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Colin E, Paasche A, Destrez A, Devauchelle B, Bettoni J, Bouquet J, Dakpé S, Testelin S. Impact of the COVID-19 Pandemic on Head and Neck Cancer Management: The Experience of the Maxillo-Facial Surgery Department of a French Regional Referral Center in a High-Incidence Area. J Clin Med 2024; 13:2439. [PMID: 38673711 PMCID: PMC11050808 DOI: 10.3390/jcm13082439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/15/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Cancer patients are at a high risk of complications in cases of infection, and head and neck cancers (HNC) are no exception. Since late 2019, SARS-CoV-2 has caused a global health crisis, with high rates and severe forms of the disease in cancer patients. Hospitalization, surgery and radiotherapy were rapidly described as increasing the risk of infection. Since March 2020, the Amiens University Hospital (France) has been taking care of COVID-19 patients while its maxillofacial surgery department managed HNC patients without interruption, even during lockdown periods. However, many questions concerning the impact on patient care were still pending. The aim of this study is to describe HNC management in our center during the first epidemic peak and to evaluate the impact of containment measures on patient treatment. Methods: We retrospectively included 44 HNC patients treated in our department between 1 March and 31 August 2020. Two groups were defined according to the period of care: lockdown (March to May) and lighter restrictions (June to August). Results: The results show typical epidemiological characteristics, maintained management times and non-downgraded procedures. Conclusions: Thus, during the first epidemic peak, continuity of care and patients' safety could be ensured thanks to adequate means, adapted procedures and an experienced surgical team.
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Affiliation(s)
- Emilien Colin
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Agnès Paasche
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Alban Destrez
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Bernard Devauchelle
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Jérémie Bettoni
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Julien Bouquet
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Stéphanie Dakpé
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Sylvie Testelin
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
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Verma A, Manojkumar A, Dhasmana A, Tripathi MK, Jaggi M, Chauhan SC, Chauhan DS, Yallapu MM. Recurring SARS-CoV-2 variants: an update on post-pandemic, co-infections and immune response. Nanotheranostics 2024; 8:247-269. [PMID: 38444741 PMCID: PMC10911975 DOI: 10.7150/ntno.91910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
The post-pandemic era following the global spread of the SARS-CoV-2 virus has brought about persistent concerns regarding recurring coinfections. While significant strides in genome mapping, diagnostics, and vaccine development have controlled the pandemic and reduced fatalities, ongoing virus mutations necessitate a deeper exploration of the interplay between SARS-CoV-2 mutations and the host's immune response. Various vaccines, including RNA-based ones like Pfizer and Moderna, viral vector vaccines like Johnson & Johnson and AstraZeneca, and protein subunit vaccines like Novavax, have played critical roles in mitigating the impact of COVID-19. Understanding their strengths and limitations is crucial for tailoring future vaccines to specific variants and individual needs. The intricate relationship between SARS-CoV-2 mutations and the immune response remains a focus of intense research, providing insights into personalized treatment strategies and long-term effects like long-COVID. This article offers an overview of the post-pandemic landscape, highlighting emerging variants, summarizing vaccine platforms, and delving into immunological responses and the phenomenon of long-COVID. By presenting clinical findings, it aims to contribute to the ongoing understanding of COVID-19's progression in the aftermath of the pandemic.
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Affiliation(s)
- Ashmit Verma
- Divyasampark iHub Roorkee for Devices Materials and Technology Foundation, Indian Institute of Technology Roorkee, Uttarakhand, 247667, India
- Samrat Ashok Technological Institute, Vidisha, Madhya Pradesh, 464001, India
| | - Anjali Manojkumar
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
- Department of Biology, College of Science, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
| | - Anupam Dhasmana
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
- South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
| | - Manish K. Tripathi
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
- South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
| | - Meena Jaggi
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
- South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
| | - Subhash C. Chauhan
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
- South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
| | - Deepak S. Chauhan
- Faculté de Pharmacie, Université de Montréal, Montréal H3C 3J7, QC, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
- Department of Pediatrics, IWK Research Center, Halifax, NS, Canada
| | - Murali M. Yallapu
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
- South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, Texas 78504, USA
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Carré J, Herzog B, Reil D, Schneider C, Pflüger M, Löbel M, Herzog M. [Impact of the COVID-19 pandemic on the diagnosis and treatment of patients with head and neck cancer in Brandenburg and Berlin]. HNO 2024; 72:90-101. [PMID: 38117331 DOI: 10.1007/s00106-023-01396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on potential limitations to the diagnosis and treatment of patients with head and neck tumours has not yet been adequately investigated. There are contradictory data on this subject. Data from larger patient collectives do not exist for Germany so far. OBJECTIVE The aim of the survey was to clarify in a large cohort whether the COVID-19 pandemic had an influence on the diagnosis and treatment of patients with head and neck tumours. METHODS A retrospective data analysis of the reporting data of the Clinical and Epidemiological Cancer Registry of Brandenburg and Berlin (Klinisch-epidemiologischen Krebsregisters Brandenburg-Berlin, KKRBB) of 4831 cases with head and neck tumours from 2018 to 2020 was performed. The period before April 01, 2020, was evaluated as a prepandemic cohort and compared with the cases of the pandemic cohort from April 1, 2020, until December 31, 2020, in terms of patient-related baseline data, tumour location, tumour stage, tumour board and treatments administered. RESULTS No differences were observed between the prepandemic and pandemic cohorts with regard to patient-related baseline data, tumour localisation and tumour stage. Likewise, no temporal delay in diagnosis, tumour board and treatment was evident during the pandemic period. On the contrary, the time interval between diagnosis and start of therapy was shortened by an average of 2.7 days in the pandemic phase. Tumours with T4 stage were more frequently treated surgically during the pandemic compared to the period before (20.8% vs. 29.6%), whereas primary radio(chemo)therapy decreased during the pandemic (53.3% vs. 40.4%). For all other tumour stages and entities, there were no differences in treatment. CONCLUSION Contrary to initial speculation that the COVID-19 pandemic may have led to a decrease in tumour cases, larger tumour stages at initial presentation and a delay in diagnosis and treatment, the cohort studied for Brandenburg and Berlin showed neither a delay in tumour treatment nor an increase in tumour size and stage at initial presentation. The treatments performed, however, were subject to a change in favour of surgery and it remains to be seen whether this trend will be maintained in the long term.
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Affiliation(s)
- Julia Carré
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Deutschland
| | - Beatrice Herzog
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Daniela Reil
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Constanze Schneider
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Maren Pflüger
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Madlen Löbel
- Interdisziplinäre Studienzentrale des Carl-Thiem-Klinikums, Thiemstr. 111, 03048, Cottbus, Deutschland
| | - Michael Herzog
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Deutschland.
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Deutschland.
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Low C, Tejero I, Toledano N, Mariano C, Alibhai S, Lemonde M, Haase K, Puts M. Impact of COVID-19 on older adults with cancer and their caregivers' cancer treatment experiences study: The ICE-OLD study. PLoS One 2023; 18:e0291756. [PMID: 37729131 PMCID: PMC10511107 DOI: 10.1371/journal.pone.0291756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
The COVID-19 pandemic and health services impacts related to physical distancing posed many challenges for older adults with cancer. The goal of this study was to examine the impact of the pandemic on cancer treatment plans and cancer treatment experiences of older adults (ie, aged 65 years and older) and their caregiver' experiences of caring for older adults during the pandemic to highlight gaps in care experienced. In this multi-centre qualitative study guided by an interpretive descriptive research approach we interviewed older adults diagnosed with cancer and caregivers caring for them. Participants were recruited via cancer treatment centres in the provinces of British Columbia and Ontario (Vancouver and Toronto), Canada, and through an online ad sent out through patient advocacy organization newsletters. Interviews were recorded and transcribed verbatim and data were analyzed using an interpretive thematic analysis approach. A total of 27 individuals (17 older adults, 52.9% female; 10 caregivers, 90% female) participated in interviews lasting on average 45 minutes. Older adults with cancer described many impacts and pressures created by the pandemic on their cancer experiences, though they generally felt that the pandemic did not impact treatment decisions made and access to care. We grouped our findings into two main themes with their accompanying sub-themes, related to: (1) alterations in the individual and dyadic cancer experience; and (2) navigating health and cancer systems during the pandemic. The additional stressors the pandemic placed on older adults during their treatment and decision-making process and their caregivers expose the need to create or avail additional supports for future disruptions in care.
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Affiliation(s)
- Cydney Low
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Isabel Tejero
- Geriatrics Department, Hospital del Mar, Barcelona, Spain
| | - Nelly Toledano
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Mariano
- BC Cancer Agency, Vancouver and Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Shabbir Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Kristen Haase
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Kanatas A, Coffey D, Spellman J, Twigg J, Lowe D, Rogers SN. Follow-up arrangements in head and neck cancer clinics during the COVID-19 pandemic: results from two tertiary UK head and neck cancer centres. Ann R Coll Surg Engl 2023; 105:S60-S68. [PMID: 34941427 PMCID: PMC10390241 DOI: 10.1308/rcsann.2021.0283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this paper is to report the pattern of follow-up that occurred for a cohort of head and neck cancer (HNC) patients across two large centres in the UK (Aintree and Leeds), as a consequence of the COVID-19 pandemic. METHODS Patients had been treated for HNC with curative intent between April 2017 and October 2019 by 14 oral and maxillofacial (OMFS) and ear nose and throat (ENT) oncology surgeons in the Patient Concerns Inventory intervention trial. In October 2020, hospital records were reviewed, and information collected on the timing and mode (face-to-face/telephone/video) of follow-up consultations. In addition, recurrence, second primary tumours and deaths were recorded. RESULTS At the start of 'lockdown', 212 members of the cohort were known to be alive. During the post-lockdown period (follow-up appointment data comprised 5 months in Aintree and 7 months in Leeds) 7 died and 13 were identified as palliative/recurrence/new primary/metastases ('new event'). In Aintree, the first ENT/OMFS consultations after lockdown were 51 (67%) telephone and 25 (33%) face-to-face appointments. In Leeds, 46 (78%) consultations were by telephone and 13 (22%) were face-to-face. The second ENT/OMFS consultations post lockdown included 11 (44%) telephone and 14 (56%) face-to-face in Aintree, and 21 (75%) telephone and 7 (25%) face-to-face in Leeds. CONCLUSIONS These data suggest that clinicians favoured remote consultations. Variations in practice were observed but reached a point of a 'hybrid follow-up approach' that included both face-to-face and remote consultations. With the emergence of telemedicine, clinicians may consider a follow-up model tailored to risk stratification. The development of the mode of such a consultation model needs further evaluation.
