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Murawa M, Szydłowski J, Andruszko A, Grabarek BO, Sirek T, Fryzowicz A, Kabaciński J, Bernet A, Banaszewski J. Objective assessment of the effect of surgery on limb function after medial femoral condyle free flap harvest: biomechanical parameters. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00306-0. [PMID: 39174406 DOI: 10.1016/j.ijom.2024.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Abstract
The aim of this study was to evaluate the influence of medial femoral condyle (MFC) free flap harvest on donor site muscle strength and kinematic parameters of gait. The study included 30 patients treated for head and neck squamous cell carcinoma who underwent reconstruction with an MFC free flap. In each case, the donor site was the left thigh. A dynamometer was used to measure muscle strength, in isokinetic bilateral mode and with concentric contraction for the extension/flexion knee pattern, at 18 months postoperative. In addition, kinematic data were obtained and evaluated. On statistical analysis, no significant difference in muscle strength of the quadriceps muscle was found between the left involved and right uninvolved lower extremities (P = 0.124). Also, when comparing hamstring strength, no statistically significant difference was found between the left involved and right uninvolved sides (P = 0.210). Moreover, spatiotemporal gait parameters did not differ significantly between the involved and uninvolved legs (all P > 0.05), and no differences in kinematic or kinetic parameters were observed. This study reports the effects of MFC free flap harvest on the knee muscle strength and locomotion of patients. For most biomechanical parameters investigated, there was no effect (positive or negative).
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Affiliation(s)
- M Murawa
- Department of Biomechanics, Poznań University of Physical Education, Poznań, Poland
| | - J Szydłowski
- Department of Paediatric Otolaryngology, Poznań University of Medical Sciences, Poznań, Poland
| | - A Andruszko
- Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, Poznań, Poland
| | - B O Grabarek
- Collegium Medicum, WSB University, Dąbrowa Górnicza, Poland; Gyncentrum, Laboratory of Molecular Biology and Virology, Katowice, Poland
| | - T Sirek
- Department of Plastic Surgery, Faculty of Medicine, Academia of Silesia, Katowice, Poland; Department of Plastic and Reconstructive Surgery, Hospital for Minimally Invasive and Reconstructive Surgery, Bielsko-Biała, Poland
| | - A Fryzowicz
- Department of Biomechanics, Poznań University of Physical Education, Poznań, Poland
| | - J Kabaciński
- Department of Biomechanics, Poznań University of Physical Education, Poznań, Poland
| | - A Bernet
- The Higher School of Strategic Planning in Dąbrowa Górnicza, Dąbrowa Górnicza, Poland
| | - J Banaszewski
- Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, Poznań, Poland.
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Clements K, Thapa A, Cowell A, Conway D, Douglas CM, Paterson C. Impact of the COVID-19 pandemic on stage and incidence of head and neck cancer: A rapid review and meta-analysis. Clin Otolaryngol 2024; 49:363-375. [PMID: 38514776 DOI: 10.1111/coa.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/24/2023] [Accepted: 02/04/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES This rapid review aims to evaluate the impact of the COVID-19 pandemic on incidence of head and neck cancer (HNC) and stage distribution at diagnosis. DESIGN Rapid review and meta-analysis. PARTICIPANTS Comparative data for new HNC patients between a pre-pandemic cohort (before March 2020) and a pandemic cohort (after March 2020 during the lockdown period). MAIN OUTCOMES MEASURED Data on tumour stage, incidence, referral pathway (number of new patient referrals), or workload levels (number of HNC treatments). Data on stage were summarised as odds ratios (OR) with 95% confidence intervals (CI), and data related to changes in numbers of diagnoses, referrals, and workload levels were summarised as a narrative synthesis. RESULTS A total of 31 reports were included in this review. Individually 16 out of 23 studies did not show a significant impact on stage relative to the pre-pandemic period. However, the meta-analysis revealed that patients diagnosed with HNC during the pandemic were 16% more likely to have nodal involvement (OR = 1.16; 95% CI 1.00-1.35), 17% more likely to have a late overall stage (OR = 1.17; 95% CI 1.01-1.36), and 32% more likely to present with advanced tumour extent (T3 and T4 stage) (OR = 1.32; 95% CI 1.08-1.62). Data on incidence was extremely limited and not currently sufficient to assess trends in burden of disease. CONCLUSIONS This review indicates that during the COVID-19 pandemic, there was upstaging of HNC at diagnosis, suggesting the provision of care to HNC patients was significantly affected.
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Affiliation(s)
- Kelten Clements
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Alekh Thapa
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Anna Cowell
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - David Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, UK
| | - Catriona M Douglas
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, UK
- Department of ENT-Head and Neck Surgery, Glasgow Royal Infirmary and Queen Elizabeth University Hospital, Glasgow, UK
| | - Claire Paterson
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, UK
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Englum BR, Sahoo S, Mayorga-Carlin M, Hayssen H, Siddiqui T, Turner DJ, Sorkin JD, Lal BK. Growing Deficit in New Cancer Diagnoses 2 Years Into the COVID-19 Pandemic: A National Multicenter Study. Ann Surg Oncol 2023; 30:8509-8518. [PMID: 37695458 PMCID: PMC10939008 DOI: 10.1245/s10434-023-14217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Large decreases in cancer diagnoses were seen early in the COVID-19 pandemic. However, the evolution of these deficits since the end of 2020 and the advent of widespread vaccination is unknown. METHODS This study examined data from the Veterans Health Administration (VA) from 1 January 2018 through 28 February 2022 and identified patients with screening or diagnostic procedures or new cancer diagnoses for the four most common cancers in the VA health system: prostate, lung, colorectal, and bladder cancers. Monthly procedures and new diagnoses were calculated, and the pre-COVID era (January 2018 to February 2020) was compared with the COVID era (March 2020 to February 2022). RESULTS The study identified 2.5 million patients who underwent a diagnostic or screening procedure related to the four cancers. A new cancer was diagnosed for 317,833 patients. During the first 2 years of the pandemic, VA medical centers performed 13,022 fewer prostate biopsies, 32,348 fewer cystoscopies, and 200,710 fewer colonoscopies than in 2018-2019. These persistent deficits added a cumulative deficit of nearly 19,000 undiagnosed prostate cancers and 3300 to 3700 undiagnosed cancers each for lung, colon, and bladder. Decreased diagnostic and screening procedures correlated with decreased new diagnoses of cancer, particularly cancer of the prostate (R = 0.44) and bladder (R = 0.27). CONCLUSION Disruptions in new diagnoses of four common cancers (prostate, lung, bladder, and colorectal) seen early in the COVID-19 pandemic have persisted for 2 years. Although reductions improved from the early pandemic, new reductions during the Delta and Omicron waves demonstrate the continued impact of the COVID-19 pandemic on cancer care.
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Affiliation(s)
- Brian R Englum
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shalini Sahoo
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Minerva Mayorga-Carlin
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
- Surgery Service, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Hilary Hayssen
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tariq Siddiqui
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
- Surgery Service, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Douglas J Turner
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
- Surgery Service, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - John D Sorkin
- Geriatrics Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brajesh K Lal
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
- Surgery Service, Veterans Affairs Medical Center, Baltimore, MD, USA.
