Introduction: The COVID-19 pandemic caused by the SARS-CoV-2 virus has altered the healthcare environment for the management of head and neck cancers.  The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits.Methods: Creation of consensus document.Results: The process yielded a consensus statement among a wide range of practitioners involved in the management of head and neck cancer patients in a multi-hospital tertiary care health system. Conclusions: These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature. 

Background: Management of head and neck cancers (HNC) in Radiation Oncology in the COVID-19 era is challenging. Aim of our work is to report organization strategies at a Radiation Therapy (RT) Department in the first European area experiencing the COVID-19 pandemic. Methods: We focused on 1) dedicated procedures for HNC, 2) radiation treatment scheduling and 3) healthcare professionals’ protection applied during the Covid-19 breakdown (from 1st March to 30th April 2020). Results: Applied procedures are reported and discussed. Forty-three pts were treated. Image-guided, Intensity Modulated RT was performed in all cases. Median overall treatment time (OTT) was 50 (IQR: 47-54.25) days. RT was interrupted/delayed in seven pts (16%) for suspected COVID-19 infection. Two health professionals managing HNC pts were proven as COVID-19 positive. Conclusion: Adequate and well-timed organization allowed for the optimization of HNC pts balancing at the best of our possibilities pts’ care and personnel’s safety.

The COVID-19 pandemic has had a significant impact on many aspects of head and neck cancer care.  The uncertainty and stress resulting from these changes has led many patients and caregivers to turn to head and neck cancer advocacy groups for guidance and support.  Here we outline some of the issues being faced by head and neck cancer patients during the current crisis and provide examples of programs being developed by advocacy groups to address them.  We also highlight the increased utilization of these organizations that has been observed as well as some of the challenges being faced by these not-for-profit groups as they work to serve the head and neck community. 

Judy Overton, BFA, MLAProgram Manager, Office of Patient Experience OfficerThe University of Texas M.D. Anderson Cancer CenterT. Boone Pickens Academic Tower1400 Pressler StHouston, Texas 77030 Kathy Denton, BS, MED, PhDThe University of Texas M.D. Anderson Cancer Center,Director, Patient ExperienceThe University of Texas M.D. Anderson Cancer CenterT. Boone Pickens Academic Tower1400 Pressler StHouston, Texas 77030 Michael Frumovitz, MD, MPHGynecologic Oncology and Reconstructive MedicineThe University of Texas M.D. Anderson Cancer CenterDan L. Duncan Building1155 Pressler StHouston, Texas 77030 Carol Lewis, MD Department of Head and Neck SurgeryThe University of Texas M.D. Anderson Cancer CenterT. Boone Pickens Academic Tower1400 Pressler StHouston, Texas 77030 Sarah Christensen, MADirector, Patient EducationThe University of Texas M.D. Anderson Cancer CenterDan L. Duncan Building1155 Pressler StHouston, Texas 77030 Jaymesson Bezerra, MSHAManager, Patient RelationsThe University of Texas M.D. Anderson Cancer CenterRotary House International 1600 Holcombe BlvdHouston, Texas 77030 Chris HernandezExec. Director, Patient Services, Patient AdvocacyThe University of Texas M.D. Anderson Cancer CenterAnderson West1515 Holcombe BlvdHouston, Texas 77030 Michele S. WalkerAssoc. Dir, Pt Advo & Pt Rel, Patient AdvocacyThe University of Texas M.D. Anderson Cancer CenterAnderson West1515 Holcombe BlvdHouston, Texas 77030 Janice P. Finder, BSN, MSN, RNDirrector, Patient Exp Clin Services, askMDAndersonThe University of Texas M.D. Anderson Cancer CenterMid Campus Building 1MC7007 Bertner AvenueHouston, Texas 77054 Ashlyn A. Proske, BSProgram Manager, askMDAndersonThe University of Texas M.D. Anderson Cancer CenterMid Campus Building 1MC7007 Bertner AvenueHouston, Texas 77054 Sanchita Jain, MBAInnovation Strategist, InnovationThe University of Texas M.D. Anderson Cancer CenterMid Campus Building 1MC7007 Bertner AvenueHouston, Texas 77054 Julai Whipple, BAInnovation Designer, InnovationThe University of Texas M.D. Anderson Cancer CenterMid Campus Building 1MC7007 Bertner AvenueHouston, Texas 77054 Wendi L. Martinez, ADN, BSN, RNDir QA & Perf Improvement, Inst Cancer Care InnovationThe University of Texas M.D. Anderson Cancer CenterMid Campus Building 1MC7007 Bertner AvenueHouston, Texas 77054 Jarod EskaInst Cancer Care InnovationThe University of Texas M.D. Anderson Cancer CenterMid Campus Building 1MC7007 Bertner AvenueHouston, Texas 77054 Elizabeth W. Sutherland, MPASPhysician Asst, Surgical OncologyThe University of Texas M.D. Anderson Cancer CenterT. Boone Pickens Academic Tower1400 Pressler St.Houston, Texas 77030 Lisa L. Triche, DNP, MS, RNAdvanced Prac Registered Nurse, Pediatrics - Patient CareThe University of Texas M.D. Anderson Cancer CenterAnderson East1515 Holcombe BlvdHouston, Texas 77054Elizabeth A. Garcia, BSN, MPA, RNAssoc VP, Patient Experience, Ofc of Chief Operating OfficerThe University of Texas M.D. Anderson Cancer Center1515 Holcombe BlvdUnit 1485Houston, Texas 77030Corresponding Author:Randal Weber, MD Chief Patient Experience Ofc, Chief Patient Experience OfficerThe University of Texas M.D. Anderson Cancer CenterT. Boone Pickens Academic Tower1400 Pressler StHouston, Texas 77030

