 54% of the TL respondents, respectively. At clinic visits, 78% were required to wear a mask over their nose/mouth, and 73% were required to wear a mask over their tracheostoma. Masks, gloves, and face shields worn by the SLP at these visits were reported by 84%, 82%, and 70% of the TL patients, respectively. Alaryngeal communication changes were recommended by the SLP for 7%-18% of TL patients, depending on their method of communication, whereas 43%-45% implemented changes on their own. Changes in tracheostoma care and HME use were recommended by the SLP for 27% and 21% of the TL respondents, respectively, whereas 54% and 47% made changes on their own. Conclusions Individuals with a TL will require in-person care even during a pandemic, as reflected in this study. Many had not been contacted by their SLP or otolaryngologist about TL guidelines that were becoming available. Notably, larger percentages of TL patients reported self-initiated changes to their communication, tracheostoma care, and HME use because of the pandemic than their SLP had advised. The types of communication changes varied in part, depending on the method of alaryngeal speech a respondent used. Supplemental Material https://doi.org/10.23641/asha.16807270.

Diagnostic pathway and stage migration of sinonasal malignancies in the era of the COVID-19 pandemic

OBJECTIVES

The COVID-19 pandemic bears the risk of delayed cancer diagnoses.

METHODS

Study on the diagnostic pathway of sinonasal malignancies during the COVID-19 pandemic.

RESULTS

Median time from first symptom to treatment initiation was not increased during the pandemic: 137 days (interquartile range [IQR] 104-193) vs 139 days (IQR 103-219) (P = .60). Median time from first appointment at our institution to treatment initiation was even reduced in 2020: 18 days (IQR 11-25) vs 11 days (IQR 7-17) (P = .02). A trend toward advanced tumor stages during the pandemic was seen: 11/30 patients (36.7%) ≥ stage 4 in 2018 to 2019 vs 12/19 patients (63.2%) ≥ stage 4 in 2020 (P = .064).

CONCLUSION

Both, time to diagnosis and time to treatment initiation were similar during the pandemic. However, a higher proportion of advanced tumors stages was observed. Despite the pandemic, we provided a swift diagnostic workflow, including a virtual tumor board decision and a prompt treatment initiation. Level of Evidence: 4.

Management of pediatric facial fractures during COVID-19 pandemic

Objective

The coronavirus disease 2019 (COVID-19) pandemic caused delays in medical and surgical interventions in most health care systems worldwide. Oral and maxillofacial surgeons (OMSs) delayed operations to protect themselves, patients, and staff. This article (1) presents one institution's experience in the management of pediatric craniomaxillofacial trauma during the COVID-19 pandemic and (2) suggests recommendations to decrease transmission.

Methods

This was a retrospective review of children aged 18 years or younger who underwent surgery at Children's Healthcare of Atlanta in Atlanta, GA, between March and August 2020. Patients (1) were aged 18 years old or younger, (2) had one or more maxillofacial fractures, and (3) underwent surgery performed by an OMS, otolaryngologist, or plastic surgeon. Medical records were reviewed regarding (1) fracture location, (2) COVID-19 status, (3) timing, (4) personal protective equipment, and (5) infection status. Descriptive statistics were computed.

Results

Fifty-eight children met the inclusion criteria. The most commonly injured maxillofacial location was the nose. Operations were performed 50.9 hours after admission. Specific prevention perioperative guidelines were used with all patients, with no transmission occurring from a patient to a health care worker.

Conclusions

With application of our recommendations, there was no transmission to health care workers. We hope that these guidelines will assist OMSs during the COVID-19 pandemic.