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Pereira MCP, Fernandes JCH, Fernandes GVO, Nor F, Marques T, Couto P. Impact of the COVID-19 Pandemic Period on Patients with Head and Neck Carcinoma: A Systematic Review. Diseases 2023; 11:diseases11020061. [PMID: 37092443 PMCID: PMC10123687 DOI: 10.3390/diseases11020061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Gustavo Vicentis Oliveira Fernandes
- Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
- Centre for Interdisciplinary Research in Health (CIIS), Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
| | - Felipe Nor
- Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI 48109, USA
| | - Tiago Marques
- Centre for Interdisciplinary Research in Health (CIIS), Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
| | - Patrícia Couto
- Centre for Interdisciplinary Research in Health (CIIS), Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal
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de Bock E, Herman ES, Bastian OW, Filipe MD, Vriens MR, Richir MC. Systematic review and meta-analysis determining the effect of implemented COVID-19 guidelines on surgical oncology volumes and clinical outcomes. Surg Oncol 2022; 45:101859. [PMID: 36242979 PMCID: PMC9529677 DOI: 10.1016/j.suronc.2022.101859] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND To provide for Coronavirus Disease 2019 (COVID-19) healthcare capacity, (surgical oncology) guidelines were established, forcing to alter the timing of performing surgical procedures. It is essential to determine whether these guidelines have led to disease progression. This study aims to give an insight into the number of surgical oncology procedures performed during the pandemic and provide information on short-term clinical outcomes. MATERIALS AND METHODS A systematic literature search was performed on all COVID-19 articles including operated patients, published before March 21, 2022. Meta-analysis was performed to visualize the number of performed surgical oncology procedures during the pandemic compared to the pre-pandemic period. Random effects models were used for evaluating short-term clinical outcomes. RESULTS Twenty-four studies containing 6762 patients who underwent a surgical oncology procedure during the pandemic were included. The number of performed surgical procedures for an oncological pathology decreased (-26.4%) during the pandemic. The number of performed surgical procedures for breast cancer remained stable (+0.3%). Moreover, no difference was identified in the number of ≥T2 (OR 1.00, P = 0.989), ≥T3 (OR 0.95, P = 0.778), ≥N1 (OR 1.01, P = 0.964) and major postoperative complications (OR 1.55, P = 0.134) during the pandemic. CONCLUSION The number of performed surgical oncology procedures during the COVID-19 pandemic decreased. In addition, the number of performed surgical breast cancer procedures remained stable. Oncological staging and major postoperative complications showed no significant difference compared to pre-pandemic practice. During future pandemics, the performed surgical oncology practice during the first wave of the COVID-19 pandemic seems appropriate for short-term results.
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Affiliation(s)
- Ellen de Bock
- Corresponding author. PO Box 85500, 3508, GA, Utrecht, the Netherlands
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Carvalho AS, Brito Fernandes Ó, de Lange M, Lingsma H, Klazinga N, Kringos D. Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a scoping review. BMC Health Serv Res 2022; 22:786. [PMID: 35715795 PMCID: PMC9204363 DOI: 10.1186/s12913-022-08166-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/06/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer comprises a high burden on health systems. Performance indicators monitoring cancer outcomes are routinely used in OECD countries. However, the development of process and cancer-pathway based information is essential to guide health care delivery, allowing for better monitoring of changes in the quality of care provided. Assessing the changes in the quality of cancer care during the COVID-19 pandemic requires a structured approach considering the high volume of publications. This study aims to summarize performance indicators used in the literature to evaluate the impact of the COVID-19 pandemic on cancer care (January-June 2020) in OECD countries and to assess changes in the quality of care as reported via selected indicators. METHODS Search conducted in MEDLINE and Embase databases. Performance indicators and their trends were collated according to the cancer care pathway. RESULTS This study included 135 articles, from which 1013 indicators were retrieved. Indicators assessing the diagnostic process showed a decreasing trend: from 33 indicators reporting on screening, 30 (91%) signalled a decrease during the pandemic (n = 30 indicators, 91%). A reduction was also observed in the number of diagnostic procedures (n = 64, 58%) and diagnoses (n = 130, 89%). The proportion of diagnoses in the emergency setting and waiting times showed increasing trends (n = 8, 89% and n = 14, 56%, respectively). A decreasing trend in the proportion of earliest stage cancers was reported by 63% of indicators (n = 9), and 70% (n = 43) of indicators showed an increasing trend in the proportion of advanced-stage cancers. Indicators reflecting the treatment process signalled a reduction in the number of procedures: 79%(n = 82) of indicators concerning surgeries, 72%(n = 41) of indicators assessing radiotherapy, and 93%(n = 40) of indicators related to systemic therapies. Modifications in cancer treatment were frequently reported: 64%(n = 195) of indicators revealed changes in treatment. CONCLUSIONS This study provides a summary of performance indicators used in the literature to assess the cancer care pathway from January 2020 to June 2020 in OECD countries, and the changes in the quality of care signalled by these indicators. The trends reported inform on potential bottlenecks of the cancer care pathway. Monitoring this information closely could contribute to identifying moments for intervention during crises.
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Affiliation(s)
- Ana Sofia Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Mats de Lange
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hester Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Azad AD, Mishra K, Lee EB, Chen E, Nguyen A, Parikh R, Mruthyunjaya P. Impact of Early COVID-19 Pandemic on Common Ophthalmic Procedures Volumes: A US Claims-Based Analysis. Ophthalmic Epidemiol 2021; 29:604-612. [PMID: 34935591 DOI: 10.1080/09286586.2021.2015394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The COVID-19 pandemic has had a profound effect on the delivery of healthcare in the United States and globally. The aim of this study was to evaluate the impact of COVID-19 on common ophthalmic procedure utilization and normalization to pre-pandemic daily rates. METHODS Leveraging a national database, Clinformatics™ DataMart (OptumInsight, Eden Prairie, MN), procedure frequencies and daily averages, defined by Current Procedural Terminology codes, of common elective and non-elective procedures within multiple ophthalmology sub-specialties were calculated. Interrupted time-series analysis with a Poisson regression model and smooth spline functions was used to model trends in pre-COVID-19 (January 1, 2018-February 29, 2020) and COVID-19 (March 1, 2020-June 30, 2020) periods. RESULTS Of 3,583,231 procedures in the study period, 339,607 occurred during the early COVID-19 time period. Anti-vascular endothelial growth factor injections (44,412 to 39,774, RR 1.01, CI 0.99-1.02; p = .212), retinal detachment repairs (1,290 to 1,086, RR 1.07, CI 0.99-1.15; p = .103), and glaucoma drainage implants/trabeculectomies (706 to 487, RR 0.93, CI 0.83-1.04; p = .200) remained stable. Cataract surgery (61,421 to 33,054, RR 0.77; CI 0.76-0.78; p < .001), laser peripheral iridotomy (1,875 to 890, RR 0.82, CI 0.76-0.88; p < .001), laser trabeculoplasty (2,680 to 1,753, RR 0.79, CI 0.74-0.84; p < .001), and blepharoplasty (1,522 to 797, RR 0.71, CI 0.66-0.77; p < .001) all declined significantly. All procedures except laser iridotomy returned to pre-COVID19 rates by June 2020. CONCLUSION Most ophthalmic procedures that significantly declined during the COVID-19 pandemic were elective procedures. Among these, the majority returned to 2019 daily averages by June 2020.