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Affiliation(s)
- A Kanatas
- The Leeds Teaching Hospitals NHS Trust, UK
| | - D Coffey
- Liverpool University Hospitals NHS Foundation Trust, UK
| | - J Spellman
- The Leeds Teaching Hospitals NHS Trust, UK
| | - J Twigg
- The Leeds Teaching Hospitals NHS Trust, UK
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Janapareddi S, Mansuri S, Khot SN, Jamwal SS, Kanta MK, Sarma SN. Evaluation of the Head and Neck Surgery During the Pandemic COVID-19: A Tertiary Care Center Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S122-S126. [PMID: 37654388 PMCID: PMC10466622 DOI: 10.4103/jpbs.jpbs_434_22] [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: 10/02/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 09/02/2023] Open
Abstract
Introduction There is a notable shift in the attitude of the admission, review, diagnostics, and follow-up of patients for all the medical sectors and of particular interest of cancer patients. The present study aimed to elaborate on the identification of patients with head and neck cancers (HNCs); the diagnostics, the triage, and the best treatment plan were all evaluated and at the same time compared with the years before the pandemic at a tertiary care center that caters to various other patients also. Materials and Methods A retrospective observational clinical study was conducted at the tertiary care center that catered to all the medical specialties. The demographics, the patient characteristics, the surgeries performed, complications, mortality, and readmissions were evaluated and compared with the pre-coronavirus disease (COVID) time. Results There was a significant difference in the complications for the pre-COVID time when the groups were compared for the matched pair. Conclusion The proper screening and triaging of the patients will help in the early intervention of the patients with the HNCs.
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Affiliation(s)
- Sreedevi Janapareddi
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Samir Mansuri
- Consultant Oral and Maxillofacial Surgeon, Ahmedabad, Gujarat, India
| | - Sunil N. Khot
- Department of ENT, Government Medical College, Miraj, Maharashtra, India
| | | | - Manoj K. Kanta
- Department of Maxillofacial Surgery, GSL Dental College and Hospital, Rajamahendravaram, Andhra Pradesh, India
| | - Sankar Narayana Sarma
- Department of Periodontics, Government Dental College and Hospital, Kadapa, Andhra Pradesh, India
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Surgical Lip Cancer Reconstruction in the COVID-19 Era: Are Free Flaps or Loco-Regional Flaps Better? SURGERIES 2023. [DOI: 10.3390/surgeries4010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Lip carcinoma is one of the most frequent conditions affecting the general population. It is among the ten most common neoplasms, but despite advances in research and therapy, its prognosis has not improved in a significant way in the past few years, making it a challenge in the medical research field and in surgical treatment. This study was conducted with the aim of evaluating the available reconstructive surgical options for the treatment of lip carcinomas in order to define which could be the most appropriate technique to achieve satisfying aesthetic and functional outcomes considering hospital resources in the COVID-19 era. Seventeen patients were included in this retrospective study, which took place between January 2019 and April 2021. There were two groups: seven patients who underwent a radial forearm free flap and ten who underwent locoregional flaps. The statistical analysis was performed to evaluate four different endpoints. Surgical length, ICU stay, and hospitalization time were minor for locoregional flaps. There was no statistically significant difference between the two groups when considering post-operative complications. Locoregional flaps have a more aesthetically pleasing result, but from a functional point of view, the results can be superimposable. Both techniques are associated with adequate speech, mouth opening, sealing, and symmetry. Given the impact of the COVID-19 pandemic on the healthcare system, locoregional flaps have been proven to be a good surgical option in the reconstruction of lip defects both in terms of aesthetics and functional outcome.
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Jin Q, Wang C, Xiao J, Yang J. The Effect of the COVID-19 Pandemic on the Decision-making Process of Mandibular Impacted Third Molar Extraction. Am J Health Behav 2023; 47:87-97. [PMID: 36945098 DOI: 10.5993/ajhb.47.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Objectives: In this study, we investigated the impact of the COVID-19 pandemic on the decision-making process for impacted mandibular third molar removal and related clinical teaching. Methods: From April 21 to April 28, 2020, we distributed a self-constructed survey via the Wenjuanxing software platform to oral clinicians engaged in the extraction of mandibular third molars. Results: We received 321 valid responses. Overall, 22.4% of clinicians were temporarily not performing tooth extractions in outpatient clinics and 50.2% of clinicians were temporarily not performing impacted tooth extractions. The main reason cited was that aerosol-generating high-speed handpieces were not recommended for use during the pandemic, opting instead for the surgical handpiece with copious saline irrigation as the main method for bone removal; the hammer-and-chisel method was considered to be too traumatic and posed too high of a risk for iatrogenic injury. Conclusions: The implementation of disease control measures during the COVID-19 pandemic significantly affected clinical decision-making regarding impacted mandibular third molar extractions; the main reason cited was the contraindication of using aerosol-generating high-speed handpieces. The hammer-and-chisel method may represent a valuable surgical application under the requirements for epidemic prevention and control. We provide a new idea for the extraction of interrupted permanent molars in the context of epidemic prevention and control is provided.
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Affiliation(s)
- Qiong Jin
- Dental Implant Center, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Chi Wang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Jin Xiao
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Jingyuan Yang
- Department of Prosthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China;,
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Prioritization of head and neck cancer patient care during the COVID-19 pandemic: a retrospective cohort study. J Otolaryngol Head Neck Surg 2023; 52:15. [PMID: 36782236 PMCID: PMC9925359 DOI: 10.1186/s40463-023-00625-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic placed considerable strain on the healthcare system, leading to the re-allocation of resources and implementation of new practice guidelines. The objective of this study is to assess the impact of COVID-19 guideline modifications on head and neck cancer (HNC) care at two tertiary care centers in Canada. METHODS A retrospective cohort study was conducted. HNC patients seen at two tertiary care centers before and after the onset of the COVID-19 pandemic (pre-pandemic: July 1st, 2019, to February 29th, 2020; pandemic: March 1st, 2020, to October 31st, 2020) were included. The pre-pandemic and pandemic cohorts were compared according to patient and tumor characteristics, duration of HNC workup, and treatment type and duration. Mean differences in cancer care wait times, including time to diagnosis, tumor board, and treatment as well as total treatment package time and postoperative hospital stay were compared between cohorts. Univariate and multivariate analyses were used to compare characteristics and outcomes between cohorts. RESULTS Pre-pandemic (n = 132) and pandemic (n = 133) patients did not differ significantly in sex, age, habits, or tumor characteristics. The percentage of patients who received surgery only, chemo/radiotherapy (CXRT) only, and surgery plus adjuvant CXRT did not differ significantly between cohorts. Pandemic patients experienced a significant time reduction compared to pre-pandemic patients with regards to the date first seen by a HNC service until start of treatment ([Formula: see text] = 48.7 and 76.6 days respectively; p = .0001), the date first seen by a HNC service until first presentation at tumor board ([Formula: see text] = 25.1 and 38 days respectively; p = .001), mean total package time for patients who received surgery only ([Formula: see text] = 3.7 and 9.0 days respectively; p = .017), and mean total package time for patients who received surgery plus adjuvant CXRT ([Formula: see text] = 80.2 and 112.7 days respectively; p = .035). CONCLUSION The time to treatment was significantly reduced during the COVID-19 pandemic as compared to pre-pandemic. This transparent model of patient-centered operative-room prioritization can serve as a model for improving resource allocation and efficiency of HNC care during emergency and non-emergency scenarios.
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Pietruszewska W, Burduk P, Rosiak O, Podlawska P, Zakrzewski B, Barańska M, Kowalczyk M, Piątkowski J, Śmigielski G, Solarz P, Staszak M, Wierzbicka M, Mikaszewski B. Impact of COVID-19 on Head and Neck Cancer Advancement Measured by Increasing Numbers of Urgent Dyspnea Cases-What Could Be Improved in the Event of Subsequent Pandemics? J Clin Med 2022; 11:6385. [PMID: 36362613 PMCID: PMC9659278 DOI: 10.3390/jcm11216385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 08/26/2023] Open
Abstract
The COVID-19 pandemic has altered all aspects of the healthcare system's organization and impacted patients with head and neck cancer (HNC) who have experienced delayed diagnosis and treatment. The pandemic resulted in the admission of patients with severe dyspnea and a need for tracheotomy due to extremely advanced HNC. This study's objective was to evaluate the clinical characteristics of two multi-center cohorts, "pre-COVID-19" and "COVID-19", of HNC patients admitted as emergencies for dyspnea. The therapeutic activity of HNC patients in four University Departments of Otolaryngology was studied over two time periods: September-February 2019/2020 and 2020/2021. A group of 136 HNC patients who underwent a tracheotomy in two-time cohorts, pre-COVID-19 (N = 59) and COVID-19 (N = 77), was analyzed. The mean tracheotomies incidence proportion was 1.82 (SD: 1.12) for the pre-COVID-19 and 3.79 (SD: 2.76) for COVID-19 period. A rise in the occurrence of emergency dyspnea was observed in the COVID-19 cohort, and the greatest increase was seen in the centers with the highest limitations on planned surgeries. In the pre-COVID-19 period, 66% of patients presented with symptoms for more than a month in comparison to 78% of patients in the COVID-19 period (p = 0.04). There was a higher incidence of laryngeal and laryngopharyngeal cancer in the COVID-19 period (63% vs. 75%, respectively). The number of tracheotomies performed under general anesthesia dropped in favor of local anesthesia during COVID-19 (64% vs. 56%, respectively) due to extremely advanced HNC. In the COVID-19 cohort, most patients received a telemedicine consultation (N = 55, 71%) in comparison to the pre-COVID-19 period (N = 14, 24%). Reorganization of the referral system, adjustment of treatment capacity for an increased number of HNC, and a reserve for more extensive resection and reconstruction surgeries should be made in the profile of otorhinolaryngological departments, ensuring future HNC treatment is not hampered in case of a new pandemic wave.
