Fundamental Principles Governing the Development of these
Recommendations
- Alignment to the extent possible with our established
multi-disciplinary practice approaches.
- Adhere to the standard of care, and when this is not possible given
the current health crisis, then supported to the extent possible by
the existing medical literature.
- Favor modalities and approaches that minimize the number of visits to
PENN Medicine, while not compromising the opportunity for cure.
- Favor modalities that minimize immune compromise during and after
treatment.
- Compliance with the evolving Center for Medicare Services (CMS)
recommendations on medical and surgical triage during the COVID-19
pandemic.1
- Avoid surgical treatment if patient is immunocompromised unless the
risk of the cancer progressing outweighs the risk posed by their
immunocompromised state.2
- COVID 19 Thyroid Cancer Guidelines as well Skin Cancer Guidelines were
created by separate respective Cancer Service Line and are not
included in the Head and Neck Cancer COVID 19 guidelines reported
herein.
- COVID-19 Testing Principles for Patients with Head and Neck Tumors
- All patients should undergo standard COVID-19 history taking by team
members for possible active infection or exposure and referred for
testing per hospital guidelines. The COVID -9 history should be
taken at the time of the initial encounter and again the day before
treatment begins and on the day of treatment.
- Depending on availability, SARS-CoV-2 testing should be done
preoperatively and prior to chemotherapy or radiation. It is
recommended that this testing be done within 24 hours of starting
cancer treatment during the surge and apogee of the COVID-19 curve
and 72 hours prior to treatment initiation later in the disease
pandemic curve.
- Patients that have tested positive for SARS-CoV-2 or are a Patient
Under Investigation (PUI) should, in general, have all treatment
deferred until the patient is no longer ill or contagious confirmed
by two negative tests a
- Some patients that have tested positive for SARS-CoV-2 or are a PUI
may start/continue radiation treatment; this recommendation is
modality specific and has been defined in the general workflow
created by the Department of Radiation Oncology for patients
undergoing radiation therapy during the COVID-19 pandemic.
- For patients who are COVID-19 positive, PUI or unable to determine
and present with acute emergencies in need of immediate surgical
intervention (e.g., bleeding or airway emergencies), the surgical
team should don appropriate Personal Protective Equipment, which in
our institution is an N95 face mask, goggles, double gown and gloves
or a full Powered Air-Purifying Respirator (PAPR) if for that
individual the N95 mask is ill fitting.3,4
- For patients who are neither COVID-19 positive or PUI the surgical
team should don N95 masks, face shields, surgical gowns and gloves
during patient assessment and treatment.