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Affiliation(s)
- Amee D Azad
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kapil Mishra
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Eric B Lee
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Evan Chen
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexander Nguyen
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ravi Parikh
- Manhattan Retina and Eye Consultants, New York, New York, USA.,Department of Ophthalmology New York University School of Medicine, New York, New York, USA
| | - Prithvi Mruthyunjaya
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
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Dorri S, Sari F, Seyedhasani SN, Atashi A, Hashemi E, Olfatbakhsh A. Practical Recommendations for the Preoperative Screening and Protective Protocols in Cancer Surgeries During COVID-19: A Systematic Review. Front Surg 2021; 8:678700. [PMID: 34901132 PMCID: PMC8653426 DOI: 10.3389/fsurg.2021.678700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/18/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction: The new coronavirus (COVID-19) has posed many new challenges to the health care and the timing of surgical care. At the beginning of the pandemic many guidelines recommended postponing elective surgical procedures to reallocate resources. As regards, delay in cancer treatment could be effective on cancer progression. The aim of this systematic review was to outline a guideline for preoperative screening before cancer surgeries and protecting health care workers during the pandemic. Materials and Methods: This study was conducted through a search in electronic databases up to August 2020. PubMed, EMBASE, Web of Science, Scopus, Science Direct, and Google Scholar databases were searched without time limitation. The keywords were a combination of preoperative, cancer surgery, COVID-19, and their synonyms. Results: The most commonly used ways to triage preoperatively were telephone pre-assessment for suspicious symptoms and history of contact or travel, 14-day self-isolation, in- hospital queries at admission, temperature monitoring, and isolation in a single room COVID-free ward or physical distancing. Reverse transcription-polymerase chain reaction (RT-PCR) test 24–72 h before operation was recommended commonly, except in inaccessible centers, but non-contrast chest-CT scan is not routinely advised for elective surgeries to salvage medical resources. Recommended personal protective equipment (PPE) for staffs were wearing N95 mask in addition to gown, gloves, eye protection in aerosol-generating procedures (AGPs), and wearing gloves, hats, and disposable surgical masks, practice distancing, and hand hygiene for all staffs. Meanwhile team separation of hospital staffs caring for COVID-19 patients, segregated areas for COVID-19 clean and contact, restriction of visitors and family members, and personal distancing are mostly recommended. Conclusion: We hope this review would be a guidance for triage, preoperative testing, and summarizing safety principles during COVID-19 pandemic alongside with surgical reintegration.
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Affiliation(s)
- Sara Dorri
- Department of Management and Health Information Technology, School of Management and Medical Information Sciences, Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fateme Sari
- Clinical Research Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Seyedeh Nahid Seyedhasani
- Department of Health Information Technology, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Alireza Atashi
- E-Health Department, Virtual School, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmatalsadat Hashemi
- Clinical Research Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Asiie Olfatbakhsh
- Clinical Research Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
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José Martelli A, Assis Machado R, Medeiros Pereira W, Balduino Guimarães Santos F, Pereira Marques N, Martelli Júnior H. Revaluation of the treatment of head and neck cancer in Brazil during the COVID-19 pandemic - phase 2. Oral Oncol 2021; 123:105600. [PMID: 34768209 PMCID: PMC8552752 DOI: 10.1016/j.oraloncology.2021.105600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Alison José Martelli
- Department of Oral Diagnosis, Dental School, University of Campinas, FOP UNICAMP, Piracicaba, São Paulo, Brazil.
| | - Renato Assis Machado
- Department of Oral Diagnosis, Dental School, University of Campinas, FOP UNICAMP, Piracicaba, São Paulo, Brazil; Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, São Paulo, Brazil
| | - Wilson Medeiros Pereira
- Health Sciences Postgraduate Program, State University of Montes Claros, Unimontes, Montes Claros, Minas Gerais, Brazil
| | - Francis Balduino Guimarães Santos
- Head and Neck Surgery Department, School of Medicine, State University of Montes Claros, Unimontes, Montes Claros, Minas Gerais, Brazil
| | - Nelson Pereira Marques
- Department of Oral Diagnosis, Dental School, University of Campinas, FOP UNICAMP, Piracicaba, São Paulo, Brazil
| | - Hercílio Martelli Júnior
- Department of Oral Diagnosis, Dental School, University of Campinas, FOP UNICAMP, Piracicaba, São Paulo, Brazil; Oral Diagnosis, Dental School, State University of Montes Claros, Unimontes, Montes Claros,Minas Gerais, Brazil.; Center for Rehabilitation of Craniofacial Anomalies, University of Alfenas, Minas Gerais, Brazil
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10
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Searl J, Kearney A, Genoa K, Doyle PC. Clinical Experiences of People With a Laryngectomy During the SARS COVID-19 Pandemic. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2430-2445. [PMID: 34665653 DOI: 10.1044/2021_ajslp-21-00117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Jeff Searl
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Ann Kearney
- Department of Otolaryngology - Head & Neck Surgery, Division of Laryngology, Stanford University School of Medicine, CA
| | - Kathryn Genoa
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Philip C Doyle
- Department of Otolaryngology - Head & Neck Surgery, Division of Laryngology, Stanford University School of Medicine, CA
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11
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Shah A, Sumer BD, Schostag K, Balachandra S, Sher DJ, Gordin EA, Day AT. Institutional patterns of head and neck oncology care during the early phase of the COVID-19 pandemic: A retrospective, pooled cross-sectional analysis. Oral Oncol 2021; 122:105564. [PMID: 34634666 PMCID: PMC8495055 DOI: 10.1016/j.oraloncology.2021.105564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Avni Shah
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Baran D Sumer
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Kelly Schostag
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sanjana Balachandra
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - David J Sher
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Eli A Gordin
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, United States.
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12
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Vasiliadou I, Noble D, Hartley A, Moleron R, Sanghera P, Urbano TG, Schipani S, Gujral D, Foran B, Bhide S, Haridass A, Nathan K, Michaelidou A, Sen M, Geropantas K, Joseph M, O'Toole L, Griffin M, Pettit L, Chambers J, Jankowska P, De Winton E, Goranova R, Singh N, Shah K, Kong Conceptualisation A. A multi-centre survey reveals variations in the standard treatments and treatment modifications for head and neck cancer patients during Covid-19 pandemic. Clin Transl Radiat Oncol 2021; 30:50-59. [PMID: 34226880 PMCID: PMC8242198 DOI: 10.1016/j.ctro.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The onset of the COVID-19 pandemic necessitated rapid changes to the practice of head and neck oncology in UK. There was a delay between the onset of the pandemic and the release of guidelines from cancer societies and networks, leading to a variable response of individual centres. This survey was conducted to assess the pre-Covid-19 pandemic standard of practice for head and neck oncology patients and the treatment modifications introduced during the first wave of the pandemic in UK. METHODOLOGY The UK National Cancer Research Institute (NCRI) Head and Neck Clinical Studies Group initiated a multi-centre survey using questionnaire to investigate the effect on feeding tube practice, radiotherapy (RT) fractionation and volumes, use of chemotherapy in the neo-adjuvant, concurrent and palliative setting, the use of immunotherapy in the palliative setting, access to radiology and histopathology services, and availability of surgical procedures. RESULTS 30 centres were approached across UK; 23 (76.7%) centres responded and were included in the survey. There were differences in the standard practices in feeding tube policy, RT dose and fractionation as well as concurrent chemotherapy use. 21 (91%) participating centres had at least one treatment modification. 15 (65%) centres initiated a change in radical RT; changing to either a hypofractionation or acceleration schedule. For post-operative RT 10 centres (43.5%) changed to a hypofractionation schedule. 12 (52.2%) centres stopped neo-adjuvant chemotherapy for all patients; 13 (56.5%) centres followed selective omission of chemotherapy in concurrent chemo-radiotherapy patients, 17 (73.9%) centres changed first-line chemotherapy treatment to pembrolizumab (following NHS England's interim guidance) and 8 (34.8%) centres stopped the treatment early or offered delays for patients that have been already on systemic treatment. The majority of centres did not have significant changes associated with surgery, radiology, histopathology and dental screening. CONCLUSION There are variations in the standard of practice and treatment modifications for head and neck cancer patients during Covid-19 pandemic. A timely initiative is required to form a consensus on head and neck cancer management in the UK and other countries.
