Prevision of multidisciplinary head and neck cancer survivorship care during the 2019 novel coronavirus pandemic

Updates in Cancer Rehabilitation Telehealth

Purpose of Review

To describe the various uses of telehealth as it applies to cancer rehabilitation and to review recent findings since the onset of the COVID-19 pandemic.

Recent Findings

Telehealth has numerous applications in cancer rehabilitation including physiatry services, skilled therapies, exercise interventions, symptom management, and support groups. Numerous studies have shown that regular physician and skilled therapy services can be provided through telehealth platforms, though certain clinical situations may require in-person visits. Telehealth exercise-based interventions are feasible, safe, and can improve quality of life. Telehealth also may be an effective tool in symtom management and as a medium for support groups.

Summary

Telemedicine and telehealth platforms are effective tools in the field of cancer rehabilitation that not only provide increased safety and convenience for a burdened patient population but may also hold the potential to elevate beyond the current standard of care.

Development of a Remote Examination of Deglutition Based on Consensus Surveys of Clinicians (Part II): Reliability and Validity in Healthy Elderly Individuals and Oral Cancer Patients

In our prior published study, we extracted evaluation items suitable for remote administration, and made a relatively simple Remote Examination of Deglutition (RED). This study aimed at verifying the reliability and validity of RED. The participants were 21 healthy elderly individuals and 72 postoperative oral cancer (OC) patients. OC patients underwent videofluoroscopic dysphagia examination, and severity was judged on the dysphagia severity scale (DSS). Reliability and validity of RED were examined in all participants under face-to-face conditions, in comparison with the Mann Assessment of Swallowing Ability (MASA). Reliability and validity of remote administration of RED were examined in 40 participants. ROC curves were used to find cut-off RED scores to predict aspiration and deglutition disorders. The Cronbach's alpha coefficient for the items was 0.882. There was a high correlation between the total score of RED and MASA in the face-to-face condition. When RED score was compared among different severity groups (DSS1-4, DSS5-6, and DSS7), the total and oral preparatory stage scores revealed significant group differences. The area under the curve (AUC) for aspiration based on the ROC curve was 0.913, with a sensitivity/specificity of 0.80/0.98. The AUC for deglutition disorders was 0.819, with a sensitivity/specificity of 0.74/0.67. In both face-to-face and remote conditions, the reliability of RED was good.The reliability and validity of RED were confirmed. RED has shown the potential to assess the likelihood of aspiration and deglutition disorders in OC patients remotely as an initial assessment tool.

Impactos da COVID-19 nos atendimentos fisioterapêuticos a mulheres com câncer de mama

Resumo Introdução: A COVID-19 trata-se de uma situação de emergência de saúde pública de importância interna-cional, cujo espectro clínico é diverso. Levando em consideração as medidas de prevenção ao coronavírus e as recomendações das autoridades de saúde, surge a preocupação de como estão os atendimentos fisiotera-pêuticos a mulheres com câncer de mama, já que sua descontinuidade pode favorecer o aparecimento de complicações, prejuízos na funcionalidade, na qualidade de vida e na realização de tratamentos complementares. Objetivo: Avaliar os impactos da pandemia de COVID-19 na continuidade dos atendimentos fisioterapêuticos a mulheres com câncer de mama. Métodos: Trata-se de uma pesquisa transversal. Os dados foram coletados por meio de questionário on-line e a população foi composta por fisioterapeutas que atuam em território brasileiro. Resultados: De um total de 40 participantes, 20% relataram não ter sofrido alteração na rotina de trabalho, 48% tiveram a carga horária reduzida, 12% sofreram aumento de carga horária, enquanto 25% foram realocadas de setor para prestar assistência aos acometidos pela COVID-19. Vinte por cento dos atendimentos foram suspensos, sendo os locais com maior continuidade na assistência os de internação hospitalar (40%) e ambulatórios (42%). Quanto ao número de mulheres atendidas antes da pandemia em comparação ao número durante o período de restrição, houve uma queda de 72%. Conclusão: Verificou-se suspensão da maior parte dos atendimentos, no entanto, em sua maioria, a continuidade da assistência foi garantida através de teleatendimento. Não obstante, os entrevistados relataram piora clínica no quadro das mulheres após o período de suspensão do tratamento.

