Head and Neck Cancer

Head and neck oncologists have had to face similar decisions, but head and neck cancer (HNC) presents unique challenges that are different from those posed by other cancers. With few exceptions, such as small basal cell cancers of the skin, well-differentiated thyroid cancer in young patients, low-grade salivary gland carcinomas, and low-grade sarcomas, most HNC is aggressive and life threatening. Cancer of the upper aerodigestive tract also has the potential to threaten essential functions such as breathing, eating, swallowing, speaking, and vision if allowed to progress to more advanced stages. We also know that delay in treatment for such cancers and advancing stage negatively impact the prognosis. To add to these challenges, patients with HNC are generally elderly and have significant comorbidity, which increases their risk of COVID-19-related death if they contract the infection. In addition, treatment for HNC itself, including surgery, radiation, and systemic therapy, may reduce the patient’s ability to combat a COVID-19 infection, and given the limited available data, the increased risk of COVID-19-related mortality in cancer patients is still not completely known. 8-12
Another major challenge in evaluating and treating patients with HNC is the added risk of potential transmission of COVID-19 virus to providers caring for such patients. The added risk stems from the high viral load that resides in the upper aerodigestive tract of infected subjects and its potential transmission from aerosol-generating procedures (AGPs) that are frequently needed in the evaluation and management of patients with HNC. Such procedures include upper aerodigestive endoscopy, intubation, tracheostomy and tracheostomy care, and surgery of the oral cavity, pharynx, larynx, and sinonasal region. Such procedures require added personal protective equipment (PPE) such as N95 masks or Powered, Air-Purifying Respirator (PAPR) for all health care providers to minimize the risk of being infected with COVID-19 while caring for patients with HNC. 13 The Center for Disease Control (CDC) 14 and the World Health Organization (WHO)15 advocated the use of added PPE such as N95 masks or PAPR while performing AGPs and recommended that, in times of shortages, these types of PPE should be prioritized for use during AGPs. Such strong recommendations were also emphasized by the American Academy of Otolaryngology, the American Head and Neck Society, the North American Skull Base Society, the American Rhinologic Society, and the American Society of Oromaxillofacial Surgery.