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Affiliation(s)
| | - David Noble
- Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | - Andrew Hartley
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | - Paul Sanghera
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | | | - Dorothy Gujral
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Bernie Foran
- Weston Park Cancer Centre, Sheffield, United Kingdom
| | - Shree Bhide
- Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | | | - Kannon Nathan
- Kent Oncology Centre, Maidstone and Canterbury, United Kingdom
| | | | - Mehmet Sen
- Leeds Cancer Centre, Leeds, United Kingdom
| | | | - Mano Joseph
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | | | | | - Laura Pettit
- Lingen Davie Cancer Centre, Shrewsbury, United Kingdom
| | | | | | | | | | | | - Ketan Shah
- Oxford University Hospitals, Oxford, United Kingdom
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13
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Joly F, Rigal O, Guittet L, Lefèvre-Arbogast S, Grellard JM, Binarelli G, Lange M, Rieux C, Fernette M, Tron L, Gernier F, Travers R, Morel A, Richard D, Griffon B, Leconte A, Bastien E, Quilan F, Pépin LF, Jardin F, Leheurteur M, Clarisse B, Lequesne J, Faveyrial A. Post-traumatic stress symptomatology and adjustment of medical oncology practice during the COVID-19 pandemic among adult patients with cancer in a day care hospital. Cancer 2021; 127:4636-4645. [PMID: 34398970 PMCID: PMC8426939 DOI: 10.1002/cncr.33856] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 12/20/2022]
Abstract
Background The COVID‐19 pandemic may induce post‐traumatic stress disorder (PTSD) symptoms among patients with cancer, who also face adaptations to their treatment. The authors assessed the occurrence of PTSD symptoms, investigated pandemic‐induced adjustments in medical oncology practice in patients with cancer, and explored risk factors for PTSD and the association between PTSD symptoms, insomnia, and quality of life (QoL). Methods This prospective French study was conducted in patients with solid/hematologic tumors who were receiving medical treatment in the day care departments of 2 cancer centers during the lockdown. Adjustments to medical oncology practice were collected from medical records. PTSD (measured using the Impact of Event Scale‐Revised), insomnia (measured using the Insomnia Severity Index), QoL (measured using the Functional Assessment of Cancer Therapy‐General instrument), and cognitive complaints (measured using the Functional Assessment of Cancer Therapy–Cognitive Function instrument) were collected through validated questionnaires. Results Clinical data and questionnaires were available for 734 and 576 patients, respectively. The median patient age was 64 years, and 69% of patients were women. Twenty‐one percent of patients had PTSD. Twenty‐seven percent (95% CI, 23%‐30%) had an adjustment in their medical oncology program, including adjournments (29%), treatment interruptions (16%), modified treatment plans (27%), or adapted monitoring (27%). Women and patients experiencing an adjustment in oncology practice had a higher odds of PTSD (odds ratio= 2.10 [95% CI, 1.07‐4.14] and 1.65 [95% CI, 1.03‐2.63]; P < .05). PTSD symptoms were correlated with worse scores for QoL, cognition, and insomnia. Conclusions Twenty‐one percent of patients with cancer experienced PTSD symptoms associated with poor QoL during the first COVID‐19–induced lockdown. Medical oncology practice was adjusted in approximately one‐quarter of patients and was associated with the occurrence of PTSD symptoms. Psychosocial support should be offered in cancer centers to promote emotional resilience and avoid PTSD symptoms in patients. Post‐traumatic stress disorder symptomatology occurred in 21% of patients with cancer during the first lockdown due to COVID‐19, was more frequent among women, and was associated with adjustment in medical oncology treatments. Caregivers should pay special attention to the psychological needs of patients with cancer to prevent or manage post‐traumatic stress disorder symptoms.
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Affiliation(s)
- Florence Joly
- Medical Oncology Department, Francois Baclesse Center, Caen, France.,Anticipe (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France.,Clinical Research, Francois Baclesse Center, Caen, France
| | - Olivier Rigal
- Medical Oncology, Henri Becquerel Center, Rouen, France.,Clinical Research, Henri Becquerel Center, Rouen, France
| | - Lydia Guittet
- Anticipe (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France
| | - Sophie Lefèvre-Arbogast
- Anticipe (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France.,Clinical Research, Francois Baclesse Center, Caen, France
| | | | - Giulia Binarelli
- Anticipe (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France.,Clinical Research, Francois Baclesse Center, Caen, France
| | - Marie Lange
- Anticipe (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France.,Clinical Research, Francois Baclesse Center, Caen, France
| | - Chantal Rieux
- Clinical Research, Francois Baclesse Center, Caen, France
| | - Marie Fernette
- Clinical Research, Francois Baclesse Center, Caen, France
| | - Laure Tron
- Anticipe (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France
| | | | | | - Adeline Morel
- Medical Oncology Department, Francois Baclesse Center, Caen, France
| | | | | | | | - Etienne Bastien
- Medical Oncology Department, Francois Baclesse Center, Caen, France
| | - Florian Quilan
- Medical Oncology Department, Francois Baclesse Center, Caen, France
| | | | - Fabrice Jardin
- Clinical Research, Henri Becquerel Center, Rouen, France.,Hematology, Henri Becquerel Center, Rouen, France
| | | | | | | | - Audrey Faveyrial
- Medical Oncology Department, Francois Baclesse Center, Caen, France
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14
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Impact of COVID-19 pandemic on the oncologic care continuum: urgent need to restore patients care to pre-COVID-19 era. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [PMCID: PMC8060543 DOI: 10.1017/s1460396921000303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background:
Globally, cancer is the second leading cause of death, and it is estimated that over 18·1 million new cases are diagnosed annually. The COVID-19 pandemic has significantly impacted almost every aspect of the provision and management of cancer care worldwide. The time-critical nature of COVID-19 diagnosis and the large number of patients requiring hospitalisation necessitated the rerouting of already limited resources available for cancer services and programmes to the care of COVID-19 patients. Furthermore, the stringent social distancing, restricted in-hospital visits and lockdown measures instituted by various governments resulted in the disruption of the oncologic continuum including screening, diagnostic and prevention programmes, treatments and follow-up services as well as research and clinical trial programmes.
Materials and Methods:
We searched several databases from October 2020 to January 2021 for relevant studies published in English between 2020 and 2021 and reporting on the impact of COVID-19 on the cancer care continuum. This narrative review paper describes the impact of the COVID-19 pandemic on the cancer patient care continuum from screening and prevention to treatments and ongoing management of patients.
