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Clements K, Thapa A, Cowell A, Conway D, Douglas CM, Paterson C. Impact of the COVID-19 pandemic on stage and incidence of head and neck cancer: A rapid review and meta-analysis. Clin Otolaryngol 2024; 49:363-375. [PMID: 38514776 DOI: 10.1111/coa.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/24/2023] [Accepted: 02/04/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES This rapid review aims to evaluate the impact of the COVID-19 pandemic on incidence of head and neck cancer (HNC) and stage distribution at diagnosis. DESIGN Rapid review and meta-analysis. PARTICIPANTS Comparative data for new HNC patients between a pre-pandemic cohort (before March 2020) and a pandemic cohort (after March 2020 during the lockdown period). MAIN OUTCOMES MEASURED Data on tumour stage, incidence, referral pathway (number of new patient referrals), or workload levels (number of HNC treatments). Data on stage were summarised as odds ratios (OR) with 95% confidence intervals (CI), and data related to changes in numbers of diagnoses, referrals, and workload levels were summarised as a narrative synthesis. RESULTS A total of 31 reports were included in this review. Individually 16 out of 23 studies did not show a significant impact on stage relative to the pre-pandemic period. However, the meta-analysis revealed that patients diagnosed with HNC during the pandemic were 16% more likely to have nodal involvement (OR = 1.16; 95% CI 1.00-1.35), 17% more likely to have a late overall stage (OR = 1.17; 95% CI 1.01-1.36), and 32% more likely to present with advanced tumour extent (T3 and T4 stage) (OR = 1.32; 95% CI 1.08-1.62). Data on incidence was extremely limited and not currently sufficient to assess trends in burden of disease. CONCLUSIONS This review indicates that during the COVID-19 pandemic, there was upstaging of HNC at diagnosis, suggesting the provision of care to HNC patients was significantly affected.
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Affiliation(s)
- Kelten Clements
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Alekh Thapa
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Anna Cowell
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - David Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, UK
| | - Catriona M Douglas
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, UK
- Department of ENT-Head and Neck Surgery, Glasgow Royal Infirmary and Queen Elizabeth University Hospital, Glasgow, UK
| | - Claire Paterson
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, UK
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2
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Bloom JR, Rodriguez-Russo C, Hsieh K, Dickstein DR, Sheu RD, Jain M, Moshier E, Liu J, Gupta V, Kirke DN, Roof S, Misiukiewicz K, Posner M, Bakst R, Sindhu KK, Sharma S. Head and Neck Cancer Patient Population, Management, and Oncologic Outcomes from the COVID-19 Pandemic. Curr Oncol 2024; 31:436-446. [PMID: 38248114 PMCID: PMC10814981 DOI: 10.3390/curroncol31010029] [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] [Received: 11/27/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
The COVID-19 pandemic precipitated drastic changes in cancer care. Its impact on the U.S. head and neck cancer population has yet to be fully understood. This study aims to understand the impact of pandemic-related changes on the head and neck cancer population. An observational study of head and neck cancer patients at a single institution during the spring of 2020 and 2019 was performed. Clinical characteristics and survival outcomes were analyzed. In 2020, 54 head and neck cancer patients were evaluated in the department of radiation oncology vs. 74 patients seen in 2019; 42% of the patients were female in 2019 versus 24% in 2020 (p = 0.036). The median follow-up time was 19.4 and 31 months for 2020 and 2019, respectively. After adjusting for stage, the relapse-free survival probability at 6 and 12 months was 79% and 69% in 2020 vs. 96% and 89% in 2019, respectively (p = 0.036). There was no significant difference in the overall survival, with 94% and 89% in 2020 and 2019, respectively (p = 0.61). Twenty-one percent of patients received induction chemotherapy in 2020 versus 5% in 2019 (p = 0.011); significantly more treatment incompletions occurred in 2020, 9% vs. 0% in 2019 (p = 0.012). Moreover, the stage-adjusted RFS differed between cohorts, suggesting head and neck cancer patients seen during the initial wave of COVID-19 may experience worse oncologic outcomes.