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Affiliation(s)
- Wioletta Pietruszewska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, 22 Kopcińskiego Str., 90-153 Lodz, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 75 Ujejskiego, 85-168 Bydgoszcz, Poland
| | - Oskar Rosiak
- Balance Disorder Unit, Department of Otolaryngology, Medical University of Lodz, 22 Kopcińskiego Str., 90-153 Lodz, Poland
| | - Paulina Podlawska
- Department of Otolaryngology and Laryngological Oncology, University of Medical Sciences, 49 Przybyszewskiego Str., 60-357 Poznań, Poland
| | - Bartosz Zakrzewski
- Department of Otolaryngology and Laryngological Oncology, University of Medical Sciences, 49 Przybyszewskiego Str., 60-357 Poznań, Poland
| | - Magda Barańska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, 22 Kopcińskiego Str., 90-153 Lodz, Poland
| | - Magdalena Kowalczyk
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, 22 Kopcińskiego Str., 90-153 Lodz, Poland
| | - Jakub Piątkowski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego, 80-214 Gdańsk, Poland
| | - Grzegorz Śmigielski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego, 80-214 Gdańsk, Poland
| | - Paweł Solarz
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 75 Ujejskiego, 85-168 Bydgoszcz, Poland
| | - Marta Staszak
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 75 Ujejskiego, 85-168 Bydgoszcz, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, University of Medical Sciences, 49 Przybyszewskiego Str., 60-357 Poznań, Poland
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479 Poznan, Poland
| | - Bogusław Mikaszewski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego, 80-214 Gdańsk, Poland
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Watson L, Hamilton D, Patterson JM. Patient experience of the acute post-surgical period following total laryngectomy during the COVID-19 era. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:737-748. [PMID: 35403774 PMCID: PMC9111097 DOI: 10.1111/1460-6984.12709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Total laryngectomy (TL) results in permanent functional changes requiring rapid development of complex new skills. A significant portion of this learning happens in the acute post-surgical stage. There is increasing interest in enhanced recovery after surgery (ERAS) protocols in TL; however, implementation has been difficult. COVID-19 has placed significant pressures on acute services, requiring rapid service changes for TL patients. AIMS To understand the acute patient experience of having a TL both before and during COVID-19. METHODS & PROCEDURES Semi-structured interviews using a pre-designed topic guide were conducted with 10 people who had undergone a TL within the last 2 years. Participants were recruited by their speech and language therapists using purposive sampling. Braun and Clarke's iterative approach to data collection and thematic analysis was used to generate key themes from the data. OUTCOMES & RESULTS Thematic analysis identified four main themes: (1) pre-operative information-giving: 'it was just words'; (2) decision-making influences: 'I just wanted them to get it all out and get it over with'; (3) coping with adjustment to the new normal: 'this is part of me now'; and (4) the importance of relationship-building: 'when you've had something like this, you need some care and understanding'. CONCLUSIONS & IMPLICATIONS The need for an individualized approach to TL intervention which incorporates medical and psycho-social approaches from pre-treatment to acute discharge is vital. ERAS models should be reviewed to shift beyond the medical model alone. Rapid service changes due to COVID-19 did not contribute any major changes to the acute patient-reported experience. WHAT THIS PAPER ADDS What is already known on the subject We know that ERAS protocols have the potential to improve patient outcomes following TL. However, the research does not consider anything other than the early oral feeding debate and it has therefore been difficult to implement ERAS protocols in current service models. COVID19 required head and neck cancer services to make quick changes to surgical pathways, with the potential that some ERAS protocols had been adopted inadvertently. In order to understand the impact of this, we need to understand the patient experience following TL both before and during COVID19. What this paper adds to existing knowledge This paper used qualitative interviews to understand the acute patient experience following TL both during and before COVID19. Findings from these interviews highlighted that people were on the most part, well prepared for the functional changes they would experience after surgery. However, people felt there were gaps in service delivery at the pre-treatment and early discharge home period. Overall, the gaps identified were from a more psycho-social need suggesting that future ERAS models of care should consider both medical and psycho-social principles to enhance patient experience and outcome. What are the potential or actual clinical implications of this work? Pre-treatment services provided to people who have a TL could be reviewed to help maximize long-term adjustment to life. Areas which could be reviewed include the method and mode of information delivery. Further work needs to be done in partnership with community services to improve the immediate discharge home experience.
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Affiliation(s)
- Laura‐Jayne Watson
- Speech & Language TherapySouth Tyneside & Sunderland NHS Foundation TrustSunderland Royal HospitalSunderlandUK
| | - David Hamilton
- OtolaryngologyHead and Neck SurgeryFreeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Joanne M. Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck CentreUniversity of LiverpoolLiverpoolUK
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Park J, Su MY, Kang KN, Kim AS, Ahn JH, Cho E, Lee JH, Kim YU. Body Map of Droplet Distributions During Oropharyngeal Suction to Protect Health Care Workers From Airborne Diseases. J Perianesth Nurs 2022; 38:180-185. [PMID: 36229328 PMCID: PMC9186442 DOI: 10.1016/j.jopan.2022.05.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/16/2022] [Accepted: 05/26/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Health care workers (HCWs), and in particular anesthesia providers, often must perform aerosol-generating medical procedures (AGMPs). However, no studies have analyzed droplet distributions on the bodies of HCWs during AGMPs. Therefore, the purpose of this study was to assess and analyze droplet distributions on the bodies of HCWs during suction of oral cavities with and without oral airways and during extubations. DESIGN Using a quasi-experiemental design, we assumed the HCWs perform suction and extubation on intubated patients, and we prepared an intubated mannequin mimicking a patient. This study performed the oral suction and extubation on the intubated mannequin (with or without oral airways in place) and analyzed the droplet distributions. METHODS We prepared a mannequin intubated with an 8.0 mm endotracheal tube, assuming the situation of general anesthesia. We designed the body mapping gown, and divided it into 10 areas including the head, neck, chest, abdomen, upper arms, forearms, and hands. We classified experiments into group O when suctions were performed on the mannequin with an oral airway, and into group X when the suctions were performed on the mannequin without an oral airway. An experienced board-certified anesthesiologist performed 10 oral suctions on each mannequin, and 10 extubations. We counted the droplets on the anesthesiologist's gown according to the divided areas after each procedure. FINDINGS The mean droplet count after suction was 6.20 ± 2.201 in group O and 13.6 ± 4.300 in group X, with a significant difference between the two groups (P < .001). The right and left hands were the most contaminated areas in group O (2.8 ± 1.033 droplets and 2.0 ± 0.943 droplets, respectively). The abdomen, right hand, left forearm, and left hand showed many droplets in group X. (1.3 ± 1.337 droplets, 3.1 ± 1.792 droplets, 3.2 ± 3.910 droplets, and 4.3 ± 2.214 droplets, respectively). The chest, abdomen, and left hand presented significantly more droplets in group X than in group O. The trunk area (chest and abdomen) was exposed to more droplets during extubations than during suctions. CONCLUSIONS During suctions, more droplets are splattered from mannequins without oral airways than from those with oral airways. The right and left hands were the most contaminated areas in group O. Moreover, the abdomen, right hand, left forearm, and left hand presented a lot of droplets in group X. In addition, extubations contaminate wider areas (the head, neck, chest and abdomen) of an HCW than suctions.
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Affiliation(s)
- Jiyeon Park
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, CA
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Ae Sook Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Jin Hee Ahn
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eunah Cho
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun-Ho Lee
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Radiological Sciences, University of California, Irvine, CA; Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea.
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13
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Ralli M, Colizza A, D’Aguanno V, Scarpa A, Russo G, Petrone P, Grassia R, Guarino P, Capasso P. Risk of SARS-CoV-2 contagion in otolaryngology specialists. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:S58-S67. [PMID: 35763275 PMCID: PMC9137374 DOI: 10.14639/0392-100x-suppl.1-42-2022-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 06/15/2023]
Abstract
COVID-19 has rapidly spread in the past two years with a profound impact on otolaryngological activities, which has undergone radical transformation to guarantee diagnostic and therapeutic procedures mainly in oncology and urgent patients, while ensuring protection for healthcare personnel and patients. During the initial phases of the pandemic, scheduled visits and elective surgeries were postponed leading to a delay in the diagnosis and treatment of several diseases, including head and neck cancer, with a shift toward more advanced cancer stages and more aggressive treatments. Aerosol and droplets are the main routes of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), thus leading to a high risk of contagion during otolaryngology visits and surgery. Therefore, the correct use of personal protective equipment (PPE) and attention to procedure-specific risks and measures to avoid contagion are of utmost importance for healthcare professionals, and especially for those dealing with otolaryngology diseases. This narrative review highlights that otolaryngological activity implies a high risk of contagion during outpatient visit, surgery, or urgent conditions. The correct use of PPE, evaluation of procedure-specific risks and reduction of non-urgent procedures are considered the main strategies to limit contagion.
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Affiliation(s)
- Massimo Ralli
- Department of Sense Organs. Sapienza University of Rome, Rome, Italy
| | - Andrea Colizza
- Department of Sense Organs. Sapienza University of Rome, Rome, Italy
| | | | - Alfonso Scarpa
- Department of Medicine, Surgery and Dentistry. University of Salerno, Salerno, Italy
| | - Gennaro Russo
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, Napoli, Italy
| | | | - Rosa Grassia
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, Napoli, Italy
| | - Pierre Guarino
- Otolaryngology Unit, Santo Spirito Hospital, Pescara, Italy
| | - Pasquale Capasso
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, Napoli, Italy
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14
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Akbari M, Motiee-Langroudi M, Heidari F, Beheshti A, Karimi E. Impact of the COVID-19 pandemic on the stage and the type of surgical treatment of laryngeal cancer. Am J Otolaryngol 2022; 43:103319. [PMID: 34968815 PMCID: PMC8694790 DOI: 10.1016/j.amjoto.2021.103319] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/08/2021] [Indexed: 11/19/2022]
Abstract
Purpose Changes in the entire health care system during COVID-19 epidemic have affected the management of patients with head and neck cancer and posed several clinical challenges for ENT surgeons. Therefore, the present study aimed to investigate the effect of COVID-19 on the stage and the type of surgical treatments used in laryngeal cancer (including total laryngectomy, supracricoid partial laryngectomy (SCPL) and transoral laser microsurgery (TLM)) and also to compare the results of April 2020 to April 2021 with the previous year. Materials and Methods This cross-sectional study was performed on all patients with a diagnosis of laryngeal cancer who underwent surgery in the tertiary care center from April 2020 to April 2021 and the year before the pandemic in the same time. Demographic, cancer stage, and treatment data of all patients were recorded and analysis in two groups. Results Patients referred at the time of the virus outbreak; 111 were male and 5 were female, and in the group of patients referred before COVID-19, 90 were male and 12 were female. The type of surgical treatment of laryngeal cancer, mean time elapsed from sampling to surgery, stage of disease and mean tumor volume was statistically significant differences in patients before and during the outbreak. Conclusion Patients who referred for diagnosis and treatment at the time of COVID-19 outbreak had more advanced stages of the disease and also the tumor volume was higher in them than patients who had referred before the outbreak. It is necessary to provide new solutions, education and treatment management for patients with laryngeal cancer in such pandemics.
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Affiliation(s)
- Maryam Akbari
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Maziar Motiee-Langroudi
- Department of Otorhinolaryngology, School of Medicine, Otorhinolaryngology Research Center Imam Khomeini Hospital, Tehran, Iran
| | - Farrokh Heidari
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Beheshti
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Karimi
- Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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15
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Metcalfe C, Dogan M, Glazzard N, Ross E, George A. Introduction of a novel telescopic pathway to streamline 2-week-wait suspected head and neck cancer referrals and improve efficiency: A prospective service evaluation. Laryngoscope Investig Otolaryngol 2022; 7:117-124. [PMID: 35155789 PMCID: PMC8823166 DOI: 10.1002/lio2.721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES This study summarizes the introduction of a novel telescopic pathway, which streamlines 2-week-wait suspected head and neck cancer referrals to our unit, describes the logistics of the pathway, and analyzes referral numbers and outcomes. We also discuss wider issues surrounding remote assessment in head and neck cancer. METHODS Data were collected prospectively between January and May 2021, capturing all 2-week-wait referrals to our unit following the introduction of a telescopic pathway which utilized a nurse-led clinic for nasendoscopic examination of selected patients and consultant-led remote assessment using store and forward technology. Information on referral numbers, waiting times and outcomes was recorded. RESULTS Three hundred and forty (185 high risk, 155 low risk) patients entered the telescopic pathway with the remaining 74 patients seen on the conventional standard of care pathway. Cancer conversion rates were 17%, <1%, and 5.4% for the high-risk telescopic, low-risk telescopic and standard of care pathways respectively. No patients discharged from the telescopic pathway were re-referred within 3 months. Review capacity for endoscopic examination was higher per consultant on the telescopic pathway versus the standard of care (p = .01). CONCLUSION A combination of risk stratification and asynchronous telescopic assessment shows promise for the management of suspected head and neck cancer referrals. Potential benefits include consultant-led care for all patients and enhanced documentation. Digital communication with patients may also assist with adherence to the new NHS 28-day diagnostic standard for cancer referrals. Ongoing data collection is required to assess how the pathway functions over a longer period. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Christopher Metcalfe
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
| | - Mehmet Dogan
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
| | - Nina Glazzard
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
| | - Elizabeth Ross
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
| | - Ajith George
- Department of Otolaryngology, Royal Stoke University HospitalUniversity Hospitals North MidlandsStoke‐on‐TrentUnited Kingdom
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Lucidi D, Valerini S, Federici G, Miglio M, Cantaffa C, Alicandri-Ciufelli M. Head and Neck Cancer During Covid-19 Pandemic: Was there a Diagnostic Delay? Indian J Otolaryngol Head Neck Surg 2022; 74:3245-3251. [PMID: 35070919 PMCID: PMC8760594 DOI: 10.1007/s12070-021-03050-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/27/2021] [Indexed: 12/05/2022] Open
Abstract
The aim of the present study is to investigate a possible delay in diagnosis and therapy administration for Head and Neck oncological patients, during the Sars-Cov2 pandemic and to compare the median tumor stage (MTS) at presentation. This is a retrospective review on patients who presented at the University Hospital of Modena with a newly diagnosis of Head and Neck cancer (HNC), comparing the first pandemic period (from March 1st, to October 15th 2020) to the same period of 2019. The time in days from the diagnostic suspicion to the beginning of the treatment, hereafter referred to as delay in treatment initiation (DTI), and the tumor stage were calculated for all the enrolled patients. Mean percentage of reduction of the clinical and surgical activities was − 25.8% (range: − 66–1.5%), with higher percentages in phase 1 for all the analyzed activities. 125 HNC patients were enrolled in the analysis as the study group, compared with a cohort of 140 patients from the previous year. The MTS was III for both groups, however a significant statistical difference was determined in the stage comparison, p = 0.023. When DTI was analyzed no statistically significant differences were appreciated. A more advanced stage at presentation was demonstrated at our institution for HNC patients during the first phase of the Covid-19 pandemic in 2020. However, a statistically significant delay in time between diagnosis and therapy administration was not assessed, thus confirming the maintenance of a high level of care even in the COVID-19 era.