Conclusions:
The COVID-19 pandemic has profoundly impacted cancer care and the management of cancer services and patients. Nevertheless, the oncology healthcare communities worldwide have done phenomenal work with joint and collaborative efforts, utilising best available evidence-based guidelines to continue to give safe and effective treatments for cancer patients while maintaining the safety of patients, healthcare professionals and the general population. Nevertheless, several healthcare centres are now faced with significant challenges with the management of the backlog of screening, diagnosis and treatment cases. It is imperative that governments, leaders of healthcare centres and healthcare professionals take all necessary actions and policies focused on minimising further system-level delays to cancer screening, diagnosis, treatment initiation and clearing of all backlogs cases from the COVID-19 pandemic in order to mitigate the negative impact on cancer outcomes.
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15
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Thompson JA, Lubek JE, Amin N, Joy R, Dyalram D, Ord RA, Taylor RJ, Wolf JS, Mehra R, Cullen KJ, Molitoris JK, Witek M, Papadimitriou JC, Morales RE, Hatten KM. Impact of the Novel Coronavirus 2019 (COVID-19) Pandemic on Head and Neck Cancer Care. Otolaryngol Head Neck Surg 2021; 166:93-100. [PMID: 33784206 PMCID: PMC8010374 DOI: 10.1177/01945998211004544] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective The study aimed to assess the impact of the coronavirus disease 2019
(COVID-19) pandemic on head and neck oncologic care at a tertiary care
facility. Study Design This was a cross-sectional study conducted between March 18, 2020, and May
20, 2020. The primary planned outcome was the rate of treatment
modifications during the study period. Secondary outcome measures were tumor
conference volume, operative volume, and outpatient patient procedure and
clinic volumes. Setting This single-center study was conducted at a tertiary care academic hospital
in a large metropolitan area. Methods The study included a consecutive sample of adult subjects who were presented
at a head and neck interdepartmental tumor conference during the study
period. Patients were compared to historical controls based on review of
operative data, outpatient procedures, and clinic volumes. Results In total, 117 patients were presented during the review period in 2020,
compared to 69 in 2019. There was an 8.4% treatment modification rate among
cases presented at the tumor conference. There was a 61.3% (347 from 898)
reduction in outpatient clinic visits and a 63.4% (84 from 230) reduction in
procedural volume compared to the prior year. Similarly, the operative
volume decreased by 27.0% (224 from 307) compared to the previous year. Conclusion Restrictions related to the COVID-19 pandemic resulted in limited treatment
modifications. Transition to virtual tumor board format observed an increase
in case presentations. While there were reductions in operative volume,
there was a larger proportion of surgical cases for malignancy, reflecting
the prioritization of oncologic care during the pandemic.
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Affiliation(s)
- Joshua Adam Thompson
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Joshua E Lubek
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Neha Amin
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Reju Joy
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Donita Dyalram
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Robert A Ord
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Rodney J Taylor
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey S Wolf
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ranee Mehra
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Kevin J Cullen
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Jason K Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matthew Witek
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John C Papadimitriou
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robert E Morales
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kyle M Hatten
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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16
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Gazivoda V, Greenbaum A, Roshal J, Lee J, Reddy L, Rehman S, Kangas-Dick A, Gregory S, Kowzun M, Stephenson R, Laird A, Alexander HR, Berger AC. Assessing the immediate impact of COVID-19 on surgical oncology practice: Experience from an NCI-designated Comprehensive Cancer Center in the Northeastern United States. J Surg Oncol 2021; 124:7-15. [PMID: 33765341 PMCID: PMC8250700 DOI: 10.1002/jso.26475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 12/29/2022]
Abstract
Background The effects of the coronavirus disease 2019 (COVID‐19) pandemic on surgical oncology practice are not yet quantified. The aim of this study was to measure the immediate impact of COVID‐19 on surgical oncology practice volume. Methods A retrospective study of patients treated at an NCI‐Comprehensive Cancer Center was performed. “Pre‐COVID” era was defined as January–February 2020 and “COVID” as March–April 2020. Primary outcomes were clinic visits and operative volume by surgical oncology subspecialty. Results Abouyt 907 new patient visits, 3897 follow‐up visits, and 644 operations occurred during the study period. All subspecialties experienced significant decreases in new patient visits during COVID, though soft tissue oncology (Mel/Sarc), gynecologic oncology (Gyn/Onc), and endocrine were disproportionately affected. Telehealth visits increased to 11.4% of all visits by April. Mel/Sarc, Gyn/Onc, and Breast experienced significant operative volume decreases during COVID (25.8%, p = 0.012, 43.6% p < 0.001, and 41.9%, p < 0.001, respectively), while endocrine had no change and gastrointestinal oncology had a slight increase (p = 0.823) in the number of cases performed. Conclusions The effects of the COVID‐19 pandemic are wide‐ranging within surgical oncology subspecialties. The addition of telehealth is a viable avenue for cancer patient care and should be considered in surgical oncology practice.
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Affiliation(s)
- Victor Gazivoda
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Alissa Greenbaum
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Joshua Roshal
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jenna Lee
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Lekha Reddy
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Shahyan Rehman
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Aaron Kangas-Dick
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Stephanie Gregory
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Maria Kowzun
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Ruth Stephenson
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Amanda Laird
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - H R Alexander
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Adam C Berger
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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17
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Riera R, Bagattini ÂM, Pacheco RL, Pachito DV, Roitberg F, Ilbawi A. Delays and Disruptions in Cancer Health Care Due to COVID-19 Pandemic: Systematic Review. JCO Glob Oncol 2021; 7:311-323. [PMID: 33617304 PMCID: PMC8081532 DOI: 10.1200/go.20.00639] [Citation(s) in RCA: 256] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE There has been noteworthy concern about the impact of COVID-19 pandemic on health services including the management of cancer. In addition to being considered at higher risk for worse outcomes from COVID-19, people with cancer may also experience disruptions or delays in health services. This systematic review aimed to identify the delays and disruptions to cancer services globally. METHODS This is a systematic review with a comprehensive search including specific and general databases. We considered any observational longitudinal and cross-sectional study design. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the studies was assessed by specific tools. The delays and disruptions identified were categorized, and their frequency was presented. RESULTS Among the 62 studies identified, none exhibited high methodological quality. The most frequent determinants for disruptions were provider- or system-related, mainly because of the reduction in service availability. The studies identified 38 different categories of delays and disruptions with impact on treatment, diagnosis, or general health service. Delays or disruptions most investigated included reduction in routine activity of cancer services and number of cancer surgeries; delay in radiotherapy; and delay, reschedule, or cancellation of outpatient visits. Interruptions and disruptions largely affected facilities (up to 77.5%), supply chain (up to 79%), and personnel availability (up to 60%). CONCLUSION The remarkable frequency of delays and disruptions in health care mostly related to the reduction of the COVID-19 burden unintentionally posed a major risk on cancer care worldwide. Strategies can be proposed not only to mitigate the main delays and disruptions but also to standardize their measurement and reporting. As a high number of publications continuously are being published, it is critical to harmonize the upcoming reports and constantly update this review.