Impacts of COVID-19 on physiotherapy care for women with breast cancer

Abstract Introdution: COVID-19 has been declared a public health emergency of international concern by the World Health Organization, with a diverse clinical spectrum. Given the coronavirus prevention measures and recommendations from health authorities, there is a concern about how physiotherapy care is provided to women with breast cancer. The discontinuity of care may favor the emergence of complications, and compromise functionality, quality of care and the provision of complementary treatments. Objective: To assess the impacts of the COVID-19 pandemic on the continuity of physiotherapy care for women with breast cancer. Methods: This is a cross-sectional study. Data were collected through an online questionnaire and the population was composed of physiotherapists, of both sexes, who work in Brazil. Results: Twenty percent of the 40 participants reported no change in their work routine, 48% had their workload reduced, 12% had an increased workload, 25% were relocated to provide assistance to patients affected by COVID-19, and 20% of consultations were suspended. The greatest continuity of care was seen in hospital admissions (40%) and outpatient clinics (42%). The number of women cared for before the pandemic compared to during the restriction period declined by 72%. Conclusion: Most consultations were suspended; however, in most cases, continuity of care was guaranteed through telerehabilitation. Nevertheless, the interviewees reported clinical worsening in women after treatment was interrupted.

Patient-reported outcomes and complications during head and neck cancer radiotherapy before versus during the COVID-19 pandemic

PURPOSE

This study compares patient-reported outcomes and treatment-related complications during radiotherapy before (August 2019-January 2020) versus during (March-Sept 2020) the COVID-19 pandemic.

MATERIALS AND METHODS

The MD Anderson Symptom Inventory-head and neck module was used to assess curative intent in H&N cancer patients' symptoms during radiotherapy.

RESULTS

There were 158 patients in the pre-pandemic cohort and 137 patients in the pandemic cohort. There was no significant difference in enteral feeding requirements between the cohorts (21% versus 30%, p = 0.07). Weight loss was higher during the pandemic (mean - 5.6% versus 6.8%, p = 0.03). On multivariate analysis, treatment during the pandemic was associated with higher symptom scores for coughing/choking while eating (2.7 versus 2.1, p = 0.013).

CONCLUSIONS

Complication rates during H&N radiotherapy during the COVID-19 pandemic were similar at our institution relative to the pre-pandemic era, although weight loss was greater and patients reported more severe choking/coughing while eating.

Telehealth for Dysphagia Across the Life Span: Using Contemporary Evidence and Expertise to Guide Clinical Practice During and After COVID-19

Purpose Our aim was to critically review recent literature on the use of telehealth for dysphagia during the COVID-19 pandemic and enhance this information in order to provide evidence- and practice-based clinical guidance during and after the pandemic. Method We conducted a rapid systematized review to identify telehealth adaptations during COVID-19, according to peer-reviewed articles published from January to August 2020. Of the 40 articles identified, 11 met the inclusion criteria. Full-text reviews were completed by three raters, followed by qualitative synthesis of the results and description of practical recommendations for the use of telehealth for dysphagia. Results Seven articles were guidelines articles, three were editorials, and one was a narrative review. One article focused on telehealth and dysphagia during COVID-19. The remaining 10 mentioned telehealth in varying degrees while focusing on dysphagia management during the pandemic. No articles discussed pediatrics in depth. The most common procedure for which telehealth was recommended was the clinical swallowing assessment (8/11), followed by therapy (7/11). Six articles characterized telehealth as a second-tier service delivery option. Only one article included brief guidance on telehealth-specific factors, such as legal safeguards, safety, privacy, infrastructure, and facilitators. Conclusions Literature published during the pandemic on telehealth for dysphagia is extremely limited and guarded in endorsing telehealth as an equivalent service delivery model. We have presented prepandemic and emerging current evidence for the safety and reliability of dysphagia telemanagement, in combination with practical guidelines to facilitate the safe adoption of telehealth during and after the pandemic.

Follow-up after oral cancer treatment-Transition to a personalized approach

BACKGROUND

Guidelines for follow-up after oral cancer treatment are not site-specific and encompass the entire head and neck area rather than the oral cavity alone. This one-size-fits-all protocol disregards the differences in aetiology, treatment and differential distribution of new disease between the subsites. With the effectiveness of follow-up in early detection of new disease being put into question, the focus of follow-up programmes might shift to other aspects of survivorship care. Personalization of follow-up is important, considering patient-specific features and needs. Furthermore, the COVID-19 pandemic urges us to rethink our follow-up practice.

