Delay in head and neck cancer care during the COVID-19 pandemic and its impact on health outcomes.

Claudiane Mahl,Paula Santos Nunes,Luís Ricardo Santos De Melo,Paulo Ricardo Martins-Filho,Maria Helena Andrade Almeida,Lois Lene Silva Santos,Victor Santana Santos,Adriano Antunes De Souza Araújo,Catarina Sampaio Carvalho,Lucindo José Quintans-Júnior

doi:10.1590/1807-3107bor-2020.vol34.0126

Claudiane Mahl, Paula Santos Nunes + Show 8 more

Open Access

https://doi.org/10.1590/1807-3107bor-2020.vol34.0126

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Abstract

The coronavirus disease 2019 (COVID-19) outbreak has created unprecedent challenges for healthcare systems worldwide. Oncology services have been reorganized to decrease the risk of nosocomial acquisition of SARS-CoV-2, but changes in treatment pathways and follow-up cancer care can result in patients receiving suboptimal or delayed care. Herein, we describe a cross-sectional nested cohort study conducted to evaluate delays in care for patients with head and neck cancer (HNC) in post-treatment follow-up or palliative care during the COVID-19 pandemic in Northeast Brazil and its impact on health outcomes. Information was extracted from medical records and supplemented by telephone interviews. We compared the following health outcomes: self-perception of anxiety or sadness, fear of COVID-19 infection, cancer-related complications during social isolation, self-medication, diagnosis of COVID-19, and death between patients with and without delayed cancer care. The Mann-Whitney U test was used to compare distributions of continuous variables and the Fisher exact test was used for categorical variables. Thirty-one HNC patients were included in the study, and no case of confirmed SARS-CoV-2 was found. Delayed cancer care due to restriction in health services was reported in 58.1% of cases, and there was no report of telemedicine use during the COVID-19 outbreak. Cancer-related complications during the COVID-19 pandemic were described for most patients (67.7%) and included pain or discomfort, swelling, and dyspnea. Eight (25.8%) patients reported use of prescribed morphine or codeine to manage pain and six (19.4%) patients reported self-medication with over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs). We found an association between delayed HNC care and the use of self-medication (p = 0.028). This study indicated that patients with delayed HNC care during the COVID-19 outbreak are more likely to use self-medication with NSAIDs for pain management. Better strategies to follow HNC patients in socioeconomically disadvantaged communities need to be discussed and implemented.

Highlights

The coronavirus disease 2019 (COVID-19) pandemic has created new challenges for healthcare systems worldwide
During the COVID-19 pandemic, studies have discussed the management of routine cancer follow-up, especially among patients with head and neck cancer (HNC), due to the risk of the spread of SARS-CoV-2 during the daily trips to the hospital for radiation therapy and the increased susceptibility to infection associated with chemotherapy-induced immunosuppression.[2]
We evaluated the delay in care for HNC patients in post-treatment follow-up or palliative care during the COVID-19 pandemic in Sergipe state, Northeast Brazil, and its impact on health outcomes

Summary

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has created new challenges for healthcare systems worldwide. COVID-19 was first reported in Wuhan, China, in late December 2019 and rapidly spread worldwide resulting in unprecedented changes to clinical practice. These included the interruption of non-essential or elective in-hospital treatments, increasing the risk of potential adverse health complications.[1] During the COVID-19 pandemic, studies have discussed the management of routine cancer follow-up, especially among patients with head and neck cancer (HNC), due to the risk of the spread of SARS-CoV-2 during the daily trips to the hospital for radiation therapy and the increased susceptibility to infection associated with chemotherapy-induced immunosuppression.[2] most patients with HNC are older adults and may have other underlying medical conditions associated with morbidity and mortality for COVID-19.3. Recent studies have indicated that the continuation of in-hospital treatment for patients with HNC can be performed safely with the use of appropriate workflow, personal protective equipment (PPE), cleaning measures to sanitize patient exam and treatment rooms, and pre-operative screening for SARS-CoV-2 infection for those undergoing su rger y.2,4,5,6 Del iver i ng t i mely HNC ca re i s increasingly recognized as critical to achieving optimal oncologic outcomes and delayed treatment may increase the risk of disease progression and death for these patients.[7]

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