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Affiliation(s)
- Rachel Riera
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.,Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petrópolis, Brazil
| | | | - Rafael Leite Pacheco
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.,Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petrópolis, Brazil.,Centro Universitário São Camilo, São Paulo, Brazil
| | | | - Felipe Roitberg
- Instituto do Câncer do Estado de São Paulo/HCFMUSP, São Paulo, Brazil.,Department of Noncommunicable Diseases, World Health Organization (WHO), Geneva, Switzerland.,European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization (WHO), Geneva, Switzerland
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18
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Fagan JJ, Noronha V, Graboyes EM. Making the Best of Limited Resources: Improving Outcomes in Head and Neck Cancer. Am Soc Clin Oncol Educ Book 2021; 41:1-11. [PMID: 33793315 PMCID: PMC8059263 DOI: 10.1200/edbk_320923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The overwhelming majority of head and neck cancers and related deaths occur in low- and middle-income countries, which have challenges related to burden of disease versus access to care. Yet the additional health care burden of the COVID-19 pandemic has also impacted access to care for patients with head and neck cancer in the United States. This article focuses on challenges and innovation in prioritizing head and neck cancer care in Sub-Saharan Africa, the Indian experience of value-added head and neck cancer care in busy and densely populated regions, and strategies to optimize the management of head and neck cancer in the United States during the COVID-19 pandemic.
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Affiliation(s)
- Johannes J. Fagan
- Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Evan Michael Graboyes
- Departments of Otolaryngology-Head and Neck Surgery and Public Health Sciences, Medical University of South Carolina, Charleston, SC
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19
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Kuliukas L, Hauck Y, Sweet L, Vasilevski V, Homer C, Wynter K, Wilson A, Szabo R, Bradfield Z. A cross sectional study of midwifery students' experiences of COVID-19: Uncertainty and expendability. Nurse Educ Pract 2021; 51:102988. [PMID: 33601117 PMCID: PMC7870440 DOI: 10.1016/j.nepr.2021.102988] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/20/2021] [Accepted: 01/31/2021] [Indexed: 01/09/2023]
Abstract
The impact of COVID-19 on midwifery students is anticipated to be multi-faceted. Our aim was to explore Australian midwifery students' experiences of providing maternity care during the COVID-19 pandemic. In a cross-sectional study 147 students were recruited through social media. Data were collected through an online survey and semi-structured interviews. Surveys were analysed using descriptive statistics; interviews and open text responses were interpreted through qualitative analysis. Findings revealed students found communication from hospitals and universities to be confusing, inconsistent and they relied on mass media and each other to remain updated. Moving to online learning and being isolated from peers made learning difficult. During clinical placements, students felt expendable in terms of their value and contribution, reflected in essential equipment such as personal protective equipment not always being available to them. Witnessing perceived compromised midwifery care increased students' emotional burden, while personal household responsibilities and financial concerns were problematic. One silver lining witnessed was women's appreciation of an improved ‘babymoon’, with fewer visitors, allowing uninterrupted time to establish breastfeeding and connection with their baby. Findings may guide management of midwifery education during future pandemics or health crises for universities and hospitals.
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Affiliation(s)
- Lesley Kuliukas
- Curtin University, Kent St, Bentley, Western Australia, 6102, Australia.
| | - Yvonne Hauck
- Curtin University, Kent St, Bentley, Western Australia, 6102, Australia.
| | - Linda Sweet
- Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | | | - Caroline Homer
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia; University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - Karen Wynter
- Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Alyce Wilson
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Rebecca Szabo
- University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Zoe Bradfield
- Curtin University, Kent St, Bentley, Western Australia, 6102, Australia.
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20
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Rajan S, Chakrabarti D, Akhtar N, Kumar V, Verma M. Searching for answers: Cancer care during the COVID pandemic. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 10:100696. [PMID: 33458450 PMCID: PMC7804375 DOI: 10.1016/j.cegh.2020.100696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 12/30/2022] Open
Abstract
The unprecedented novel coronavirus disease pandemic has wreaked havoc on healthcare systems worldwide and raised myriads of questions. The delivery of cancer care is an essential service that cannot take a backseat, even amid a global pandemic. Oncology involves the disciplines of surgical oncology, radiotherapy, chemotherapy, and palliative care which are all affected, including the possible impact of the pandemic on the mental health of patients and healthcare workers alike. This commentary attempted to review these questions in light of the best available evidence. The delivery of cancer care is generally safe when routine safety precautions are followed, and decisions are based on rational scheduling and logistical prioritisation. The impact on the mental health is profound that needs to be addressed with adequate avenues. Teleoncology is a reasonable alternative, whenever applicable. Evidence-based decision making should be the standard of care, and multidisciplinary management decisions are as indispensable as ever.
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Affiliation(s)
- Shiv Rajan
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Deep Chakrabarti
- Department of Radiation Oncology, King George's Medical University, Lucknow, India
| | - Naseem Akhtar
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Vijay Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, India
| | - Mranalini Verma
- Department of Radiation Oncology, King George's Medical University, Lucknow, India
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21
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Qazi UA, Sutton J, Farner SC, Bhandari L. Impact of the COVID-19 Pandemic on the Practice of Hand and Upper Extremity Surgeons. Cureus 2020; 12:e12072. [PMID: 33489490 PMCID: PMC7805423 DOI: 10.7759/cureus.12072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective The purpose of this study was to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on the practice of hand and upper extremity surgeons. Methods We assessed how the pandemic affected the practice on multiple fronts including professional, personal, and practice aspects. The survey was conducted through an online questionnaire that had six sections: demographics, clinic, elective surgery, emergency surgery, urgent surgery, and human resources. The survey was sent to 586 Kleinert Society members who are all practicing hand and upper extremity surgeons. Results We received 35 responses from the United States and 53 from the rest of the world. Based on our findings, the clinic volume was reduced by >50% in the early stages, subsequently returning to a level that was 25-50% lower than pre-COVID-19 times in later stages. A corresponding decrease in elective surgeries was also noted. The need for preoperative COVID-19 tests added to the logistics of surgery, causing delays of three to six hours for emergency cases and >24 hours for urgent cases. The hand surgeons witnessed multiple furloughs, layoffs, and even COVID-19 infections among nursing and support staff. Most hand surgeons continued to perform urgent and emergency surgeries during the pandemic. The application of telemedicine was not popular and had multiple drawbacks. Hand surgeons are modifying their practice by adopting measures such as social distancing, reducing the clinic volume, and using personal protective equipment (PPE). Conclusions As COVID-19 is likely to prevail for the foreseeable future, these measures are here to stay. The initial reduction in the clinic and elective volume has improved but has not reached pre-COVID-19 levels, suggesting a slow recovery. As reopening measures will lead to more people rejoining employment, subsequently, more patients with hand-related conditions are likely to present to the clinics. Rapid COVID-19 testing and supply of PPEs will play a crucial role in the near future to enable hand surgeons to continue their service while taking care of their personal health.
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Affiliation(s)
- Uzair A Qazi
- Hand Surgery, Kleinert Kutz and Associates for Hand and Microsurgery, Louisville, USA
| | - Julianne Sutton
- Research, Kleinert Kutz and Associates for Hand and Microsurgery, Louisville, USA
| | - Scott C Farner
- Hand Surgery, Kleinert Kutz and Associates for Hand and Microsurgery, Louisville, USA
| | - Laxminarayan Bhandari
- Hand Surgery, Kleinert Kutz and Associates for Hand and Microsurgery, Louisville, USA
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22
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Chone CT. Increased mortality from head and neck cancer due to SARS-CoV-2 pandemic. Braz J Otorhinolaryngol 2020; 87:1-2. [PMID: 33288451 PMCID: PMC7674011 DOI: 10.1016/j.bjorl.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlos Takahiro Chone
- Universidade de Campinas, Departamento de Otorrinolaringologia e Cabeça e Pescoço, Campinas, SP, Brazil.