COVID-19 and otorhinolaryngology: Returning to practice

This article aims to focus on key points and provide an overview of the current knowledge of the Coronavirus Disease (COVID-19); the increased susceptibility of otorhinolaryngologists to the virus; its effects and impact on the ENT practice; disruption of specialist clinic services; as well as associated risks in ENT surgical procedures. Mitigation strategies that can be employed to efficiently return to practice and ensuring the highest level of safety to both the patient and the otorhinolaryngologist is emphasised whilst simultaneously adapting to the new normal. Attention was given to understanding of the virus, its effect on the ENT discipline and practice, counter measures to mitigate and minimise risk to allow for continuation of ENT services once restrictions and lockdowns are progressively lifted. Otorhinolaryngological manifestations are common symptoms of COVID-19. Evidence suggests that the highest rates of nosocomial spread were seen amongst otorhinolaryngologists. The COVID-19 pandemic unexpectedly halted a majority of the otorhinolaryngology activities, which impacted service provision in the ENT practice. As the pandemic evolves, and with its duration unpredictable, this may necessitate a fundamental shift in the way otorhinolaryngology is practiced as there may be further global viral pandemics in future and the ENT fraternity has to now adapt to the new normal. Continued vigilance is imperative and strategies optimally implemented to ensure safe return to both ENT specialist clinic services and surgeries is vital. There are currently no uniform best-practice recommendations for otorhinolaryngology in the COVID-19 setting, although key strategies to prevent the virus spread have become evident to be able to effectively ‘flatten the curve’ of COVID-19 infections over time.

"One stop" clinic for upper gastrointestinal cancer-an alternative to "straight to test" referrals?

BACKGROUND

Patients suspected to have upper gastrointestinal (UGI) cancer can be referred directly for investigation; however, at times this may result to inappropriate referrals. This study explores the model of a "one-stop" clinic as an alternative to the direct referral system. The current study aims to assess the feasibility and outcomes of a one-stop UGI clinic and evaluate sensitivity and specificity of "on-the-day" diagnoses.

METHODS

A retrospective analysis of case notes of patients seen in one-stop clinic, between January 2017 and January 2019, was conducted. All General Practitioner (GP) referrals were screened by a specialist nurse.

RESULTS

After completion of the post-GP referral screening process, 252 patients (median age 68 years, IQR 58.8-77.3 years; M:F ratio 118:134) were allocated to the one-stop clinic. OGD was not required, contra-indicated or declined in 27 cases (10.7%). The records of three patients could not be found. One patient did not attend. Overall, 221 patients underwent testing and received "on-the-day" diagnoses. Sensitivity was 94% (range 87-100%), and specificity was 92% (88-96%). Ninety-six percent of patients received a diagnosis on the day.

CONCLUSIONS

The one-stop clinic was feasible and had good specificity and sensitivity. The finding of 10.7% of cases not being suitable for OGD indicates that a patient/specialist consultation is necessary to prevent misuse of endoscopy appointments. The authors recommend widespread adoption of one-stop clinics in UGI surgery.

Systematic review on telemedicine platforms in lockdown periods: Lessons learned from the COVID-19 pandemic

With the onset of the coronavirus disease 2019 (COVID-19) outbreak, the transformation of the care delivery model from conventional in-person (face to face) to largely virtual or remote care has been accelerated to appropriately allocate resources and constrain the spread of the virus. In this regard, telemedicine is a breakthrough technology to battle against the COVID-19 emergency. Therefore, we sought to identify the telemedicine applications in the COVID-19 pandemic (tele-COVID) according to interaction modes, transmission modalities, and disease categories. This systematic review was conducted through searching five databases including PubMed, Scopus, ProQuest, Web of Science, and Science Direct. Inclusion criteria were studies clearly outlining any use of telemedicine interactive mode during the COVID-19 pandemic, written in English language and published in peer-reviewed journals in 2020. Finally, 43 articles met the inclusion out of the 1118 search results. Telemedicine provides a diversity of interaction modes and modalities affordable by patients and physicians including short message service, E-mail and web portals, secure telephone calls or VOIP, video calls, interactive mobile health applications (m-Health), remote patient monitoring, and video conferencing. Transmission of video data using synchronized video calls via common social media had the highest and exchange of data using store-forward service via secure messaging technology and prerecorded multimedia had the lowest popularity for virtual disease management during the COVID-19 outbreak. Selection of telemedicine communication services and interaction modes with regard to its use-case, disease category, and application plays a significant role in the success of remote disease management infrastructures in this scenario and their implication for a better future healthcare system.

