Marci Lee Nilsen, PhD, RN, CHPN, (Mlf981@pitt.edu) Assistant Professor, University of Pittsburgh, School of Nursing;
David Clump, MD, PhD (clumpda2@upmc.edu), Assistant Professor, University of Pittsburgh, School of Medicine; Mark Kubik, MD (kubik
mw2@upmc.edu), ), Assistant Professor, University of Pittsburgh, School of Medicine; Karen Losego, PT, DPT, CLT-LANA (
peltzkj@upmc.edu), University of Pittsburgh Medical Center; Alyssa Mrozek (
mrozekac@upmc.edu)
University of Pittsburgh Medical Center; Elizabeth Pawlowicz, DMD (
pawlowiczec2@upmc.edu), Assistant Professor, University of Pittsburgh, School of Dental Medicine; Debra Pickford, RN (
PickfordDM@upmc.edu) University of Pittsburgh Medical Center; Shaum Sridharan, MD (
sridharans2@upmc.edu), Assistant Professor, University of Pittsburgh, School of Medicine; Katie Traylor, DO (traylorks@upmc.edu), Assistant Professor, University of Pittsburgh, School of Medicine; Tamara Wasserman-Wincko, MS, CCC-SLP, (wassermantl@upmc.edu) Director of Speech-Language Pathology Division, University of Pittsburgh, School of Medicine; Kelly Young, SLP (
youngkh@upmc.edu) University of Pittsburgh Medical Center; Dan Zandberg, MD (
zandbergdp@upmc.edu), Associate Professor, University of Pittsburgh, School of Medicine; Jonas T. Johnson, MD (johnsonjt@upmc.edu), Professor,
University of Pittsburgh, School of Medicine
CORRESPONDING AUTHOR: Marci Lee Nilsen, PhD., RN, CHPN Assistant Professor Department of Acute and Tertiary Care – the University of Pittsburgh, School of Nursing 3500 Victoria Street, 318A Victoria Building, Pittsburgh, PA 15261 412-648-3027
Mlf981@pitt.edu KEYWORDS: Coronavirus; COVID-19; Cancer; Survivorship; Head and Neck; Treatment Effects
DISCLOSURE STATEMENT: The authors have no conflicts of interest to declare.
ACKNOWLEDGEMENTS: NONE
FUNDING: Beckwith Institute
Introduction
In 2006, the Institute of Medicine’s (IOM) report, From Cancer
Patient to Cancer Survivor: Lost in Transition, called attention to the
need for a structured approach to the care of cancer
survivors.1 The
need for surveillance for recurrent cancer, as well as prevention of
second primaries, has always been essential. However, the report
emphasized that cancer survivors experience a multitude of physical and
psychosocial consequences stemming from both cancer and its treatment.
The IOM report recommends healthcare providers utilize systematic,
evidence-based approaches to the identification and management of these
treatments.1 Based on a systematic review and
consensus expert opinion, the American Cancer Society has provided
healthcare providers with clinical practice guidelines for the care of
head and neck cancer survivors. These guidelines address five key areas:
1) surveillance for recurrence, 2) screening for second primary cancers,
3) assessment and management of physical and psychosocial effects of
cancer and treatment, 4) health promotion, and 5) care
coordination.2 In addition to endorsing these clinical
practice guidelines, the American Society of Clinical Oncology
emphasized the importance of team-based, collaborative care to address
the complex needs of HNC survivors.3 While models of
survivorship care delivery vary greatly, the overall goal of these
programs is to provide comprehensive and tailored follow-up
care.4
To optimize the quality of care we provide our HNC survivors, UPMC
opened a multidisciplinary, HNC-specific survivorship clinic in December
2016. To tailor care, every patient evaluated in this clinic is surveyed
with validated patient-reported outcomes questionnaires (PROs),
including the University of Washington Quality of Life. Based on the
PROs and patient assessment, the visit is personalized to provide an
evaluation of recurrence, prevention of second primaries, identification
of treatment-effects, and, subsequently, coordination of care. Our
initial report of 238 patients with cancer of the oral cavity,
oropharynx, and laryngopharynx demonstrated that over half of patients
reported at least three treatment‐related effects that impacted their
daily life with in the last seven days.5 To date, we
had over 1,100 HNC survivors in our clinic, and our observations
regarding late and long-term treatment effects have remained consistent.
Through our work, we have also highlighted how health literacy,
financial toxicity, and other treatment-related effects can impact the
quality of life in post-treatment patients.6-9
The onset of the 2019 novel coronavirus (COVID-19) pandemic has
necessitated social distancing and wide-spread efforts to curb medical
care, which could be reasonably postponed or delayed. Cancer care,
including diagnosis, treatment, and management of side effects and
toxicities, remains essential, and delays are not appropriate. However,
the pandemic has challenged us to meet the needs of our patients in
alternative methods in order to maintain safety and limit the spread of
the virus. We have highlighted measures our team has taken to transform
care for patients across the care trajectory during this unprecedented
time.