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23
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Abate SM, Mantefardo B, Basu B. Postoperative mortality among surgical patients with COVID-19: a systematic review and meta-analysis. Patient Saf Surg 2020; 14:37. [PMID: 33062056 PMCID: PMC7549731 DOI: 10.1186/s13037-020-00262-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic puts perioperative providers and staff at risk of viral exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during aerosol-generating procedures, particularly in asymptomatic carriers.However, the perioperative risk for adverse outcomes in SARS-CoV-2 infected patients remain uncertain and the topic of debate. The current study was designed to determine the postoperative mortality in COVID-19 patients based on a systematic review and meta-analysis of the global published peer-reviewed literature. METHODS A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019, to August15, 2020, without language restriction. All observational studies reporting the prevalence of mortality were included while case reports and reviews were excluded. The data from each study were extracted with two independent authors with a customized format excel sheet and the disagreements were resolved by the third author. The methodological quality of included studies was evaluated using a standardized critical appraisal Tool adapted from the Joanna Briggs Institute. RESULTS A total of 715 articles were identified from different databases and 45 articles were selected for evaluation after the successive screening. Twenty-three articles with 2947 participants were included. The meta-analysis revealed a very high global rate of postoperative mortality among COVID-19 patients of 20% (95% CI: 15 to 26) and a postoperative ICU admission rate of 15% (95% confidence interval (CI):10 to 21). CONCLUSION The unexpected high postoperative mortality rate in SARS-CoV-2 infected patients of 20% in the global literature mandates further scrutiny in assuring appropriate surgical indications and perioperative surgical safety measures in this vulnerable cohort of patients. REGISTRATION This systematic review and meta-analysis was registered in Prospero's international prospective register of systematic reviews (CRD42020203362) on August 10, 2020.
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, PO.BOX:419, Dilla, Ethiopia
| | - Bahiru Mantefardo
- Department of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences, University of Calcutta, Kolkata, India
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24
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Wickemeyer JL, Yu J. A Model for Undergraduate Medical Student Education in Otolaryngology During the Post–COVID-19 Era. Otolaryngol Head Neck Surg 2020; 164:562-565. [DOI: 10.1177/0194599820959276] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical learning environment is limited for undergraduate medical education in otolaryngology as the result of coronavirus disease 2019. In an effort to foster and rebuild the attending–medical student relationship, we have developed the R4 teaching model. This model encourages the student to read background information, respond to questions, and review online with faculty with the goal of realization of clinical decision making with gained knowledge. Within the R4 model, there are learning environment subtypes, including real patient cases, journal club, interactive quizzes, flipped classroom, and attending-lead discussions. In the absence of a multitude of “live” patients, our curricula reinstate the core of clinical teaching for medical students.
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Affiliation(s)
- Johanna L. Wickemeyer
- Otolaryngology Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeffrey Yu
- Otolaryngology Head and Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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25
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Singh HK, Patil V, Chaitanya G, Nair D. Preparedness of the cancer hospitals and changes in oncosurgical practices during COVID-19 pandemic in India: A cross-sectional study. J Surg Oncol 2020; 122:1276-1287. [PMID: 32841395 PMCID: PMC7461483 DOI: 10.1002/jso.26174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Coronavirus disease-2019 (COVID-19) pandemic has impacted cancer care across India. This study aimed to assess (a) organizational preparedness of hospitals (establishment of screening clinics, COVID-19 wards/committees/intensive care units [ICUs]/operating rooms [ORs]), (b) type of major/minor surgeries performed, and (c) employee well-being (determined by salary deductions, paid leave provisions, and work in-rotation). METHODS This online questionnaire-based cross-sectional study was distributed to 480 oncosurgeons across India. We used χ2 statistics to compare responses across geographical areas (COVID-19 lockdown zones and city tiers) and type of organization (government/private, academic/nonacademic, and dedicated/multispecialty hospitals). P < .05 was considered significant. RESULTS Total of 256 (53.3%) oncologists completed the survey. About 206 hospitals in 85 cities had screening clinics (98.1%), COVID-19 dedicated committees (73.7%), ward (67.3%), ICU's (49%), and OR's (36%). Such preparedness was higher in tier-1 cities, government, academic, and multispecialty hospitals. Dedicated cancer institutes continued major surgeries in all oncological subspecialties particularly in head and neck (P = .006) and colorectal oncology (P = .04). Employee well-being was better in government hospitals. CONCLUSION Hospitals have implemented strategies to continue cancer care. Despite limited resources, the significant risk associated and financial setbacks amidst nationwide lockdown, oncosurgeons are striving to prioritize and balance the oncologic needs and safety concerns of cancer patients across the country.
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Affiliation(s)
- Hemant Kumar Singh
- Department of Surgery, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
| | - Vijayraj Patil
- Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Ganne Chaitanya
- Department of Neurology, Epilepsy and Cognitive Neurophysiology Lab, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deepa Nair
- Department of Head Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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26
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Tzeng CWD, Teshome M, Katz MHG, Weinberg JS, Lai SY, Antonoff MB, Bird JE, Shafer A, Davis JW, Adelman DM, Moon B, Reece G, Prabhu SS, DeSnyder SM, Skibber JM, Mehran R, Schmeler K, Roland CL, Tran Cao HS, Aloia TA, Caudle AS, Swisher SG, Vauthey JN. Cancer Surgery Scheduling During and After the COVID-19 First Wave: The MD Anderson Cancer Center Experience. Ann Surg 2020; 272:e106-e111. [PMID: 32675511 PMCID: PMC7373457 DOI: 10.1097/sla.0000000000004092] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To summarize the multi-specialty strategy and initial guidelines of a Case Review Committee in triaging oncologic surgery procedures in a large Comprehensive Cancer Center and to outline current steps moving forward after the initial wave. SUMMARY OF BACKGROUND DATA The impetus for strategic rescheduling of operations is multifactorial and includes our societal responsibility to minimize COVID-19 exposure risk and propagation among patients, the healthcare workforce, and our community at large. Strategic rescheduling is also driven by the need to preserve limited resources. As many states have already or are considering to re-open and relax stay-at-home orders, there remains a continued need for careful surgical scheduling because we must face the reality that we will need to co-exist with COVID-19 for months, if not years. METHODS The quality officers, chairs, and leadership of the 9 surgical departments in our Division of Surgery provide specialty-specific approaches to appropriately triage patients. RESULTS We present the strategic approach for surgical rescheduling during and immediately after the COVID-19 first wave for the 9 departments in the Division of Surgery at The University of Texas MD Anderson Cancer Center in Houston, Texas. CONCLUSIONS Cancer surgeons should continue to use their oncologic knowledge to determine the window of opportunity for each surgical procedure, based on tumor biology, preoperative treatment sequencing, and response to systemic therapy, to safely guide patients through this cautious recovery phase.