Virtual otolaryngologic management of sleep apnea patients: Lessons learned from COVID-19 pandemic

OBJECTIVE

To discuss the virtual management options and strategies learned during the COVID-19 pandemic for treatment of patients with sleep complaints and sleep disordered breathing presenting to the otolaryngologist.

METHODS/RESULTS

The addition of a virtual evaluation can be beneficial in assessing the patient presenting to the otolaryngologist with sleep complaints. With the implementation of telemedicine, validated subjective assessment tools, and a limited physical exam, patients can be triaged for the need for treatment implementation, further evaluation or testing, and counseled regarding various management options.In this article, we discuss the lessons learned from the authors' collective experience on how to effectively use telemedicine as a tool in the management repertoire for patients with sleep disorders.

CONCLUSION

The otolaryngologist will commonly see patients with sleep complaints, particularly patients diagnosed with obstructive sleep apnea not able to tolerate conservative therapies. These patients are well suited for virtual evaluation utilizing telemedicine. The technology and workflows which have been developed during the COVID-19 pandemic can be carried forward for select patients to improve access and efficiency of care.Level of evidence: 5.

Virtual Care in Rhinology

Background

The SARS-CoV-2 (COVID) pandemic has resulted in an increase in virtual care. While some specialties are well suited to virtual care, Otolaryngology – Head and Neck Surgery could be limited due to reliance on physical examination and nasal endoscopy, including Rhinology. It is likely virtual care will remain integrated for the foreseeable future and it is important to determine the strengths and weaknesses of this treatment modality for rhinology.

Methods

A survey on virtual care in rhinology was distributed to 61 Canadian rhinologists. The primary objective was to determine how virtual care compared to in-person care in each area of a typical appointment. Other areas focused on platforms used to deliver virtual care and which patients could be appropriately assessed by virtual visits.

Results

43 participants responded (response rate 70.5%). The majority of participants use the telephone as their primary platform. History taking and reviewing results (lab work, imaging) were reported to be equivalent in virtual care. Non-urgent follow up and new patients were thought to be the most appropriate for virtual care. The inability to perform exams and nasal endoscopy were reported to be significant limitations.

Conclusion

It is important to understand the strengths and limitations of virtual care. These results identify the perceived strengths and weaknesses of virtual care in rhinology, and will help rhinologists understand the role of virtual care in their practices.

Graphical abstract

Patterns of Technology Use Among Patients With Head and Neck Cancer and Implications for Telehealth

OBJECTIVE

To describe baseline technology use within the head and neck cancer (HNC) population prior to the COVID-19 pandemic.

STUDY DESIGN

Cross-sectional analysis of National Health Interview Survey (NHIS) data.

SETTING

The NHIS is a survey of population health administered in person annually to a nationally representative sample of noninstitutionalized US residents via a complex clustered sampling design.

METHODS

Data regarding technology use, cancer history, and demographics were extracted from the NHIS. The study population comprised individuals who completed the NHIS Sample Adult survey from 2012 to 2018 and self-reported a cancer diagnosis. Poisson regression was used to evaluate associations between demographics and general or health-related technology use and prevalence ratios reported.

RESULTS

Patients with HNC were less likely to use general technology (computers, internet, or email) when compared with other patients with cancer (60% vs 73%, P < .001), although this difference was not statistically significant after controlling for sociodemographic factors. Among patients with HNC, older age, lower education, and lower income were negatively associated with general technology use (adjusted prevalence ratio [aPR], 0.71 [95% CI, 0.59-0.87] for age 65-79 years vs <50 years; aPR, 0.66 [95% CI, 0.51-0.85] for high school vs master; aPR, 0.66 [95% CI, 0.48-0.91] for income 100%-200% vs >400% federal poverty level). Older age and lower education were negatively associated with health-related technology use (aPR, 0.46 [95% CI, 0.32-0.67] for age 65-79 years vs <50 years; aPR, 0.47 [95% CI, 0.30-0.74] for high school vs master).

CONCLUSION

Socioeconomic disparities exist in technology use rates among patients with HNC. Access to technology may pose a barrier to telehealth visits for many patients with HNC due to the unique socioeconomic demographics of this patient population.