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Affiliation(s)
- Daniela Lucidi
- Otolaryngology and Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Sara Valerini
- Otolaryngology and Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Gaia Federici
- Otolaryngology and Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Matteo Miglio
- Otolaryngology and Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Carla Cantaffa
- Otolaryngology and Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125 Modena, Italy
| | - Matteo Alicandri-Ciufelli
- Otolaryngology and Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41125 Modena, Italy
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Kang SK, Qamar SN, Tikka T, Milner TD. Deltopectoral Flap Reconstruction of the Posterior Pharyngeal Wall: A Single Stage Pedicle Flap Alternative Solution to the Free Flap Reconstruction of Circumferential Laryngopharyngeal Defects. Indian J Otolaryngol Head Neck Surg 2022; 74:416-421. [PMID: 35018287 PMCID: PMC8736326 DOI: 10.1007/s12070-021-03019-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/28/2021] [Indexed: 11/24/2022] Open
Abstract
The first option for reconstruction of a circumferential pharyngeal defect following extensive pharyngo-laryngectomy is free tissue transfer. Despite that, pedicled flaps can be used when microsurgical expertise is not available or if other patient related or region related issues deem free tissue transfer unfavourable. The aim of this study was to review the operative feasibility and functional outcomes following dual flap reconstruction of circumferential pharyngeal defects.This was a retrospective study of all patients (n = 8) who underwent either primary (n = 5) or salvage (n = 3) circumferential laryngopharyngectomy + /– cervical oesophagectomy, followed by dual flap reconstruction, with a deltopectoral flap to reconstruct the posterior wall from 2005 to 2020. The main outcome measures were operative complications, hospital stay and functional outcomes (speech and swallowing). The operation was feasible in all patients, with dual flap reconstruction using a deltopectoral flap, combined with a pectoralis major flap (n = 5) or a supraclavicular flap (n = 3). All patients developed a small, lateralised, self-healing fistula at the site of the deltopectoral flap 3-point junction. This did not require any intervention, or impact on adjuvant treatment. Functional outcomes were favourable, with all patients achieving oral diet. One patient required gastrostomy diet supplementation, and one patient required stricture dilatation. Of the patients able to receive a speech valve (n = 4), all achieved intelligible speech. Dual flap reconstruction of circumferential pharyngeal defects represents a feasible alternative option for a complex reconstructive problem. The predictable operative recovery and favourable functional outcomes indicate that the use of both a deltopectoral flap and a second flap is a robust reconstructive solution.
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Affiliation(s)
- Swee Keong Kang
- Department of Otolaryngology, Head and Neck Surgery, Monklands University Hospital, Airdre, Scotland
| | - Sabih Nadeem Qamar
- Department of Otolaryngology, Head and Neck Surgery, Monklands University Hospital, Airdre, Scotland
| | - Theofano Tikka
- Department of Otolaryngology, Head and Neck Surgery, Monklands University Hospital, Airdre, Scotland
| | - Thomas Daniel Milner
- Department of Otolaryngology, Head and Neck Surgery, Monklands University Hospital, Airdre, Scotland
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Shift of radiotherapy use during the first wave of the COVID-19 pandemic? An analysis of German inpatient data. Strahlenther Onkol 2022; 198:334-345. [PMID: 34994804 PMCID: PMC8739685 DOI: 10.1007/s00066-021-01883-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/01/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the change in inpatient radiotherapy related to COVID-19 lockdown measures during the first wave of the pandemic in 2020. METHODS We included cases hospitalized between January 1 and August 31, 2018-2020, with a primary ICD-10 diagnosis of C00-C13, C32 (head and neck cancer, HNC) and C53 (cervical cancer, CC). Data collection was conducted within the Medical Informatics Initiative. Outcomes were fractions and admissions. Controlling for decreasing hospital admissions during holidays, calendar weeks of 2018/2019 were aligned to Easter 2020. A lockdown period (LP; 16/03/2020-02/08/2020) and a return-to-normal period (RNP; 04/05/2020-02/08/2020) were defined. The study sample comprised a control (admission 2018/19) and study cohort (admission 2020). We computed weekly incidence and IR ratios from generalized linear mixed models. RESULTS We included 9365 (CC: 2040, HNC: 7325) inpatient hospital admissions from 14 German university hospitals. For CC, fractions decreased by 19.97% in 2020 compared to 2018/19 in the LP. In the RNP the reduction was 28.57% (p < 0.001 for both periods). LP fractions for HNC increased by 10.38% (RNP: 9.27%; p < 0.001 for both periods). Admissions for CC decreased in both periods (LP: 10.2%, RNP: 22.14%), whereas for HNC, admissions increased (LP: 2.25%, RNP: 1.96%) in 2020. Within LP, for CC, radiotherapy admissions without brachytherapy were reduced by 23.92%, whereas surgery-related admissions increased by 20.48%. For HNC, admissions with radiotherapy increased by 13.84%, while surgery-related admissions decreased by 11.28% in the same period. CONCLUSION Related to the COVID-19 lockdown in an inpatient setting, radiotherapy for HNC treatment became a more frequently applied modality, while admissions of CC cases decreased.
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19
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Stevens MN, Patro A, Rahman B, Gao Y, Liu D, Cmelak A, Wiggleton J, Kim YJ, Langerman A, Mannion K, Sinard RJ, Netterville JL, Rohde SL, Topf MC. Impact of COVID-19 on presentation, staging, and treatment of head and neck mucosal squamous cell carcinoma. Am J Otolaryngol 2022; 43:103263. [PMID: 34653954 PMCID: PMC8500684 DOI: 10.1016/j.amjoto.2021.103263] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES During the COVID-19 pandemic, maintenance of safe and timely oncologic care has been challenging. The goal of this study is to compare presenting symptoms, staging, and treatment of head and neck mucosal squamous cell carcinoma during the pandemic with an analogous timeframe one year prior. MATERIALS AND METHODS Retrospective cohort study at a single tertiary academic center of new adult patients evaluated in a head and neck surgical oncology clinic from March -July 2019 (pre-pandemic control) and March - July 2020 (COVID-19 pandemic). RESULTS During the pandemic, the proportion of patients with newly diagnosed malignancies increased by 5%, while the overall number of new patients decreased (n = 575) compared to the control year (n = 776). For patients with mucosal squamous cell carcinoma (SCC), median time from referral to initial clinic visit decreased from 11 days (2019) to 8 days (2020) (p = 0.0031). There was no significant difference in total number (p = 0.914) or duration (p = 0.872) of symptoms. During the pandemic, patients were more likely to present with regional nodal metastases (adjusted odds ratio (OR) 2.846, 95% CI 1.072-3.219, p = 0.028) and more advanced clinical nodal (N) staging (p = 0.011). No significant difference was seen for clinical tumor (T) (p = 0.502) or metastasis (M) staging (p = 0.278). No significant difference in pathologic T (p = 0.665), or N staging (p = 0.907) was found between the two periods. CONCLUSION Head and neck mucosal SCC patients presented with more advanced clinical nodal disease during the early months of the COVID-19 pandemic despite no change in presenting symptoms.
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Affiliation(s)
- Madelyn N Stevens
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Ankita Patro
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Bushra Rahman
- Vanderbilt University School of Medicine, 1161 21st Ave S, Nashville, TN 37232, USA
| | - Yue Gao
- Department of Biostatistics, Vanderbilt University, 2525 West End Ave Ste 1100, Nashville, TN 37203, USA
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University, 2525 West End Ave Ste 1100, Nashville, TN 37203, USA
| | - Anthony Cmelak
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Ave, Nashville, TN 37232, USA
| | - Jamie Wiggleton
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Young J Kim
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Alexander Langerman
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Kyle Mannion
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Robert J Sinard
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - James L Netterville
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Sarah L Rohde
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Michael C Topf
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
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20
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Petrović-Lazić M, Babac S, Ilić-Savić I. The impact of the COVID-19 pandemic on the quality of life of laryngectomized patients. ACTA FACULTATIS MEDICAE NAISSENSIS 2022. [DOI: 10.5937/afmnai39-36517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introduction: Quality of life is a state of complete physical, mental and social well-being. Due to the COVID-19 pandemic, which led to changes in the daily routine, there was a change in the psychosocial functioning of individuals. Given that laryngectomized patients belong to a vulnerable group that requires psychological support after surgery, specific epidemiological measures during the COVID-19 pandemic could only further increase the fear and reluctance that is especially pronounced after surgery. Aim: The aim of this study was to investigate whether there was a link between the quality of life of laryngectomized patients and the COVID-19 pandemic. Method: The literature review was performed through the Google Scholar Advanced Search search engine and the Consortium of Libraries of Serbia for Unified Acqusition - KoBSON. Results: The first wave of the COVID-19 pandemic significantly disrupted the emotional well-being of patients with head and neck cancer. These patients became even more anxious due to the high mortality from the COVID-19 viral infection, hospital occupancy and missed therapeutic examinations. The need for togetherness, impaired concentration and attention, irritability and fear that family members might suffer from a deadly disease were the most common behavioral problems identified during the COVID-19 pandemic. Conclusion: The psychological burden associated with the direct and indirect effects of the COVID-19 pandemic should not be overlooked, given the fact that laryngectomized patients have twice the risk of suicide compared to patients who have undergone other types of cancer. Assessing the quality of life in laryngectomized patients is very important because it enables the timely identification of mental disorders and suggests the necessary support measures.