The novel coronavirus disease 2019 (COVID-19) pandemic continues to have extensive effects on public health as it spreads rapidly across the globe. Head and neck cancer patients are a particularly susceptible population to these effects, and we expect there to be a potential surge in patients presenting with head and neck cancers after the surge in COVID-19. Furthermore, the impact of social distancing measures could result in a shift towards more advanced disease at presentation. With appropriate anticipation, multidisciplinary head and cancer teams could potentially minimize the impact of this surge and plan for strategies to provide optimal care for head and neck cancer patients.

IntroductionThe ongoing worldwide pandemic due to COVID-19 has forced drastic changes on the daily lives of the global population. This is most notable within the healthcare sector. The current paper outlines the response of the head and neck oncologic surgery (HNS) division within our academic otolaryngology department in the state of Alabama.MethodsData with regard to case numbers and types were obtained during the pandemic and compared with time matched data. Our overall approach to managing previously scheduled and new cases, personal protective equipment (PPE) utilization, outpatient clinic, and resident involvement is summarized.DiscussionOur HNS division saw a 55% reduction in surgical volume during the peak of the COVID-19 pandemic. We feel that an early and cohesive strategy to triaging surgical cases, PPE usage, and minimizing exposure of personnel is essential to providing care for HNS patients during this pandemic.

The SARS-CoV-2 pandemic has rapidly transformed healthcare delivery around the globe. Because of the heavy impact of COVID-19 spread, cancer treatments have necessarily been de-prioritized, thus exposing patients to increased risk of morbidity and mortality due to delayed care. In this scenario, cancer specialists need to assess critical oncology patients case by case to carefully balance risk versus benefit in treating tumors and preventing SARS-CoV-2 infection. Here we report early insights into how the management of patients with sinonasal and anterior skull base cancer might be affected by the COVID-19 pandemic. We provide recommendations for preoperative tests, indications for immediate care versus possible delayed treatment, warnings relating to dural resection and intracranial dissection given the potential neurotropism of SARS-CoV2 and practical suggestions for managing cancer care in a period of limited resources. We also postulate some thoughts on the promising role of telemedicine in multidisciplinary case discussions and post-treatment surveillance.

Introduction For the ENT surgeon there are many challenges that show-up in the clinical management of a patient affected by a Head and Neck cancer during COVID-19 pandemic, especially in the postoperative period. Methods During the acute COVID-19 emergency phase in Italy, we analysed the management of a patient affected by a Head and Neck cancer. We reported several clinical data about the hospitalization period, pointing out the difficulties encountered both from clinical and management point of view. Results During pandemic, we admitted 27 oncological patients at our ENT department. Delays in surgical procedures, complications of hospitalizations, need for radiological studies and possible transfer to other hospital ward, due to suspect Sars-CoV-2 infection, were registered. Conclusions The changes in the whole health care system during the COVID-19 pandemic have impacted the management of head and neck cancer patients, generating several clinical challenges for the ENT surgeon.