The impact of the coronavirus (COVID-19) pandemic on elective paediatric otolaryngology outpatient services - An analysis of virtual outpatient clinics in a tertiary referral centre using the modified paediatric otolaryngology telemedicine satisfaction survey (POTSS)

INTRODUCTION

Virtual outpatient clinics (VOPC) have been integrated into both paediatric and based adult outpatient services due to a multitude of factors, including increased demand for services, technological advances and rising morbidity secondary to ageing populations. The novel coronavirus disease (COVID-19) has accentuated pressures on the National Health Service (NHS) infrastructure, particularly elective services, whilst radically altering patterns of practice.

AIM

To evaluate the impact of the COVID-19 pandemic on paediatric otolaryngology outpatient services whilst collating patient feedback to elicit long-term sustainability post COVID-19.

METHOD

A retrospective analysis of VOPCs was undertaken at a tertiary paediatric referral centre over a 3-month capture period during the COVID-19 pandemic. Demographic, generic clinic (presenting complaint, new vs. follow-up, consultation type), as well as outcome data (medical or surgical intervention, discharge vs. ongoing review, onward referral, investigations, and conversion to face-to-face) was collated. Additionally a modified 15-point patient satisfaction survey was created. The Paediatric Otolaryngology Telemedicine Satisfaction survey (POTSS), was an adaptation of 4 validated patient satisfaction tools including the General Medical Council (GMC) patient questionnaire, the telehealth satisfaction scale (TESS), the telehealth usability questionnaire (TUQ), and the telemedicine satisfaction and usefulness questionnaire (TSUQ).

RESULTS

Of 514 patients reviewed virtually over a 3-month period, 225 (45%) were randomly selected to participate, of which 200 met our inclusion criteria. The most common mode of consultation was telephony (92.5%, n = 185). Non-attendance rates were reduced when compared to face-to-face clinics during an equivalent period prior to the COVID-19 pandemic. A significant proportion of patients (29% compared to 26% pre-VOPC) were discharged to primary care. Nine percent were listed for surgery compared to 19% pre-VOPC. A subsequent face-to-face appointment was required in 10% of participants. Overall, the satisfaction when assessing the doctor-patient relationship, privacy & trust, as well as consultation domains was high, with the overwhelming majority of parents' content with the future integration and participation in VOPCs.

CONCLUSION

An evolving worldwide pandemic has accelerated the need for healthcare services to reform in order to maintain a steady flow of patients within an elective outpatient setting without compromising patient care. Solutions must be sustainable long-term to account for future disruptions, whilst accounting for evolving patient demographics. Our novel survey has demonstrated the vast potential that the integration of VOPCs can offer paediatric otolaryngology services within a carefully selected cohort of patients.

Facial Surgery in the Era of SARS-CoV-2 and Beyond: Challenges, Considerations, and Initiatives

The SARS-CoV-2 pandemic resulted in the implementation of healthcare practice regulations and restrictions across the United States. To facilitate safe patient management practices for facial plastic and reconstructive surgeons, appropriate guidelines and recommendations should be followed. Guidelines and recommendations should include a synthesis of the best evidence available from public health authorities and respected members in the surgery community. This review contains evidence-based suggestions that prioritize the safety of healthcare professionals and patients to help guide facial and reconstructive surgeons toward safe patient management.

Recommendations from the Canadian Association of Head and Neck Surgical Oncology for the Management of Head and Neck Cancers during the COVID-19 pandemic

INTRODUCTION

The SARS-CoV-2 virus (COVID19) pandemic has placed extreme pressures on the Canadian Healthcare system. Many health care regions in Canada have cancelled or limited surgical and non-surgical interventions on patients to preserve healthcare resources for a predicted increase in COVID19 related hospital admissions. Also reduced health interventions may limit the risk of possible transmission of COVID19 to other patients and health care workers during this pandemic. The majority of institutions in Canada have developed their own operational mandates regarding access to surgical resources for patients suffering from Head and Neck Cancers during this pandemic. There is a large degree of individual practitioner judgement in deciding access to care as well as resource allocation during these challenging times. The Canadian Association of Head and Neck Surgical Oncology (CAHNSO) convened a task force to develop a set of guidelines based on the best current available evidence to help Head and Neck Surgical Oncologists and all practitioners involved in the care of these patients to help guide individual practice decisions.