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21
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Mayo-Yáñez M, Palacios-García JM, Calvo-Henríquez C, Ayad T, Saydy N, León X, Parente P, Chiesa-Estomba CM, Lechien JR. COVID-19 Pandemic and its Impact on the Management of Head and Neck Cancer in the Spanish Healthcare System. Int Arch Otorhinolaryngol 2021; 25:e610-e615. [PMID: 34777593 PMCID: PMC8580159 DOI: 10.1055/s-0041-1736425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/04/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has represented a major challenge for healthcare systems worldwide, changing the habits of physicians. A reorganization of healthcare activity has been necessary, limiting surgical activity to essential cases (emergencies and oncology), and improving the distribution of health resources.
Objective
To analyze the impact of the COVID-19 pandemic on head and neck cancer surgery management in Spain.
Methods
A cross-sectional study, through an anonymous and voluntary online survey distributed to 76 Spanish otorhinolaryngology departments.
Results
A total of 44 centers completed the survey, 65.9% of which were high-volume. A total of 45.5% of them had to stop high-priority surgery and 54.5% of head and neck surgeons were relocated outside their scope of practice. Surgeons reported not feeling safe during their usual practice, with a decrease to a 25% of airway procedures. A total of 29.5% were “forced” to deviate from the “standard of care” due to the epidemiological situation.
Conclusions
Approximately half of the departments decreased their activity, not treating their patients on a regular basis, and surgeons were reassigned to other tasks. It seems necessary that the head and neck surgeons balance infection risk with patient care. The consequences of the reported delays and changes in daily practice should be evaluated in the future in order to understand the real impact of the pandemic on the survival of head and neck cancer patients.
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Affiliation(s)
- Miguel Mayo-Yáñez
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
| | - José M Palacios-García
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Otorhinolaryngology - Head and Neck Surgery Department, Hospital Universitario Virgen Macarena (HUVM), Sevilla, Andalucía, Spain
| | - Christian Calvo-Henríquez
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain.,Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario Santiago de Compostela (CHUS), Santiago de Compostela, Galicia, Spain
| | - Tareck Ayad
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Nadim Saydy
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Xavier León
- Otorhinolaryngology - Head and Neck Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
| | - Pablo Parente
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain
| | - Carlos Miguel Chiesa-Estomba
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Otorhinolaryngology - Head and Neck Surgery Department, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - Jérôme R Lechien
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.,Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain.,Human Anatomy & Experimental Oncology Department, Faculty of Medicine UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
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22
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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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23
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Mukarramah DA, Rini IS, Sofyan RF, Kiat MI, Iskandar I, Ritana A, Brahma B. Oncologic Head and Neck Reconstructive Microsurgery during the COVID-19 Pandemic in Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2021. [DOI: 10.1055/s-0041-1736420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Background Head and neck cancer is one of the leading cancers worldwide. Complex head and neck procedures are potentially aerosol-generating and considered high risk for coronavirus disease 2019 (COVID-19) transmission between the patients, surgeons, and other health-care workers (HCWs). Several adjustments in the microsurgery procedure were needed. The COVID-19 protocol was developed and applied to minimize the COVID-19 transmission. The study objectives were to describe the preoperative, intraoperative, and postoperative protocols applied and the characteristics of patients who underwent head and neck reconstructive microsurgery during the COVID-19 pandemic in Dharmais Cancer Hospital-National Cancer Center.
Methods This study was a retrospective descriptive study of patients who underwent head and neck reconstructive microsurgery between March 2020 and December 2020 in the plastic surgery department and surgical oncology department, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia. The patients' characteristics including sex, age, location of the defects, the flap type, flap survival, and complications were obtained from medical records and analyzed using SPSS version 23.
Results There were 55 patients, 30 (54.54%) patients were female, and 25 (45.45%) patients were male. The mean age at the time of surgery was 51.32 ± 1.85 years. The most common cancer type was squamous cell carcinoma for 49.09% (n = 27/55). The most frequent location was tongue for 25.45% (n = 14/55). Anterolateral thigh flap was also the most used flap in this study for 50.91% (n = 14/55). The overall survival rate of this study was 83.64% (n = 46/55). There were nine patients (16.36%) who were found with postoperative complications. There was no nosocomial infection with COVID-19 for patients, surgeons, and other HCWs.
Conclusion Microsurgery can be performed even in the COVID-19 pandemic as the gold standard for oncologic head and neck reconstruction by applying protocols to protect the patients, surgeons, and other HCWs.
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Affiliation(s)
- Dewi Aisiyah Mukarramah
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Irena Sakura Rini
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Rian Fabian Sofyan
- Department of Surgical Oncology, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Muhammad Irsyad Kiat
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Iskandar Iskandar
- Department of Surgical Oncology, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Azmi Ritana
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
| | - Bayu Brahma
- Department of Surgical Oncology, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia
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24
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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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25
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Yan F, Rauscher E, Hollinger A, Caputo MA, Ready J, Nguyen SA, Fakhry C, Nathan CAO, Leonardis C, Yearout D, Day TA, Moore MG. Concerns and Needs of Patients With Head and Neck Cancer in the COVID-19 Era. OTO Open 2021; 5:2473974X211047794. [PMID: 34616997 PMCID: PMC8489761 DOI: 10.1177/2473974x211047794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the concerns and needs of patients and survivors of head and neck cancer (HNC) in the COVID-19 era. Study Design Prospective cross-sectional survey. Setting Contact lists of 5 North American HNC advocacy groups. Methods A 14-question survey was distributed to the contact lists of 5 HNC advocacy groups evaluating patient and survivor needs and concerns related to their cancer care and COVID-19. Results There were 171 respondents, with 75% in the posttreatment period. The most common concern was contraction of COVID-19 (49%). More patients in active treatment preferred in-person visits than those in the early (≤5 years) and late (>5) survivorship period (72% vs 61% vs 40%, P < .001). A higher percentage of late survivors preferred virtual visits (38% vs 28%, P = .001). In total, 91 (53.2%) respondents sought emotional support outside of immediate family and friends. This included cancer support groups (36.2%), the medical team (29.7%), and other sources outside of these (34.1%), including faith-based organizations and online communities. A higher proportion of women than men (62% vs 41%, P = .001) were seeking emotional support outside of immediate family and friends. Conclusions During the early stages of the COVID-19 pandemic, patients with HNC who were actively undergoing treatment had increased need for support resources and preferred in-person provider visits. Alternatively, a higher percentage of patients >5 years from treatment preferred virtual visits. Emotional support outside of family and friends was sought out by a majority of respondents. Further research is needed to determine what support and educational resources are needed to best aid these various populations.
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Affiliation(s)
- Flora Yan
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Erika Rauscher
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Amanda Hollinger
- The Head and Neck Cancer Alliance, Charleston, South Carolina, USA
| | - Mary Ann Caputo
- Support for People With Oral and Head and Neck Cancer, Locust Valley, New York, USA
| | - John Ready
- Foundation for Voice Restoration, Greenville, Carolina, USA
| | - Shaun A Nguyen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carole Fakhry
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Cherie-Ann O Nathan
- Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Chris Leonardis
- Support for People With Oral and Head and Neck Cancer, Locust Valley, New York, USA
| | | | - Terry A Day
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael G Moore
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
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26
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Chhibber A, Kharat A, Kneale D, Welch V, Bangpan M, Chaiyakunapruk N. Assessment of health equity consideration in masking/PPE policies to contain COVID-19 using PROGRESS-plus framework: a systematic review. BMC Public Health 2021; 21:1682. [PMID: 34525995 PMCID: PMC8443429 DOI: 10.1186/s12889-021-11688-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/29/2021] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION There is increasing evidence that COVID-19 has unmasked the true magnitude of health inequity worldwide. Policies and guidance for containing the infection and reducing the COVID-19 related deaths have proven to be effective, however the extent to which health inequity factors were considered in these policies is rather unknown. The aim of this study is to measure the extent to which COVID-19 related policies reflect equity considerations by focusing on the global policy landscape around wearing masks and personal protection equipment (PPE). METHODS A systematic search for published documents on COVID-19 and masks/PPE was conducted across six databases: PubMed, EMBASE, CINAHL, ERIC, ASSIA and Psycinfo. Reviews, policy documents, briefs related to COVID-19 and masks/PPE were included in the review. To assess the extent of incorporation of equity in the policy documents, a guidance framework known as 'PROGRESS-Plus': Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus (age, disability etc.) was utilized. RESULTS This review included 212 policy documents. Out of 212 policy documents, 190 policy documents (89.62%) included at least one PROGRESS-plus component. Most of the policy documents (n = 163, 85.79%) focused on "occupation" component of the PROGRESS-plus followed by personal characteristics associated with discrimination (n = 4;2.11%), place of residence (n = 2;1.05%) and education (n = 1;0.53%). Subgroup analysis revealed that most of the policy documents (n = 176, 83.01%) were focused on "workers" such as healthcare workers, mortuary workers, school workers, transportation workers, essential workers etc. Of the remaining policy documents, most were targeted towards whole population (n = 30; 14.15%). Contrary to "worker focused" policy documents, most of the 'whole population focused' policy documents didn't have a PROGRESS-plus equity component rendering them equity limiting for the society. CONCLUSION Our review highlights even if policies considered health inequity during the design/implementation, this consideration was often one dimensional in nature. In addition, population wide policies should be carefully designed and implemented after identifying relevant equity related barriers in order to produce better outcomes for the whole society.
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Affiliation(s)
| | - Aditi Kharat
- School of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Dylan Kneale
- The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, UK
| | - Vivian Welch
- Bruyere Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Mukdarut Bangpan
- The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, UK
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, University of Utah, Salt Lake City, UT, USA.
- School of Pharmacy, Monash University, Subang Jaya, Malaysia.
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27
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Panda S, Vig S, Singh CA, Konkimalla A, Thakar A, Sakthivel P, Sikka K, Kumar R, Bhatnagar S, Mohan A, Tiwari P, Meena VP, Garg RK, Bollu S, Thakur K. Head and Neck Surgery During COVID-19 Pandemic: Experience from a Tertiary Care in India. Indian J Surg Oncol 2021; 12:279-289. [PMID: 34539130 PMCID: PMC8435157 DOI: 10.1007/s13193-021-01424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Head and neck pathologies requiring surgical intervention are considered a high-risk subsite in the context of COVID-19 pandemic by virtue of its close proximity to the mucosa of the upper aerodigestive tract. Retrospective review of all head and neck surgical procedures is undertaken during the pandemic from 23rd April 2020 to 30th September 2020. One hundred procedures were performed on 98 patients. COVID-19 status determined by SARS-Cov-2 RT-PCR at baseline was negative for 81, positive in 8 and unknown in 11. The RT-PCR negative subgroup included 40 diagnostic procedures and 41 ablative and or reconstructive procedures for head and neck neoplasms. None of the patients or health-care workers converted to COVID-19-positive status during the duration of the hospital stay. There were no cases with 30-day mortality. Clavien-Dindo grading for postoperative complications was as follows: 1–4, 2–12, 3a-2, 3b-1. Eleven patients with unknown COVID-19 status at baseline underwent emergency tracheostomy in a COVID-19 designated operating room for upper airway obstruction secondary to head and neck cancer. Of the 8 procedures conducted on known cases of COVID-19, 6 were tracheostomies performed for COVID-19 ARDS. The rest were maxillectomy for acute invasive mucormycosis and incision and drainage for parotid abscess. A matched-pair analysis was performed with similarly staged historical cohort operated during January to December 2016 to compare peri-operative complication rates (Clavien-Dindo Score). Incidence of complication with higher Clavien Dindo Score (>/=3a) was found to be lower in those patients operated during the pandemic (p=0.007). By meticulous preoperative COVID-19 screening and isolation, head and neck surgical procedures can be continued to avoid delay in diagnosis and treatment without jeopardising the risk of transmission of COVID-19 to the patients or health-care workers.
