Physical Examination
On March 23, 2020, Pennsylvania’s governor issues his first stay at home order, which included the county where UPMC’s flagship hospital and cancer center are located. Stay at home orders are meant to flatten the pandemic curve, and for many cancer survivors, monitoring via telemedicine is feasible. However, for many patients, physical examination and, possibly, flexible laryngoscopy may be needed. When a biopsy is required, a gown, eye protection, and N95 mask are used. Many of our newly diagnosed HNC patients will need to be discussed in a multidisciplinary conference. To conduct treatment discussions and planning, we have transitioned to a virtual multidisciplinary conference.10
When symptom burden is impacting health, we have selectively invited patients to the HNC Survivorship Clinic for face to face evaluation and coordination of care. Symptoms most likely to result in a recommendation for a face to face visit are increasing pain or deterioration in function. Face masks, eye protection, and gloves are routinely employed. We continue to use functional endoscopic evaluation of swallowing (FEES) selectively employing personal protective equipment. We have been able to continue to have patients provided physical therapy at establishments local to them, and we have provided swallowing therapy using a televideo technology.