Type of treatment
Several groups developed recommendations on the management of patients
with head and neck cancer during the pandemic, including both general
recommendations as well as specific surgical and non-surgical
recommendations 16–20. Treatment of head and neck
cancer has been restricted around the world due to capacity limitations
and to the increased risk of infection for both staff and patients. In
our centre, the intensive care unit (ICU) had only limited restrictions,
therefore decision-making process for surgical treatment was not
influenced by any ICU-related restrictions. With regard to non-surgical
treatment, we observed some delays during the 12-month Covid-19 study
period related to inpatient coronavirus infections during the course of
radiotherapy, which perhaps explains why there were no significant
differences between the two periods in the proportion of patients
eligible for radical surgery (71% vs. 75.4%). Kiong and colleagues did
not observe any differences in surgical vs. non-surgical treatment,
although fewer patients were considered eligible for primary surgery
than in our study (47.3% vs. 73.2%).
We also assessed the type of treatment in two specific anatomic
locations (larynx and oropharynx), which were selected because
oncological outcomes for this two sites are similar regardless of the
treatment type in patients with early-stage disease21–25. We found no significant differences between
the pre-Covid and Covid periods in terms of the proportion of laryngeal
cancer patients treated surgically (80% vs. 74%, respectively), but we
did find a significant difference in early-stage oropharyngeal cancer
(47% vs. 86%), perhaps due to the use of minimally-invasive surgery
(mainly robotic surgery) in these patients, where the risk of
tracheostomy is low and the hospital stay is much shorter than in
radical radiotherapy.
Our data shows that a significantly higher proportion of patients
received palliative radiotherapy during the pandemic period (20.5% vs.
32.9%) and palliative care alone was indicated in a higher percentage
of patients (1.8% vs. 6.2%). Both of these findings are likely
directly related to the pandemic. Although disease severity (TNM
staging) did not differ in the two periods, the limited access to basic
medical care (with the consequent delays in diagnosis and treatment),
resulted in an increase in the number of patients ineligible for radical
treatment due to comorbidities and cancer-related malnutrition. Of the
21 patients in the Covid-19 period referred to best supportive care, six
were offered palliative radiotherapy but declined due to
pandemic-related fear. Given the importance of palliative care to ensure
adequate pain management and nutritional and respiratory support, we
believe that a symptom-based approach to these patients should be taken
during the pandemic. In this regard, Singh and colleagues published
recommendations on the management of palliative patients during the
pandemic, emphasizing the need for better access to drugs, greater use
of teleconsultation, and wider community support 26.