Discussion/Conclusion
The Institute of Medicine has established the goals of quality-based healthcare: safe, effective, patient-centered, timely, efficient and equitable for all patients20. In our head and neck program, we strive to provide patients with highly coordinated and efficient care. However, the current pandemic has significantly impacted our ability to meet these goals for care delivery. An urgent effort was needed to mitigate the impact of the pandemic on patient care requiring an assessment of our available resources in the context of this widespread communicable disease.
Using these guidelines has led to a significant shift in the management of head and neck cancer patients at our institution21. Advanced oral cavity lesions requiring a mandibulectomy and/or maxillectomy currently represent the majority of head and neck surgical cases. More in depth analyses on the overall effect of the COVID-19 pandemic on surgical volume, case deferral, and use of alternative therapeutic options are being described in the literature21,22 and are beyond the scope and purpose of this current report. These recommendations are intended to provide a concise set of guidelines for the practicing head and neck clinician during a healthcare crisis, such as the COVID-19 pandemic, and may serve as a foundation to be modified in the event of future pandemics. Furthermore, these guidelines should be used in the context of individual institutional priorities, healthcare personnel safety, pandemic intensity, and availability of resources. Lastly, we continue to advocate for consideration of individual cases in a multidisciplinary fashion based on patient circumstances, and risk of disease progression.