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Affiliation(s)
- Ching-Wei D Tzeng
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew H G Katz
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Justin E Bird
- Department of Orthopedic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aaron Shafer
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David M Adelman
- Department of Plastics and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bryan Moon
- Department of Orthopedic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregory Reece
- Department of Plastics and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John M Skibber
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza Mehran
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kathleen Schmeler
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christina L Roland
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hop S Tran Cao
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A Aloia
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abigail S Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jean-Nicolas Vauthey
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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27
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Turri‐Zanoni M, Battaglia P, Karligkiotis A, Locatelli D, Castelnuovo P. Managing care for patients with sinonasal and anterior skull base cancers during the COVID-19 pandemic. Head Neck 2020; 42:1503-1506. [PMID: 32415882 PMCID: PMC7276918 DOI: 10.1002/hed.26257] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 01/12/2023] Open
Abstract
The SARS-CoV-2 pandemic has rapidly transformed health care delivery around the globe. Because of the heavy impact of COVID-19 spread, cancer treatments have necessarily been de-prioritized, thus exposing patients to increased risk of morbidity and mortality due to delayed care. In this scenario, cancer specialists need to assess critical oncology patients case by case to carefully balance risk vs benefit in treating tumors and preventing SARS-CoV-2 infection. Here, we report early insights into how the management of patients with sinonasal and anterior skull base cancer might be affected by the COVID-19 pandemic. We provide recommendations for preoperative tests, indications for immediate care vs possible delayed treatment, and warnings relating to dural resection and intracranial dissection, given the potential neurotropism of SARS-CoV2 and practical suggestions for managing cancer care in a period of limited resources. We also postulate some thoughts on the promising role of telemedicine in multidisciplinary case discussions and posttreatment surveillance.
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Affiliation(s)
- Mario Turri‐Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life SciencesUniversity of InsubriaVareseItaly
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences University of InsubriaVareseItaly
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life SciencesUniversity of InsubriaVareseItaly
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences University of InsubriaVareseItaly
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life SciencesUniversity of InsubriaVareseItaly
| | - Davide Locatelli
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences University of InsubriaVareseItaly
- Division of Neurosurgery, Department of Biotechnology and Life SciencesUniversity of InsubriaVareseItaly
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life SciencesUniversity of InsubriaVareseItaly
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences University of InsubriaVareseItaly
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28
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Mehanna H, Hardman JC, Shenson JA, Abou-Foul AK, Topf MC, AlFalasi M, Chan JYK, Chaturvedi P, Chow VLY, Dietz A, Fagan JJ, Godballe C, Golusiński W, Homma A, Hosal S, Iyer NG, Kerawala C, Koh YW, Konney A, Kowalski LP, Kraus D, Kuriakose MA, Kyrodimos E, Lai SY, Leemans CR, Lennon P, Licitra L, Lou PJ, Lyons B, Mirghani H, Nichols AC, Paleri V, Panizza BJ, Parente Arias P, Patel MR, Piazza C, Rischin D, Sanabria A, Takes RP, Thomson DJ, Uppaluri R, Wang Y, Yom SS, Zhu YM, Porceddu SV, de Almeida JR, Simon C, Holsinger FC. Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus. Lancet Oncol 2020; 21:e350-e359. [PMID: 32534633 PMCID: PMC7289563 DOI: 10.1016/s1470-2045(20)30334-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.
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Affiliation(s)
- Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK.
| | - John C Hardman
- Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK
| | - Jared A Shenson
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
| | - Ahmad K Abou-Foul
- Department of Otolaryngology and Head and Neck Surgery, Walsall Manor Hospital, Walsall, UK
| | - Michael C Topf
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
| | - Mohammad AlFalasi
- Department of Otolaryngology, United Arab Emirates University, Alain, United Arab Emirates
| | - Jason Y K Chan
- Department of Otorhinolaryngology and Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
| | - Pankaj Chaturvedi
- Department of Otorhinolaryngology and Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| | - Velda Ling Yu Chow
- Department of Surgery, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Andreas Dietz
- Department of Ear, Nose and Throat Surgery, University of Leipzig, Leipzig, Germany
| | - Johannes J Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | - Christian Godballe
- Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Centre, Poznan, Poland
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sefik Hosal
- Department of Otolaryngology-Head and Neck Surgery, Atilim University Faculty of Medicine, Ankara, Turkey
| | - N Gopalakrishna Iyer
- Department of Head and Neck Surgery, National Cancer Centre and Singapore General Hospital, Singapore
| | - Cyrus Kerawala
- Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University, Seoul, South Korea
| | - Anna Konney
- Department of Otolaryngology, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, School of Medical Science, Kumasi, Ghana
| | - Luiz P Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Sao Paulo, Brazil
| | - Dennis Kraus
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine, Northwell Health Cancer Institute, New York, NY, USA
| | - Moni A Kuriakose
- Department of Otolaryngology-Head and Neck Surgery, Cochin Cancer Research Centre, Cochin, India
| | - Efthymios Kyrodimos
- First Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stephen Y Lai
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Rene Leemans
- Department of Otolaryngology and Head and Neck Surgery, Amsterdam University Medical Centre, Cancer Center Amsterdam, VU University, Amsterdam, Netherlands
| | - Paul Lennon
- Department of Otolaryngology and Head and Neck Surgery, St James's Hospital and The Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Lisa Licitra
- Foundation IRCCS, Division of Medical Oncology, National Institute of Cancer of Milan, University of Milan, Milan, Italy
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Bernard Lyons
- Department of Otolaryngology Head and Neck Surgery, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Haitham Mirghani
- Department of Otolaryngology and Head and Neck Surgery, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Anthonny C Nichols
- Department of Otolaryngology-Head and Neck Surgery and Department of Oncology, University of Western Ontario, London, ON, Canada
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK
| | - Benedict J Panizza
- Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Pablo Parente Arias
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Mihir R Patel
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, National Institute of Cancer of Milan, University of Milan, Milan, Italy
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia-Hospital Universitario San Vicente Fundación, Medellin, Colombia; CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin, Colombia
| | - Robert P Takes
- Department of Otolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - David J Thomson
- Department of Clinical Oncology, The Christie National Health Service Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Ravindra Uppaluri
- Division of Otolaryngology-Head and Neck Surgery, Dana-Farber and Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University, Shanghai Cancer Center, Shanghai, China
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Yi-Ming Zhu
- Department of Head and Neck Surgery, National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sandro V Porceddu
- Department of Cancer Services, Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery and Department of Surgical Oncology, University Health Network, Toronto, ON, Canada; Department of Otolaryngology-Head and Neck Surgery, Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Chrisian Simon
- Department of Otolaryngology and Head and Neck Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
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29
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Maniakas A, Jozaghi Y, Zafereo ME, Sturgis EM, Su SY, Gillenwater AM, Gidley PW, Lewis CM, Diaz E, Goepfert RP, Kupferman ME, Gross ND, Hessel AC, Pytynia KB, Nader M, Wang JR, Lango MN, Kiong KL, Guo T, Zhao X, Yao CMKL, Appelbaum E, Alpard J, Garcia JA, Terry S, Flynn JE, Bauer S, Fournier D, Burgess CG, Wideman C, Johnston M, You C, De Luna R, Joseph L, Diersing J, Prescott K, Heiberger K, Mugartegui L, Rodriguez J, Zendehdel S, Sellers J, Friddell RA, Thomas A, Khanjae SJ, Schwarzlose KB, Chambers MS, Hofstede TM, Cardoso RC, Wesson RA, Won A, Otun AO, Gombos DS, Al‐Zubidi N, Hutcheson KA, Gunn GB, Rosenthal DI, Gillison ML, Ferrarotto R, Weber RS, Hanna EY, Myers JN, Lai SY. Head and neck surgical oncology in the time of a pandemic: Subsite-specific triage guidelines during the COVID-19 pandemic. Head Neck 2020; 42:1194-1201. [PMID: 32342541 PMCID: PMC7267348 DOI: 10.1002/hed.26206] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 02/03/2023] Open
Abstract
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.
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