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Affiliation(s)
- Smriti Panda
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Saurabh Vig
- Department of Onco-Anesthesia, Pain and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chirom Amit Singh
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Abhilash Konkimalla
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Alok Thakar
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Pirabu Sakthivel
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesia, Pain and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pavan Tiwari
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ved Prakash Meena
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit K. Garg
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sumanth Bollu
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
| | - Kuldeep Thakur
- Department of Otorhinolaryngology and,Head and Neck Surgery, All India Institute of Medical Sciences, 110029 New Delhi, India
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Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study. Cancer 2021; 127:2476-2488. [PMID: 33345297 DOI: 10.1002/cncr.33320] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/26/2020] [Accepted: 10/08/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. METHODS This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19-positive patients and infections in the surgical team were determined by univariate analysis. RESULTS Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. CONCLUSIONS Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. LAY SUMMARY Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment.
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Abstract
PURPOSE OF REVIEW The strain on healthcare resources in light of the COVID-19 pandemic has forced many head and neck surgeons to explore reconstructive options that may decrease length of stay. Here, we review three common and versatile regional flaps used in head and neck reconstruction that are comparable alternatives to free tissue transfer. RECENT FINDINGS Initial anatomic descriptions of the facial artery musculocutaneous (FAMM) flap, the supraclavicular artery island flap and the submental artery island flap were published decades ago. Since then, many have proposed modifications to these descriptions to improve technical ease and patient outcomes. Benefits of regional flaps include ease of harvest, comparable outcomes to free tissue microvascular flaps, shorter operative time and hospital length of stay. Drawbacks to regional flaps include limitations to size and reach, partial necrosis, wound dehiscence and surgeon experience. The integrity of the vascular pedicle is also contingent upon vessel preservation during the cancer ablation. SUMMARY Although a resurgence of regional flaps began well before the COVID-19 pandemic, many institutions began looking for alternatives to free flap reconstruction to conserve healthcare resources and minimize patient hospitalization time in the past year. There has been a revival of regional flaps such as the FAMM, supraclavicular and submental flaps that are valuable reconstructive options for many defects of the head and neck.
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Tan H, Preston J, Hunn S, Kwok M, Borschmann M. COVID-19 did not delay time from referral to definitive management for head and neck cancer patients in a regional Victorian centre. ANZ J Surg 2021; 91:1364-1368. [PMID: 34185361 PMCID: PMC8420257 DOI: 10.1111/ans.17057] [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: 04/10/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 12/01/2022]
Abstract
Background The COVID‐19 pandemic has had widespread impacts on health services, particularly regarding the provision of urgent elective surgical services. It has influenced the evaluation of surgical patients, patient willingness to consult with medical services, and the ability to provide timely care to these patients. The aim of this study is to assess the impact of the COVID‐19 pandemic on the time to definitive management for head and neck cancer in a regional setting. Methods A retrospective review was performed through the University Hospital Geelong Head and Neck Unit records and electronic medical records. Ethics approval for quality assurance was attained. The primary outcome was time from the first clinic appointment to commencement of definitive management. Statistical analysis was performed using Prism (version 8.0, GraphPad). Results A total of 127 patients were identified, 64 in the pre‐COVID and 63 in the post‐COVID period. In the post‐COVID period, more patients (14.3%) had their first clinic appointment with telehealth compared to the pre‐COVID period (1.6%). There was also no significant difference in time from referral to first clinic appointment or time from first clinic appointment to date of definitive treatment decision or multidisciplinary meeting. There was no significant difference in definitive treatment modality between groups. Conclusion Despite increased adoption of telemedicine and increased public health considerations, there was no increase in time to definitive treatment from the time of referral to a regional head and neck cancer service.
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Affiliation(s)
- Hannah Tan
- Department of Otolaryngology, Head and Neck Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Joel Preston
- Department of Otolaryngology, Head and Neck Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Samuel Hunn
- Department of Otolaryngology, Head and Neck Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Matthew Kwok
- Department of Otolaryngology, Head and Neck Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Michael Borschmann
- Department of Otolaryngology, Head and Neck Surgery, Barwon Health, Geelong, Victoria, Australia
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Changing trend in the management of head neck cancers during the COVID-19 pandemic. Eur Arch Otorhinolaryngol 2021; 279:1453-1460. [PMID: 34120204 PMCID: PMC8199848 DOI: 10.1007/s00405-021-06898-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/19/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the present study, we have shared our experience in managing head neck cancers, especially the oral malignancies, during the crisis of COVID 19. MATERIALS AND METHODS Patients with oral cancers underwent pedicle/local flaps and free flaps reconstruction based on the availability of intensive care unit and comorbidities of the patients. The clinical outcomes were compared at the end of one week, one month, and three months after the primary surgery. RESULTS Pedicle/local flaps were used in 25 cases and radial/fibular free flaps were used in 8 cases for the reconstruction of soft tissue defects. Patients with pedicle flap reconstruction had better clinical outcomes, including lesser ICU stay as compared to free flaps. CONCLUSION Pedicle flap can be a valid alternative to the free flap for the soft tissue reconstruction in advanced oral malignancies during the COVID pandemic period in the Indian subcontinent, especially with limited infrastructure of the hospitals.
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Iyer S, Subramaniam S, Thankappan K, Rao N, Satyapalan D, Ravikumar B, Vasudevan A. Perceptions of the Health Care Workers about the Guideline Implemented for Safe Surgical Practice during COVID-19 Pandemic in a University Teaching Hospital. Surg J (N Y) 2021; 7:e73-e82. [PMID: 34104719 PMCID: PMC8175121 DOI: 10.1055/s-0041-1726130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/19/2021] [Indexed: 11/03/2022] Open
Abstract
One area of health care delivery that has been affected badly in most of the institutions is the running of the surgical services. This is due to various factors such as the presence of asymptomatic carrier stage, increased morbidity and mortality in surgical procedures in a COVID-19 patient, and possible transmission of disease to the health care workers (HCWs). A guideline was formulated in our institution, which is a tertiary care university teaching hospital to resume the surgical activities in full. Following its implementation, a questionnaire-based study was conducted to understand the perception of the HCWs about the guidelines. The questionnaire had four domains with questions related to the impact of the epidemic on the practices, composition of the guidelines, its implementation, and effects. There were 217 responders which included doctors and the supportive staff. Majority of the responders welcomed the introduction of the guidelines, and felt that it ensured patient's safety and helped streamline the services. Quarantine and preoperative reverse transcription polymerase chain reaction testing were found to be appropriate measures by the respondents. In some areas, there was a difference in the responses from the doctors to that from the supportive group which assumed statistical significance. These included the reason for drop in patient numbers was the reduced patient accessibility which was felt mainly by the doctors. The doctors perceived a delay in carrying out the work, increased workload, and mental agony due to the presence of the guidelines.
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Affiliation(s)
- Subramania Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.,Department of Plastic Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sobha Subramaniam
- Department of Pulmonology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Nageswara Rao
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Dipu Satyapalan
- Department of Infection Control, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Beena Ravikumar
- Department of Medical Administration, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Anu Vasudevan
- Department of Biostatistics, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Cavalcanti IDL, Soares JCS. Impact of COVID-19 on cancer patients: A review. Asia Pac J Clin Oncol 2021; 17:186-192. [PMID: 32970923 DOI: 10.1111/ajco.13445] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/18/2020] [Indexed: 12/18/2022]
Abstract
To inform about the impact of COVID-19 on cancer patients, a literature review was carried out, using the descriptors "COVID-19," "SARS-CoV-2," "Oncology," and "Coronavirus," in the Pubmed, Sciencedirect, and Scifinder databases. Fifty-three articles were included after analyzing the inclusion and exclusion criteria, being divided into five sessions: Epidemiological aspects of COVID-19; Pathophysiology of COVID-19; Clinical aspects of cancer patients; Risks to cancer patients infected with COVID-19; and Care for cancer patients amid a pandemic. The cancer patient has a weakened immune system, due to characteristics specific to the development of cancer or even chemotherapy, leaving these patients more susceptible to infections by COVID-19. Thus, the development of protection plans for cancer patients should be encouraged, reducing the exposure of these patients to the SARS-CoV-2 virus, contributing to the maintenance of the health of the cancer patient, and avoiding possible therapeutic complications that can lead the patient to death.
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Affiliation(s)
- Iago Dillion Lima Cavalcanti
- PhD student in Biological Sciences, Master in Pharmaceutical Science, Federal University of Pernambuco (UFPE), Recife, Brazil
| | - José Cleberson Santos Soares
- PhD student in Therapeutic Innovation, Master in Pharmaceutical Science, Federal University of Pernambuco (UFPE), Recife, Brazil
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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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Ito A, Kobayashi K, Shiotsuka M, Sato T, Omura G, Matsumoto Y, Ikeda A, Sakai A, Eguchi K, Takano T, Matsumoto F, Kobayashi O, Iwata S, Yoshimoto S. Uniform infection screening allowed safe head and neck surgery during the coronavirus disease 2019 pandemic in Japan. Jpn J Clin Oncol 2021; 51:400-407. [PMID: 33048119 PMCID: PMC7665677 DOI: 10.1093/jjco/hyaa195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/27/2020] [Indexed: 01/08/2023] Open
Abstract
Background The purpose of this study was to determine whether a uniform infection screening protocol could be used to safely perform head and neck cancer surgery during the coronavirus disease 2019 pandemic and clarify how surgical treatment changed compared with the pre-pandemic period. Materials and methods During the unprecedented coronavirus disease 2019 pandemic in Tokyo, we continued providing head and neck cancer care, guided by our own uniform screening protocol. In this study, medical records of 208 patients with head and neck malignancy, who underwent surgical treatment at our hospital during the first and second wave of pandemic for each 2-month period (first wave: 30 March 2020–30 May 2020, second wave: 14 July 2020–14 September 2020) and the 2-month pre-pandemic period (30 October 2019–30 December 2020), were analysed. Results A total of 133 patients were admitted for surgical treatment and all, except six patients with emergency tracheostomy, were screened according to the protocol. As a result, all 127 patients received surgical treatment as planned, and all 1247 medical staff members involved in the surgeries were uninfected by severe acute respiratory syndrome coronavirus 2. During the first wave of pandemic, 20% reduction of head and neck surgery was requited; however, restrictions of surgery were not necessary during the second wave. Surgical procedure, length of hospitalization, postoperative complications and number of medical staff were unchanged compared with pre-pandemic period. Conclusion Our data indicate that continuation of head and neck anticancer surgical treatment in an epidemic area during the coronavirus disease 2019 pandemic were safe and feasible, if adequate and strict preventive measures are vigorously and successfully carried out.
