Head and Neck Oncology
At tertiary referral centers, many head and neck cancer patients have
traditionally traveled far distances for oncologic care. In the setting
of the COVID-19 pandemic, concerns exist for exposing patients to
COVID-19. Retroactive to January 27, 2020, the federal government has
approved unprecedented steps to expand telemedicine services under
Medicare and Medicaid with HIPAA flexibilities.33 This
provides the ability to discuss pathology results and radiographic
imaging findings with patients without direct patient contact, as well
as continue important longitudinal cancer care. The more difficult
decisions include delay of treatment for patients who are currently
undergoing or starting chemoradiation. For solid tumor patients,
adjuvant therapy with curative intent should proceed, despite the threat
of COVID-19 infection during treatment.34 As outlined
in the CMS Adult Elective Surgery and Procedures Recommendations, cancer
surgery is categorized as a Tier 3a procedure and should not be
postponed.15 Although oncologic procedures may
continue as scheduled with preoperative COVID-19 diagnostic testing and
quarantine, operative intervention requires prioritization; for example,
definitive radiation therapy for a T1/T2 laryngeal carcinoma instead of
a high-risk microscopic laryngeal resection using CO2/KTP laser may be
appropriate for some patients during the COVID-19 pandemic. Additional
consideration may be given to patients undergoing resections requiring
microvascular reconstruction due to anticipated postoperative
hospitalization and use of hospital resources. Continued
multidisciplinary discussions regarding all head and neck oncologic
patients are essential. Similar to other otolaryngology procedures in
suspected or confirmed patients with COVID-19, enhanced PPE should be
used at all times as discussed above.