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Affiliation(s)
- Julie R. Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Carlos Rodriguez-Russo
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Daniel R. Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Ren-Dih Sheu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Mayuri Jain
- Department of Population Health Science and Policy, Tisch Cancer Institute Biostatistics Shared Resource Facility, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute Biostatistics Shared Resource Facility, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jerry Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Diana N. Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Scott Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Krzysztof Misiukiewicz
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Marshall Posner
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY 10029, USA
| | - Richard Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Kunal K. Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Sonam Sharma
- Department of Radiation Oncology, Summit Health, Berkeley Heights, NJ 07922, USA
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Lein A, Liu DT, Haas M, Salkic A, Ibrisevic A, Uscuplic S, Harcinovic A, Brkic T, Thurner T, F Brkic F. Impact of the COVID-19 pandemic on management of surgically treated laryngeal squamous cell carcinoma. BIOMOLECULES & BIOMEDICINE 2024; 24:188-195. [PMID: 37638405 PMCID: PMC10787613 DOI: 10.17305/bb.2023.9481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the treatment of cancer patients, particularly in terms of treatment choices. This study aimed to assess the effects of the COVID-19 pandemic on the management of surgically treated laryngeal squamous cell carcinoma (LSCC) patients, focusing specifically on changes in treatment modalities. We retrospectively analyzed the data from 102 patients who underwent surgical treatment for LSCC between January 1, 2019, and December 31, 2021, at our tertiary medical center. Patient demographics, histological characteristics, and treatment modalities were extracted from electronic medical records and compared between two time periods: pre-COVID-19 and during COVID-19, marked by the introduction of the hospital entry triage. Of the total patients, 53 (52%) were in the pre-COVID-19 group, and 49 (48%) were in the COVID-19 group. No significant differences in patient characteristics at the initial work-up were observed between the two groups. However, a significant shift in treatment modalities was noted. Fewer patients received postoperative adjuvant therapy in the COVID-19 group (70.5%) compared to the pre-COVID-19 group (95.5%). Importantly, this change did not significantly impact the one-year overall survival (OS) rates. The reduction in the use of postoperative adjuvant therapy during the COVID-19 pandemic may be attributed to efforts to minimize hospital visits due to the risk of COVID-19 infection. Further research is warranted to validate these findings and to investigate the potential effects of such changes in treatment modalities on the long-term survival.
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Affiliation(s)
- Alexander Lein
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - David T Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Haas
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Almir Salkic
- Department of Otorhinolaryngology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Azra Ibrisevic
- Department of Otorhinolaryngology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sabrina Uscuplic
- Department of Otorhinolaryngology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Alen Harcinovic
- Department of Otorhinolaryngology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Taria Brkic
- Friedrich-Alexander University, Erlangen-Nuernberg, Germany
| | - Thomas Thurner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Faris F Brkic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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Clements K, Cowell A, White G, Flynn W, Conway DI, Douglas CM, Paterson C. The COVID-19 pandemic has not changed stage at presentation nor treatment patterns of head and neck cancer: A retrospective cohort study. Clin Otolaryngol 2023; 48:587-594. [PMID: 36929626 PMCID: PMC10946702 DOI: 10.1111/coa.14048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/02/2022] [Accepted: 02/25/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES To evaluate the impact of the COVID-19 lockdown measures on HNC, by comparing the stage at presentation and treatment of HNC before and after the most severe COVID-19 restrictions. DESIGN A retrospective cohort study. SETTING A regional cancer network serving a patient population of 2.4 million. PARTICIPANTS Newly diagnosed patients with HNC between June and October 2019 (pre-pandemic) and June and October 2021 (post-pandemic). MAIN OUTCOME MEASURES Symptom duration before diagnosis, stage at diagnosis, patient performance status (PS) and intent of treatment delivered (palliative vs. curative). RESULTS Five hundred forty-five patients were evaluated-250 in the 2019 and 295 in the 2021 cohort. There were no significant differences in symptom duration between the cohorts (p = .359) or patient PS (p = .821). There were no increased odds of presenting with a late (Stage III or IV) AJCC cancer stage in 2021 compared with 2019 (odds ratio [OR] = 0.90; 95% confidence interval [CI]: 0.76-1.08); nor increased odds of receiving palliative rather than curative treatment in 2021 compared with 2019 (OR = 0.68; 95% CI: 0.45-1.03). CONCLUSION The predicted stage shift to more advanced disease at the time of diagnosis of HNC due to the COVID-19 pandemic has not been realised in the longer term. In keeping with this, there was no difference in symptom duration, patient PS, or treatment patterns between the 2019 and 2021 cohorts.
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Affiliation(s)
- Kelten Clements
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUK
| | - Anna Cowell
- Beatson West of Scotland Cancer CentreGlasgowUK
| | - Gillian White
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUK
| | - William Flynn
- Department of Otolaryngology – Head and Neck SurgeryGlasgow Royal InfirmaryGlasgowUK
| | - David I. Conway
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUK
- Glasgow Head and Neck Cancer (GLAHNC) Research GroupGlasgowUK
| | - Catriona M. Douglas
- Department of Otolaryngology – Head and Neck SurgeryGlasgow Royal InfirmaryGlasgowUK
- Glasgow Head and Neck Cancer (GLAHNC) Research GroupGlasgowUK
| | - Claire Paterson
- Beatson West of Scotland Cancer CentreGlasgowUK
- Glasgow Head and Neck Cancer (GLAHNC) Research GroupGlasgowUK
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Nadarajan AR, George NA, Thomas S, Varghese BT, Iype EM, K.M JK. Impact of COVID-19 on Disease Progression and Postoperative Complications in Patients with Head and Neck Cancer. Indian J Surg Oncol 2023:1-5. [PMID: 37363709 PMCID: PMC10248326 DOI: 10.1007/s13193-023-01779-9] [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: 04/10/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
The COVID-19 pandemic has created a remarkable challenge for the healthcare system. The delayed presentation, diagnosis, and treatment of head and neck cancer during the COVID-19 pandemic is expected to adversely affect outcomes. COVIDSurg collaborative group in 2020 concluded surgery ≥ 4 weeks after a positive COVID-19 swab result was associated with a lower risk of postoperative mortality. The aim of this study is to assess the disease progression due to COVID-19 infection in patients with head and neck cancer planned for surgery and to analyze the postoperative complications in head and neck cancer patients who underwent surgery after COVID-19 infection. This is an ambispective observational study and included patients with head and neck cancer who recovered from COVID-19 infection and underwent surgery from June 2020 to May 2022. There were a total of 1849 patients with head and neck cancer operated in the mentioned study period during COVID-19 pandemic. One hundred fifty-nine patients had documented COVID-19 infection. One hundred two patients had oral cavity carcinoma (64%), and 38 patients had thyroid carcinoma (23.8%). Early disease was noted in 49 patients (30.8%) and locally advanced disease in 108 patients (67.9%). Mean duration of delay in surgery was 4 weeks. Disease progression was noted in 27 patients (17%) out of which 15 patients were inoperable. Thirty-seven out of 159 patients (23%) had postoperative complications, and it included 2 mortality. There was increased trend noted in pulmonary complications and hemorrhage when compared to pre-COVID-19 era. Due to COVID-19 pandemic, delayed elective head and neck cancer surgery has resulted in higher rates of inoperability. COVID-19 has been associated with increased postoperative pulmonary complications and hemorrhage.