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Affiliation(s)
- Akiko Ito
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo
| | - Kenya Kobayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo
| | - Mika Shiotsuka
- Department of Infection Disease, National Cancer Center Hospital, Tokyo
| | - Tetsufumi Sato
- Department of Anesthesia and Intensive care, National Cancer Center Hospital, Tokyo, Japan
| | - Go Omura
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo
| | | | - Atsuo Ikeda
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo
| | - Azusa Sakai
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo
| | - Kohtaro Eguchi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo
| | - Tomonari Takano
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo
| | - Fumihiko Matsumoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo
| | - Osamu Kobayashi
- Department of Infection Disease, National Cancer Center Hospital, Tokyo
| | - Satoshi Iwata
- Department of Infection Disease, National Cancer Center Hospital, Tokyo
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo
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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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Ambulatory Patients with Cardiometabolic Disease and Without Evidence of COVID-19 During the Pandemic. The CorCOVID LATAM Study. Glob Heart 2021; 16:15. [PMID: 33833939 PMCID: PMC7894376 DOI: 10.5334/gh.932] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background SARS-CoV-2 pandemic has modified the cardiovascular care of ambulatory patients. The aim of this survey was to study changes in lifestyle habits, treatment adherence, and mental health status in patients with cardiometabolic disease, but no clinical evidence of COVID-19. Methods A cross-sectional survey was conducted in ambulatory patients with cardiometabolic disease using paper/digital surveys. Variables investigated included socioeconomic status, physical activity, diet, tobacco use, alcohol intake, treatment discontinuation, and psychological symptoms. Results A total of 4,216 patients (50.9% males, mean age 60.3 ± 15.3 years old) from 13 Spanish-speaking Latin American countries were enrolled. Among the study population, 46.4% of patients did not have contact with a healthcare provider, 31.5% reported access barriers to treatments and 17% discontinued some medication. Multivariate analysis showed that non-adherence to treatment was more prevalent in the secondary prevention group: peripheral vascular disease (OR 1.55, CI 1.08-2.24; p = 0.018), heart failure (OR 1.36, CI 1.05-1.75; p = 0.017), and coronary artery disease (OR 1.29 CI 1.04-1.60; p = 0.018). No physical activity was reported by 38% of patients. Only 15% of patients met minimum recommendations of physical activity (more than 150 minutes/week) and vegetable and fruit intake. Low/very low income (45.5%) was associated with a lower level of physical activity (p < 0.0001), less fruit and vegetables intake (p < 0.0001), more tobacco use (p < 0.001) and perception of depression (p < 0.001). Low educational level was also associated with the perception of depression (OR 1.46, CI 1.26-1.70; p < 0.01). Conclusions Patients with cardiometabolic disease but without clinical evidence of COVID-19 showed significant medication non-adherence, especially in secondary prevention patients. Deterioration in lifestyle habits and appearance of depressive symptoms during the pandemic were frequent and related to socioeconomic status.
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Short Term Outcomes of Head and Neck Oncology Surgery During Covid-19 Pandemic: Experience from a Tertiary Cancer Care Centre in North India. Indian J Otolaryngol Head Neck Surg 2021; 74:2822-2826. [PMID: 33437685 PMCID: PMC7790726 DOI: 10.1007/s12070-020-02334-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/14/2020] [Indexed: 12/04/2022] Open
Abstract
With the entire world in the midst of COVID-19 pandemic, several health care facilities have stopped or delayed performing elective surgeries in order to cater to ever increasing number of COVID-19 patients. Moreover, there were initial reports of poor surgical outcomes in patients who underwent surgery and were found to be positive for COVID-19 infection in post-operative period. In this study, we have evaluated the short-term outcomes of head and neck oncology patients operated in our institute following a strict screening protocol and conducting COVID-19 testing by Reverse transcriptase polymerase chain reaction once the test was available. 68 patients operated between 1st April and 30th September, 2020 (COVID-19 era, study group) were compared with 59 patients operated during 1st October, 2019 to 31st March 2020 (Non COVID-19 era, control group). The comparison between the groups was done by measuring 30 days complication rate as defined by Dindo–Clavien classification. 10.3% of patients developed complications in study group as compared to 8.5% of patients in control group which was statistically non-significant (p = 0.7). Importantly, none of the patients developed any sign or symptom suggestive of COVID-19 infection in post-operative period in study group. Head and neck oncology related cancer procedures including complex reconstruction can safely be performed during COVID-19 era by proper screening and pre-operative testing for COVID-19. We also suggest use of N95 masks and face shields as bare minimum in order to ensure the safety of health care workers even after a negative COVID-19 report.
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The influence of the SARS-CoV-2 pandemic on oral and maxillofacial surgery: a nationwide survey among 54 hospitals and 240 private practices in Germany. Clin Oral Investig 2021; 25:3853-3860. [PMID: 33409692 PMCID: PMC7787613 DOI: 10.1007/s00784-020-03715-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/25/2020] [Indexed: 01/12/2023]
Abstract
Objective The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has created hitherto unknown challenges for healthcare systems and patient care. This study aimed to analyze its influence on patient care and healthcare management in oral and maxillofacial surgery (OMFS) in Germany. Materials and methods A nationwide survey of the German Association of Oral and Maxillofacial Surgery was performed. Individual questionnaires containing 10 questions for university as well as non-university hospitals and 15 questions for private practices (PPs) for OMFS were created to collect data for patient numbers and surgical procedures conducted, usage of personal protection equipment (PPE), SARS-CoV-2 tests, and economic aspects. Results Fifty-four hospitals and 240 PPs participated in the study. The reduction in ward capacities and number of surgical procedures ranged from 17 to 78%. PPE consisted of standard surgical masks (58% hospitals, 64% PPs) and FFP2/N95/KN95 respirators (45% hospitals, 48% PPs). Preoperative SARS-CoV-2 tests were more frequently performed in hospitals (34% vs 2%). At PPs, turnover for medical and dental procedures billed to the public insurance had reduced to 58.81% and 62.43%, respectively, of the corresponding values for 2019, and 58.75% of the PPs had applied for short-time allowances. Conclusion With the exception of some elective procedures, primary patient care in OMFS has been assured during the pandemic. However, the immense economic burden on hospitals and PPs cannot be conclusively assessed at this point. Clinical relevance For OMFS, the German healthcare system has shown the ability to adapt to emergency situations such as the SARS-CoV-2 pandemic. Adequate surgical capacities in OMFS are necessary even during pandemics.
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Surgical oncology of the head and neck district during COVID-19 pandemic. Eur Arch Otorhinolaryngol 2021; 278:3107-3111. [PMID: 33394125 PMCID: PMC7779644 DOI: 10.1007/s00405-020-06517-3] [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: 06/30/2020] [Accepted: 11/23/2020] [Indexed: 10/31/2022]
Abstract
PURPOSE A new member of the Coronaviridae family caused a worldwide pandemic emergency called Coronavirus disease 2019 (COVID-19). Health care workers who come into contact with the upper aero-digestive tract during diagnostic and therapeutic procedures, such as otolaryngologists, oral and maxillofacial surgeons, and head and neck surgeons, may undergo profound changes in their activities and are particularly at risk. We analysed the impact of COVID-19 on our oncological surgical activity. METHODS To address the emergency and guarantee safety of patients referred to our Unit, reproducible guidelines were followed. Surgical activity data during COVID-19 were compared to previous years (2018 and 2019). RESULTS From 21st February to 25th of May 113 surgical procedures were performed. The average of the two selected years (2018-2019) is 84.5, showing an increase of 34.5% of our activities (statistically significant, p = 0.0011). No patient showed perioperative or postoperative contagion. CONCLUSION Due to the conversion of regular Hospitals into COVID Centers, Cancer Centers may encounter an increased demand for procedures. Following strict guidelines, it seems possible to face surgical activity on cancer patients and respect standard procedures aimed at containing the spread of COVID-19 infection.
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The impact of the COVID-19 outbreak on supportive care for oral mucositis: current concepts and practice. Support Care Cancer 2021; 29:2255-2258. [PMID: 33392774 PMCID: PMC7779243 DOI: 10.1007/s00520-020-05966-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/16/2020] [Indexed: 01/12/2023]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) markedly affected the way healthcare professionals approach patients with cancer worldwide, not only in terms of therapeutic decision-making but also in terms of supportive care. With the rapid appearance of signs and symptoms and the need of close re-assessment, standard management of oral mucositis has been challenged by physical distancing and limited resources due to the global crisis. Building on the clinical experience developed during the acute phase by members of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO), the implications of COVID-19 on the prevention, assessment, and treatment of mucositis are critically reported. Inspired by the restructuring of supportive care measures in response to the pandemic, suggestions for new models of approaching acute side effects are also discussed.
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Hanna GJ, Rettig EM, Park JC, Varvares MA, Lorch JH, Margalit DN, Schoenfeld JD, Tishler RB, Goguen LA, Annino DJ, Haddad RI, Uppaluri R. Hospitalization rates and 30-day all-cause mortality among head and neck cancer patients and survivors with COVID-19. Oral Oncol 2021; 112:105087. [PMID: 33190021 PMCID: PMC7833708 DOI: 10.1016/j.oraloncology.2020.105087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/15/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The impact of COVID-19 on patients with cancer is emerging, but data are urgently needed for head and neck cancer (HNC) patients or survivors who are inherently high-risk for severe illness and mortality with SARS-CoV-2 infection. METHODS This multi-institution, academic cohort study collected comprehensive data on clinical risk factors, COVID-19 symptoms and viral testing patterns, information about hospitalization rates, and predictors of survival among HNC patients with active disease or in remission. The primary endpoint was 30-day all-cause mortality from the date of confirmed COVID-19. We performed multivariate analysis to understand the prognostic value of clinical and laboratory parameters on outcomes. RESULTS Thirty-two patients with COVID-19 and HNC were included. Median age was 70 (range: 38-91) with 38% aged 75+, and 34% resided in long-term care facilities (LTCF). Thirteen (41%) had active cancer, with 6 (19%) on cancer therapy within 4 weeks of COVID-19 diagnosis. New or worsening cough and fatigue were the most commonly reported presenting symptoms. More than 30% required >1 SARS-CoV-2 test before confirming a positive result. Twenty (63%) required hospitalization. At data cutoff, 7 (22%) had died (1 on active cancer treatment), with a 30-day all-cause mortality of 18.9% (95%CI: 11.4-33.6) among all patients, and 71.5% (95%CI: 38.2-92.3) among those requiring intensive care unit (ICU) admission. ICU admission and residing in a LTCF predicted worse outcomes (p < 0.01), while age, gender, and recent treatment did not. CONCLUSIONS We observed high 30-day all-cause mortality among HNC patients with COVID-19, but most were not on active cancer therapy.