MAIN BODY

The majority of head and neck surgical oncology from initial diagnosis and work up to surgical treatment and then follow-up involves aerosol generating medical procedures (AGMPs) which inherently put head and neck surgeons and practitioners at high risk for transmission of COVID19. The aggressive nature of the majority of head and neck cancer negates the ability for deferring surgical treatment for a prolonged period of time. The included guidelines provide recommendations for resource allocation for patients, use of personal protective equipment for practitioners as well as recommendations for modification of practice during the current pandemic.

CONCLUSION

1. Enhanced triaging should be used to identify patients with aggressive malignancies. These patients should be prioritized to reduce risk of significant disease progression in the reduced resource environment of COVID19 era. 2. Enhanced triaging including aggressive pre-treatment COVID19 testing should be used to identify patients with high risk of COVID19 transmission. 3. Enhanced personal protective equipment (PPE) including N95 masks and full eye protection should be used for any AGMPs performed even in asymptomatic patients. 4. Enhanced PPE including full eye protection, N95 masks and/or powered air purifying respirators (PAPRs) should be used for any AGMPs in symptomatic or presumptive positive COVID 19 patients.

Significant applications of virtual reality for COVID-19 pandemic

BACKGROUND AND AIMS

During COVID-19 pandemic, researchers are using innovative technologies for fast-tracking the development to end this menace. Virtual Reality (VR) also offers an imperative role for fighting this pandemic, through audiovisual-based virtual communication.

METHODS

A brief study on Virtual Reality and its applications for the COVID-19 pandemic is carried out by employing keywords as Virtual reality or VR and COVID-19 from the databases of SCOPUS, Google Scholar, PubMed, Web of science Academia and ResearchGate.

RESULTS

VR is beneficial for remote sites for exploring telemedicine, planning, treatment, and controlling of the infections by providing proper awareness to the people regarding this disease.

CONCLUSIONS

VR technology develops a platform to reduce the face to face interaction of doctors with the infected COVID-19 patients. Through live video streaming, it helps to improve surveillance systems on the ongoing situation.

The COVID-19 Pandemic and Planetary Health. A Critical Review of Epidemiology, Prevention, Clinical Characteristics and Treatments for Oral, Head and Neck Health Professionals. Do We Have a Roadmap?

Introduction  Coronavirus disease 19 (COVID-19) is potentially the greatest global public health crisis of this century. This disease emerged as an outbreak of pneumonia of unknown cause in Wuhan, the capital city of the Hubei province in China, in December 2019. Otolaryngologists, head and neck surgeons and dentists are at an increased risk of occupational disease. Objective  The present review summarizes currently published evidence of Covid-19 epidemiology, clinical characteristics, treatment and prevention. No proven effective treatments for this disease currently exist. Data Synthesis  COVID-19 started from a zoonotic transmission event associated with a large seafood market that also traded in live wild animals, and it soon became clear that efficient person-to-person transmission was also occurring. Symptoms are varied, and not all patients develop all of them. Conclusion  Social distancing seems to have been successful in several places in the world. However, this recommendation alone is not enough to contain the disease, and it is not a long-term solution. Large-scale testing by health professionals of representative samples of the population may give an estimate of the progression of the disease. Different treatments are under test and bring hope of a cure to the population. However, no current treatments (April 27, 2020) have been proven to be the key to success in the treatment of patients with COVID-19. Planetary health is a useful concept to understand the current drivers of this pandemic and to draw a roadmap for science and healthcare that may guide actions to fight economic depression and ensure a healthy recovery.