AIM: The COVID-19 pandemic has resulted in society experiencing unprecedented challenges for healthcare practitioners and facilities serving at the frontlines of this pandemic. With regards to oral cancer, there is a complete absence of literature regarding the long-term impact of pandemics on patients with oral potentially malignant disorders (OPMDs). The objective of this article is to put forth an institutional multidisciplinary approach for the evaluation and management of OPMDs. METHODS: A multidisciplinary approach was put formalized within our institution to risk stratify patients based on need for in-person assessment versus telehealth assessment during the COVID-19 pandemic. RESULTS: With judicious risk stratification of patients based on clinical features of their OPMD and with consideration of ongoing mitigation efforts and regional pandemic impact, providers are able to safely care for their patients.  CONCLUSIONS: The COVID-19 pandemic has required healthcare practitioners to make novel decisions that are new to us with development of creative pathways of care that focused on patient safety, mitigation efforts, and clinical management of disease processes. The care of patients with OPMDs requires special considerations especially as patients at high-risk for severe COVID-19 illness are also higher risk for the development of OPMDs.

Gupta, Anand1,#; Arora, Vipin2; Nair, Deepa3; Agrawal,Nishant4; Su, Yu-xiong5; Holsinger, Christopher F. 6; Chan, Jason7,#1  Department of Dentistry (Oral and Maxillofacial Surgery), Government Medical College & Hospital, Chandigarh, India. 2 Department of ENT and Head Neck Surgery, University College of Medical Sciences and GTB Hospital, Delhi, India.3 Department Head and Neck Surgical Oncology, Tata Memorial Centre, HBNI University, Mumbai, India.4 Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medicine, Chicago, IL, United States.5 Division of Oral and Maxillofacial Surgery, Faculty of Dentistry,The University of Hong Kong, Hong Kong SAR.6 Division of Head and Neck Surgery, Stanford University, Palo Alto, CA, USA.7 Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong.  Keywords: Strategies for management; head and neck cancer; COVID-19; pandemic; Indian Scenario.Disclosure: Nothing to disclose.Funding: No funding received. Corresponding Authors:Anand GuptaAssistant ProfessorDepartment of Dentistry (Oral and Maxillofacial Surgery), Government Medical College and Hospital (GMCH)Sector 32 B, Chandigarh, INDIA Pin code- 160030Telephone no. +91-9810720642E mail- [email protected] Jason YK ChanAssistant ProfessorDepartment of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong.Pin code-Telephone no. +85-235053288Email :[email protected]

Introduction: The COVID-19 pandemic has raised controversies regarding safe and effective care of head and neck cancer patients. It is unknown how much the pandemic has changed surgeon practice. Methods: A questionnaire was distributed to head and neck surgeons assessing opinions related to treatment and concerns for the safety of patients, self, family, and staff. Results: A total of 67 head and neck surgeons responded during the study period. Surgeons continued to recommend primary surgical treatment for oral cavity cancers. Respondents were more likely to consider non-surgical therapy for patients with early glottic cancers and HPV-mediated oropharynx cancer. Surgeons were least likely to be concerned for their own health and safety and had the greatest concern for their resident trainees. Conclusions: This study highlights differences in the willingness of head and neck surgeons to delay surgery or alter plans during times when hospital resources are scarce and risk is high.

BACKGROUNDCoronavirus has serially overtaken our metropolitan hospitals. At peak, patients with acute respiratory distress syndrome may outnumber mechanical ventilators. In our Miami hospital system COVID-19 cases have multiplied for 4 weeks and elective surgery has been suspended.METHODSAn otolaryngologic triage committee was created to appropriately allocate resources to patients. Hospital ethicists provided support. Our tumor conference screened patients for non-surgical options. Patients were tested twice for Sars-CoV-2 before performing urgent contaminated operations. N95 masks and protective equipment were conserved when possible. Patients with low-grade cancers were advised to delay surgery, and other difficult decisions were made.RESULTSHundreds of surgeries were cancelled. Sixty-five cases supervised over three weeks are tabulated. Physicians and patients expressed discomfort regarding perceived deviations from standards, but risk of Covid-19 exposure tempered these discussions.CONCLUSIONSWe describe the use of actively managed surgical triage to fairly balance our patient’s health with public health concerns.

