Introduction
The COVID-19 pandemic due to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has disrupted and transformed the delivery of healthcare in ways that few would have imagined or thought possible. Clinicians, healthcare administrators, insurance companies, policy makers, researchers, and patients are all grappling with how to deliver and access medical care in the COVID-19 era while planning for an unpredictable future contingent on several unknowns (e.g. viral seasonality, vaccine development). The various stakeholders are charting a course for healthcare delivery during a time of unprecedented resource scarcity, relatively uncertain but potentially significant personal risk (for clinicians and patients), and massive economic upheaval. In response to the COVID-19 pandemic, best practices in healthcare delivery for head and neck cancer (HNC) have been upended amid urgent efforts to protect patients, providers, and communities while stewarding scarce resources.
As the pandemic has unfolded across the world, it has become increasingly clear that COVID-19 is a disease with varying incidence and mortality in racial/ethnic subgroups.1,2 While the causes for COVID-19-related racial and ethnic differences are still being examined, they seem to stem from 1) long-standing systemic inequities and differences in social determinants of health, access to care, and quality of care; and 2) biologic determinants such as comorbidity burden, genetics, and immune phenotype.3-5COVID-19 reminds us that determinants of health are multifactorial. Thought leaders in global public health have recently called for development of polysocial risk scores, adapted from the polygenic risk modeling to quantify social determinants of health.6In that sense, the COVID-19 pandemic has been described as a magnifying glass that has brought attention yet again to stark racial/ethnic disparities in health outcomes in the US.3
We have long recognized that HNC is a disease with marked racial/ethnic disparities in outcomes.7-11 Although the reasons underlying observed racial/ethnic differences in mortality for patients with HNC are multifactorial, disparities in both access to care and timely cancer care are major drivers for poor outcomes.8,11-15 While the calls to view healthcare delivery as science that informs national improvement priorities are not new,16 the disruptive forces of the COVID-19 pandemic regarding crisis standards of care are unprecedented. It is imperative that we consider how COVID-19-related changes to healthcare delivery exacerbate existing disparities in access to care and may worsen oncologic outcomes for patients with HNC. Many health care system changes attributable to COVID-19 will likely persist long after the pandemic has waned.17 We must explore strategies to mitigate disparities in care for HNC patients that have arisen from this “stress test” on our healthcare delivery system.