FINDINGS

This paper discusses ways in which routine follow-up in patients treated for oral cancer can be optimized. Patients with a high risk of new disease might benefit from an intensified follow-up regimen, whilst patients with a low risk of new disease, a low chance of cure or limited life expectancy could benefit from a de-intensified follow-up regimen. The latter could include a shorter follow-up period and focus on goals other than early detection of new disease. Education of patients to report new symptoms early is of vital importance as the majority of new disease presents symptomatically. Other health care professionals such as specialist nurses and dentists need to play an important leading role in survivorship care. Remote consultations may be useful to perform more efficient and patient-centred follow-up care.

CONCLUSION

Routine follow-up needs to be seen as an integrated part of an individualized survivorship plan that is provided by the entire multidisciplinary team.

Speech-Language Pathology and Audiology Care in the COVID-19 Era: Shared Experiences

Purpose

The COVID-19 pandemic has rapidly altered the global health-care system and stretched scarce resources to the limit. Resource limitations include personal protective equipment and medical devices; however, limited resources also include the more valuable health-care professional. Recent focus has been on the acute management of COVID-19. Still, there is a need to focus on the long-term rehabilitation of patients moving out of the acute treatment phase and into survivorship due to chronic respiratory concerns and other COVID-19 complications. Multidisciplinary, collaborative teams will support positive outcomes. Thus, speech-language pathologists too must carefully consider their role in patient care during a global pandemic. What makes the COVID-19 pandemic unique is the rapid minimally mitigated spread of the disease from close contact to most regions of the world. However, what appears to be true is a collective experience and common bond across regional borders.

Conclusions

Perhaps, this global pandemic may lead to a global partnership, a shared experience, and mutually dependent relationships. Global health is no longer “international service” or something that happens “over there”; global health is our reality.

Systematic rapid living review of the impact of the COVID-19 pandemic on cancer survivors: update to August 27, 2020

Background

The COVID-19 pandemic has resulted in drastic changes in the global healthcare delivery landscape and has had practical repercussions for cancer survivors. This systematic rapid living review has been undertaken to synthesise the available knowledge regarding the impact of the COVID-19 pandemic in a timely manner. This initial rapid review will present the findings of literature published up to August 27, 2020.

Design

A systematic search of PubMed, Scopus and Google Scholar databases was conducted to identify all articles, available in English language, regarding the impact of the COVID-19 pandemic on cancer survivors published between December 2019 and August 27, 2020. The search strategy employed the following search strings: “covid-19 OR coronavirus OR sars-cov-2” with “cancer survivors OR cancer survivorship”.

Results

The database search yielded 1639 articles, of which 19 were included. Of the 19 selected articles, there were 12 expert opinion articles, two literature reviews, two prospective cohort studies, one retrospective cohort study, one descriptive study and one pooled meta-analysis that comment on the impact of the COVID-19 pandemic on the physical wellbeing (16 articles), psychosocial wellbeing (15 articles) and financial wellbeing of cancer survivors (3 articles).

Conclusions

Limited definitive evidence exists regarding the impact of the COVID-19 pandemic on cancer survivors. Currently available literature provides preliminary indications of wide-ranging impacts of the pandemic on cancer survivors with respect to the requirement to adapt to new means of healthcare delivery as well as their physical, psychosocial and economic wellbeing. The pandemic has left survivors dealing with the consequences of rigorous cancer treatment in the context of new challenges related to social isolation, financial hardship and uncertainty with respect to their ongoing care. Additional rigorously designed research initiatives are required to elucidate the impact of the pandemic on cancer survivors.

Prevision of multidisciplinary head and neck cancer survivorship care during the 2019 novel coronavirus pandemic

The 2019 Coronavirus Pandemic challenges the delivery of care for patients with head and neck cancer. An important aspect of this care has been the evolution of enhanced survivorship services, which include surveillance for recurring cancer and prevention of second primaries. The application of evidence‐based approaches to the identification and management of treatment and tumor‐related toxicities has embraced the use of validated patient‐reported outcomes instruments, health promotion, and care coordination. In this manuscript, we describe how our multidisciplinary team of survivorship providers has accommodated to the need to provide patients with social distancing while acknowledging the importance of continued care during treatment and through the spectrum of survivorship.