COVID-19 pandemic and health care disparities in head and neck cancer: Scanning the horizon

The COVID-19 pandemic has profoundly disrupted head and neck cancer (HNC) care delivery in ways that will likely persist long term. As we scan the horizon, this crisis has the potential to amplify preexisting racial/ethnic disparities for patients with HNC. Potential drivers of disparate HNC survival resulting from the pandemic include (a) differential access to telemedicine, timely diagnosis, and treatment; (b) implicit bias in initiatives to triage, prioritize, and schedule HNC-directed therapy; and (c) the marked changes in employment, health insurance, and dependent care. We present four strategies to mitigate these disparities: (a) collect detailed data on access to care by race/ethnicity, income, education, and community; (b) raise awareness of HNC disparities; (c) engage stakeholders in developing culturally appropriate solutions; and (d) ensure that surgical prioritization protocols minimize risk of racial/ethnic bias. Collectively, these measures address social determinants of health and the moral imperative to provide equitable, high-quality HNC care.

Head and neck surgical oncology in the time of a pandemic: Subsite-specific triage guidelines during the COVID-19 pandemic

BACKGROUND

COVID-19 pandemic has strained human and material resources around the world. Practices in surgical oncology had to change in response to these resource limitations, triaging based on acuity, expected oncologic outcomes, availability of supportive resources, and safety of health care personnel.

METHODS

The MD Anderson Head and Neck Surgery Treatment Guidelines Consortium devised the following to provide guidance on triaging head and neck cancer (HNC) surgeries based on multidisciplinary consensus. HNC subsites considered included aerodigestive tract mucosa, sinonasal, salivary, endocrine, cutaneous, and ocular.

RECOMMENDATIONS

Each subsite is presented separately with disease-specific recommendations. Options for alternative treatment modalities are provided if surgical treatment needs to be deferred.

CONCLUSION

These guidelines are intended to help clinicians caring for patients with HNC appropriately allocate resources during a health care crisis, such as the COVID-19 pandemic. We continue to advocate for individual consideration of cases in a multidisciplinary fashion based on individual patient circumstances and resource availability.

Outpatient Otolaryngology in the Era of COVID-19: A Data-Driven Analysis of Practice Patterns

Introduction

Coronavirus disease 2019 (COVID-19) has induced a prioritization of acute care and telehealth, affecting the quantity of patients seen and the modality of their care.

Study Design

Retrospective review.

Setting

Single-institution study conducted within the Division of Otolaryngology at the Yale School of Medicine.

Subjects and Methods

Data on all outpatient appointments within the Division of Otolaryngology were obtained from administrative records of billing and scheduling from March 16 to April 10, 2020. For comparison, a corresponding period from 2019 was also utilized.

Results

Of 5913 scheduled visits, 3665 (62.0%) were seen between March 18 and April 12, 2019, in comparison with 649 of 5044 (12.9%) during the corresponding COVID-19–affected period. The majority of completed visits performed in weeks 1 and 2 were in person, while the majority in weeks 3 and 4 were via telehealth. Among subspecialties, a larger proportion of completed visits in 2020 were performed by pediatric and head and neck oncology otolaryngologists as compared with general/specialty otolaryngologists (P < .001). Older adults (≥65 years) were less likely to have telehealth visits than younger adults (18-64 years; 45.6% vs 59.6%, P = .003).

Conclusions

A major decrease in the completion rates of scheduled visits was seen in the COVID-19–affected period, though this was not proportional among subspecialties. An associated increase in telehealth visits was observed. After COVID-19–related hospital policy changes, approximately 2 weeks passed before telehealth visits surpassed in-person visits, though this was not true among older adults.

Head and neck virtual medicine in a pandemic era: Lessons from COVID-19

The 2019 novel coronavirus disease (COVID‐19) has presented the world and physicians with a unique public health challenge. In light of its high transmissibility and large burden on the health care system, many hospitals and practices have opted to cancel elective surgeries in order to mobilize resources, ration personal protective equipment and guard patients from the virus. Head and neck cancer physicians are particularly affected by these changes given their scope of practice, complex patient population, and interventional focus. In this viewpoint, we discuss some of the many challenges faced by head and neck surgeons in this climate. Additionally, we outline the utility of telemedicine as a potential strategy for allowing physicians to maintain an effective continuum of care.