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Affiliation(s)
- Glenn J Hanna
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA.
| | - Eleni M Rettig
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, Brigham & Women's Hospital, Boston, MA
| | - Jong C Park
- Massachusetts General Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Mark A Varvares
- Massachusetts General Cancer Center, Massachusetts General Hospital, Boston, MA; Massachusetts Eye & Ear Infirmary, Boston, MA
| | - Jochen H Lorch
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA
| | - Danielle N Margalit
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Radiation Oncology, Brigham & Women's Hospital, Boston, MA
| | - Jonathan D Schoenfeld
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Radiation Oncology, Brigham & Women's Hospital, Boston, MA
| | - Roy B Tishler
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Radiation Oncology, Brigham & Women's Hospital, Boston, MA
| | - Laura A Goguen
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, Brigham & Women's Hospital, Boston, MA
| | - Donald J Annino
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, Brigham & Women's Hospital, Boston, MA
| | - Robert I Haddad
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA
| | - Ravindra Uppaluri
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, Brigham & Women's Hospital, Boston, MA
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Cassoni A, Pucci R, Mangini N, Fadda MT, Battisti A, Giovannetti F, Terenzi V, Della Monaca M, Priore P, Raponi I, Valentini V. Head and Neck Cancer Treatment during COVID-19 Pandemic: A Central Experience in Rome. Emergency Management, Infection Prevention and Control. Cancers (Basel) 2020; 13:E33. [PMID: 33374237 PMCID: PMC7795055 DOI: 10.3390/cancers13010033] [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] [Received: 11/18/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic has significantly affected the surgical units, especially those operating on the airways. This study evaluates the series of patients with tumors of the head and neck treated by our unit during Phase-1 of the pandemic and the efficacy of the preventive measures implemented for protecting both the patients and staff. A screening program was administered to all the patients who had to undergo surgery. None of the patients tested and operated during Phase 1, between 10 March and 18 May 2020, were positive for COVID-19. A significant portion of the patients was suffering from tumors in advanced stages (T3 and T4). Two patients developed respiratory symptoms during their stay at the unit, so they were put in precautionary isolation and tested, but resulted negative for COVID-19. All the surgical department staff followed the Italian Ministry of Health's prevention protocol and underwent serological testing. IgG and IgM were negative in everyone, thus confirming that nobody had been exposed to the virus. This study highlights the commitment to efficiently treating patients suffering from tumors of the head and neck region and confirms the effectiveness of the safety measures used to protect our patients and staff's health.
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Affiliation(s)
- Andrea Cassoni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Resi Pucci
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Nicolò Mangini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Maria Teresa Fadda
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Andrea Battisti
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Filippo Giovannetti
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Valentina Terenzi
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Marco Della Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Paolo Priore
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Ingrid Raponi
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Valentino Valentini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
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Cernei C, Shrivastava MK, Colquhoun-Flannery W, Winter SC. Timing and volume of information produced for the Otolaryngologist during the COVID-19 pandemic in the UK: A review of the volume of online literature. Clin Otolaryngol 2020; 46:318-324. [PMID: 33220155 PMCID: PMC7753750 DOI: 10.1111/coa.13669] [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] [Received: 07/11/2020] [Revised: 11/03/2020] [Accepted: 11/08/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND The SARS-CoV-2 was first reported in December 2019 in Wuhan, China and has been declared a pandemic in March 2020. COVID-19 has caused unprecedented and lasting biopsychosocial effects worldwide. All healthcare professionals have faced life-threatening risks by attending their daily jobs. The daily emergence of advice and guidelines was necessary to ensure the safety of patients and staff. To this effect, all elective services came to a halt to preserve hospitals' capacity for dealing with the sickest. This retrospective, descriptive review aims to assess the volume and timing of the advice released specifically relevant to UK ENT specialists. METHODS Two separate searches were performed. One involved online advice published in English by international, national and ENT-specific organisations between January 1 and May 31. The date, title, source, type of advice and link to the advice were recorded in Excel. The resources were analysed per week of publication. A second separate search for peer-reviewed publications was conducted using PubMed Central and Cochrane databases. FINDINGS COVID-19-related guidance was considered, of which 175 were identified. 52/175 (29.7%) articles were published by international organisations. 56/175 (32%) were produced by national organisations, and 67/175 (38.28%) were produced by ENT specific organisations. The peak guidance production took place in the third and fourth week of March (16/03/2020-29/03/2020) with 72/175 publications. Of these, 27/70 came from the international category, 17/70 from national bodies and 26/70 from ENT-specific organisations. 13 863 total publications relating to COVID-19 were found using PubMed and Cochrane search strategies; 76% were relevant to ENT. CONCLUSION The challenges faced by ENT relate to the unprecedented, sudden and daily changes to clinical practice. Multiple bodies interpreted the guidance, giving an opportunity for confusion and delay in treatments for patients. Implementing a system with clear lines of communication and dissemination of information will improve our response to future pandemic events whilst maintaining a commercial awareness to better use the human and financial resources of an already financially restricted NHS.
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Affiliation(s)
| | | | | | - Stuart C Winter
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Oxford University NHS Foundation Trust, Oxford, UK
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45
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Hoffmann TK, Greve J, Laban S, Schuler PJ. [Treatment of patients with head and neck cancer during the COVID-19 pandemic]. HNO 2020; 69:14-16. [PMID: 33170312 PMCID: PMC7653450 DOI: 10.1007/s00106-020-00967-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 12/19/2022]
Affiliation(s)
- T K Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89081, Ulm, Deutschland.
| | - J Greve
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89081, Ulm, Deutschland
| | - S Laban
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89081, Ulm, Deutschland
| | - P J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89081, Ulm, Deutschland
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46
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de Boutray M, Kün-Darbois JD, Sigaux N, Lutz JC, Veyssiere A, Sesque A, Savoldelli C, Dakpe S, Bertin H, Lallemant B, Llobet A, du Cailar M, Lauwers F, Davrou J, Foletti JM. Impact of the COVID-19 lockdown on the epidemiology of maxillofacial trauma activity: a French multicentre comparative study. Int J Oral Maxillofac Surg 2020; 50:750-755. [PMID: 33172710 PMCID: PMC7648505 DOI: 10.1016/j.ijom.2020.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/20/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P = 0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed.
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Affiliation(s)
- M de Boutray
- Department of Maxillofacial Surgery, Gui de Chauliac University Hospital Centre, Montpellier University, Montpellier, France.
| | - J-D Kün-Darbois
- Department of Maxillofacial and Oral Surgery, Angers University Hospital, Angers, France.
| | - N Sigaux
- Department of Maxillofacial and Facial Plastic Surgery, Lyon Sud Hospital Centre, Hospices Civils de Lyon, Pierre-Benite, France.
| | - J-C Lutz
- Department of Maxillofacial Surgery and Stomatology, Strasbourg University Hospital Centre, Strasbourg, France.
| | - A Veyssiere
- Department of Maxillofacial and Plastic Surgery, Caen University Hospital, Caen, France.
| | - A Sesque
- Oral and Maxillofacial Surgery Department, Estaing University Hospital, Clermont Ferrand, France.
| | - C Savoldelli
- Head and Neck University Institute, Nice University Hospital, Nice, France.
| | - S Dakpe
- Department of Maxillofacial Surgery, Amiens University Hospital Centre, Amiens, France; UR CHIMERE 7516, Picardie Jules Verne University, Amiens, France.
| | - H Bertin
- Department of Oral and Maxillofacial Surgery, Nantes University Hospital, Nantes, France.
| | - B Lallemant
- Department of Head and Neck Surgery, University Hospital Centre of Nîmes, Nîmes, France.
| | - A Llobet
- Department of Maxillofacial and Oral Surgery, Perpignan Hospital Centre, Perpignan, France.
| | - M du Cailar
- Maxillofacial Surgery Unit, Purpan University Hospital, Toulouse, France.
| | - F Lauwers
- Maxillofacial Surgery Unit, Purpan University Hospital, Toulouse, France.
| | - J Davrou
- Department of Maxillofacial Surgery and Stomatology, La Pitié-Salpêtrière University Hospital, AP-HP, Paris, France.
| | - J-M Foletti
- Aix Marseille University, APHM, IFSTTAR, LBA, La Conception University Hospital, Department of Maxillofacial Surgery, Marseille, France.
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Salari A, Jalaeefar A, Shirkhoda M. What is the best treatment option for head and neck cancers in COVID-19 pandemic? A rapid review. Am J Otolaryngol 2020; 41:102738. [PMID: 32979663 PMCID: PMC7499174 DOI: 10.1016/j.amjoto.2020.102738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 12/28/2022]
Abstract
With the onset of the COVID-19 crisis in late 2019, the health care systems of different countries are experiencing stressful conditions. Many patients need care in hospital wards and intensive care units (ICU). Head & neck cancers (HNC) are in a special condition in this pandemic. The main treatment in these patients is surgery. Most of these patients need care in the ICU, which is reduced in capacity in pandemic conditions. It's important to note that delays in the surgery of these patients make them non-operable and on the other hand increase mortality and morbidity. Numerous non-surgical alternative therapies have been proposed in these conditions, but there are fundamental questions about these suggestions. 1 How long should we look for alternative therapies? Because many countries are facing a second wave of the disease. 2 What's the effect of these alternative therapies and the delay in starting standard treatments in patients' survival? Different countries have different financial resources; many countries, patients face restrictions on receiving alternative therapies to standard treatments, and in non-pandemic conditions, long queues are given for non-surgical treatments such as chemo-radiotherapy. There are numerous guidelines to guide head and neck surgeons to the best choice in this situation. It seems that different countries have to make individual decisions based on the prevalence of COVID-19 and the financial resources and facilities of the health care system. In this review article, we have collected the opinions of world-renowned guidelines and institutions on how to treat HNCs during the pandemic.
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Affiliation(s)
- Abolfazl Salari
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohsen Jalaeefar
- Department of General Surgery, Subdivision of Surgical Oncology, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shirkhoda
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.
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48
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Fedorov AV, Kurganov IA, Emelyanov SI. [Surgical care during the new coronavirus (Covid-19) pandemic]. Khirurgiia (Mosk) 2020:92-101. [PMID: 33030009 DOI: 10.17116/hirurgia202009192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Safe and reasonable surgical care in the context of COVID-19 pandemic is difficult task. The main current issues are selection of patients for surgical treatment, principles of surgical treatment in cancer patients, possibilities of endoscopic surgery, organization of surgical department and operating theatre, surgical strategy in infected patients. Own experience and rational implementation of the recommendations developed by international research and practical communities are extremely important for optimizing surgical treatment of patients in a pandemic, as well as for ensuring the safety of patients and medical staff.
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Affiliation(s)
- A V Fedorov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - I A Kurganov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - S I Emelyanov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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49
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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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50
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Solano N, Gutiérrez P, Parra E, Castrillo A. Management of patients with oral cancer during the covid-19 pandemic. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2020. [DOI: 10.1051/mbcb/2020044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Introduction: The influence of the COVID-19 pandemic on healthcare to the public is severe. There is a high viral load in the nasal and oral cavities of infected patients, especially endangering those specialties focused around this region. Within the field of action of oral and maxillofacial surgeons, the approach and management of oral cancer is one relevant area. The present review aims to collect and discuss aspects of the management of inpatients and outpatients with oral cancer during the COVID-19 pandemic. Corpus: The care of the patient affected with oral cancer is imperative. Following strict biosecurity protocols, procedures such as clinical examinations for cancer patients and biopsies can be performed. In the case of benign slowly growing tumors, deferral of surgery until the COVID-19 pandemic situation has settled is recommended. In the case of malignant tumors, surgery must be performed using appropriate biosecurity measures. Conclusion: The reduction of elective surgery is necessary; nevertheless, urgent oncologic and emergency surgery still has to be performed. Strategies must be developed to reduce the number of infections. The adequate approach of the COVID-19 challenge merits significant changes in the infrastructure of outpatient units, inpatient units, and operating rooms.
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