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Affiliation(s)
- Abinaya R. Nadarajan
- Department of Surgical Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | - Nebu Abraham George
- Department of Head & Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | - Shaji Thomas
- Department of Head & Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | - Bipin T. Varghese
- Department of Head & Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
| | - Elizabeth Mathew Iype
- Department of Head & Neck Oncology, Regional Cancer Center, Thiruvananthapuram, India
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Tolia M, Symvoulakis EK, Matalliotakis E, Kamekis A, Adamou M, Kountourakis P, Mauri D, Dakanalis A, Alexidis P, Varveris A, Antoniadis C, Matthaios D, Paraskeva M, Giaginis C, Kamposioras K. COVID-19 Emotional and Mental Impact on Cancer Patients Receiving Radiotherapy: An Interpretation of Potential Explaining Descriptors. Curr Oncol 2023; 30:586-597. [PMID: 36661695 PMCID: PMC9857784 DOI: 10.3390/curroncol30010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/24/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Significant changes in the accessibility and viability of health services have been observed during the COVID-19 period, particularly in vulnerable groups such as cancer patients. In this study, we described the impact of radical practice and perceived changes on cancer patients’ mental well-being and investigated potential outcome descriptors. Methods: Generalized anxiety disorder assessment (GAD-7), patient health (PHQ-9), and World Health Organization-five well-being index (WHO-5) questionnaires were used to assess anxiety, depression, and mental well-being. Information on participants, disease baseline information, and COVID-19-related questions were collected, and related explanatory variables were included for statistical analysis. Results: The mean score values for anxiety, depression, and mental well-being were 4.7 ± 5.53, 4.9 ± 6.42, and 72.2 ± 18.53, respectively. GAD-7 and PHQ-9 scores were statistically associated (p < 0.001), while high values of GAD-7 and PHQ-9 questionnaires were related to low values of WHO-5 (p < 0.001).Using the GAD-7 scale, 16.2% of participants were classified as having mild anxiety (GAD-7 score: 5−9).Mild to more severe anxiety was significantly associated with a history of mental health conditions (p = 0.01, OR = 3.74, 95% CI [1.372−10.21]), and stage category (stage III/IV vs. I/II, p = 0.01, OR = 3.83, 95% CI [1.38−10.64]. From the participants, 36.2% were considered to have depression (PHQ-9 score ≥ 5). Depression was related with older patients (p = 0.05, OR = 1.63, 95% CI [1.16−2.3]), those with previous mental health conditions (p = 0.03, OR = 14.24, 95% CI [2.47−81.84]), those concerned about the COVID-19 impact on their cancer treatment (p = 0.027, OR = 0.19, 95% CI [0.045−0.82]) or those who felt that COVID-19 pandemic has affected mental health (p = 0.013, OR = 3.56, 95% CI [1.30−9.72]). Additionally, most participants (86.7%) had a good well-being score (WHO-5 score ≥ 50). Mental well-being seemed more reduced among stage I−III patients than stage IV patients (p = 0.014, OR = 0.12, 95% CI [0.023−0.65]). Conclusion: There is a necessity for comprehensive cancer care improvement. These patients’ main concern related to cancer therapy, yet the group of patients who were mentally affected by the pandemic should be identified and supported.
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Affiliation(s)
- Maria Tolia
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | - Emmanouil K. Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | - Emmanouil Matalliotakis
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | | | - Marios Adamou
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
| | | | - Davide Mauri
- Medical Oncology, University of Ioannina, 45500 Ioannina, Greece
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Petros Alexidis
- Department of Radiation Oncology, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Antonios Varveris
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | - Chrysostomos Antoniadis
- Department of Radiation Oncology, School of Medicine, University of Crete, 71300 Heraklion, Greece
| | | | - Maria Paraskeva
- Oncology Department, General Hospital of Rhodes, 85133 Rhodes, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, 81400 Lemnos, Greece
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