As this ever-evolving pandemic lays itself, more of its impact is being understood. Until recently, most guidelines were reported to aid in managing and treating suspected or confirmed cases. Research institutions around the world are responding with a sense of confusion. Some are continuing routinely, especially those who are overseeing clinical trials that could offer life-saving therapies, particularly against the novel coronavirus. Since research must continue even in the face of a shutdown, we aim to collate the currently available recommendations from various organizations and provide guidance to head and neck researchers across the world during these trying times.

The 2019 novel coronavirus disease (COVID-19) pandemic has been spreading worldwide at an alarming rate. Healthcare workers have been confronted with the challenge of not only treating patients with the virus, but also managing the disruption of healthcare services caused by COVID-19. In anticipation of outbreak, clinic sessions and operation theatre lists have been actively cut back since February 2020 to reduce hospital admissions and clinic attendances. This has severely disrupted healthcare services, leading to accumulating clinic caseload and substantial delays for operations. The head and neck cancer service has been faced with the difficult task of managing the balance between infection risk to healthcare providers and the risk of disease progression from prolonged waiting times. We share our experience in Hong Kong on the mitigation of head and neck cancer service disruption through telehealth and multi-institution collaboration.

The global pandemic of 2019 Novel Coronavirus Disease (COVID-19) has tremendously altered routine medical service provision and imposed unprecedented challenges to the healthcare system. This impacts patients with dysphagia complications caused by head and neck cancers. As this pandemic of COVID-19 may last longer than SARS in 2003, a practical workflow for managing dysphagia is crucial to ensure a safe and efficient practice to patients and healthcare personnel. This document provides clinical practice guidelines based on available evidence to date to balance the risks of SARS-CoV-2 exposure with the risks associated with dysphagia. Critical considerations include reserving instrumental assessments for urgent cases only, optimizing the non-instrumental swallowing evaluation, appropriate use of PPE, and use of telehealth when appropriate. Despite significant limitations in clinical service provision during the pandemic of COVID-19, a safe and reasonable dysphagia care pathway can still be implemented with modifications of setup and application of newer technologies.

BackgroundThe coronavirus infection is rapidly spreading putting a strain on healthcare services across the globe. Oral cancer patients are susceptible often immunosuppressed due to the disease and/or the treatment received.MethodsWe performed a simulationof the currently available data using a multi state and hazards model to provide an objective model for counseling and decision making for healthcare workers.ResultsStage IV oral cancer patients that did not receive treatment had progression of disease and an increased mortality rate than patients that receive treatment but did not contract COVID-19. The patients that received treatment and got affected with COVID-19 had a far worse impact and higher mortality rate than all other groups.ConclusionIsolation and deferring treatment for stage IV oral cancer patients, so as to avoid hospital visits and contration of COVID-19, is an advisable strategy based on this model.

Background: Pulmonary complications and infections frequently affect patients with head and neck squamous cell carcinoma (HNSCC). Common characteristics can predispose these patients to the development of severe respiratory illness, which may be particularly relevant during the  2019 coronavirus disease (COVID-19) pandemic. Methods: A scoping review was performed to assess the impact of pulmonary comorbidities and adverse respiratory outcomes in HNSCC patients. Results: Advanced age, history of tobacco and alcohol abuse, and cardiopulmonary comorbidities are significant risk factors for the development of adverse respiratory outcomes. Treatment  toxicities from radiation or chemoradiation therapy significantly increase these risks.  Conclusion: Respiratory complications are a frequent cause of morbidity and mortality among HNSCC patients, and the COVID-19 pandemic may disproportionately affect this population.  Interventions designed to decrease smoking and alcohol use, improve oral hygiene, and aggressively manage medical comorbidities are important to the long-term management and health of these patients.  

The practices of head and neck surgical oncologists must evolve to meet the unprecedented needs placed on our healthcare system by the Coronavirus Disease 2019 (COVID-19) pandemic. Guidelines are emerging to help guide the provision of head and neck cancer care, though in practice, it can be challenging to operationalize such recommendations. Head and neck surgeons at Wuhan University faced significant challenges in providing care for their patients. Similar challenges were faced by the University of Toronto during the severe acute respiratory syndrome (SARS) pandemic in 2003. Herein, we outline our combined experience and key practical considerations for maintaining an oncology service in the midst of a pandemic.