Oropharyngeal Cancer Early Outcomes and Challenges During the COVID-19 Pandemic

Abstract

Purpose/Objective(s)The COVID-19 pandemic triggered a national emergency which drastically affected the practice of medicine. Studies have already shown that delays in cancer screening/diagnosis/treatment have ensued, and some project this will translate into increased mortality. We aimed to evaluate if early oropharyngeal cancer (OPC) outcomes with radiation therapy (RT) were affected.Materials/MethodsOn 3/17/2020, in response to the crisis in New York City, telemedicine consultations were implemented at our institution and patients followed prospectively. The Covid cohort (COV) includes new patients through July 2020. They were compared to a contemporary pre-Covid (PC) historical cohort of new patients from November 2019 to 3/16/2020. We reviewed medical records and collected clinicopathologic factors for OPC patients treated with curative intent RT. The Kaplan-Meier method was used to estimate time-to-event outcomes.ResultsMedian follow-up was 8.6 [1.0-13.8] months for all (5.8 months COV, 10.1 months PC). Both cohorts encompassed ∼19 weeks, but half as many consults were seen during the pandemic (n = 38 COV, n = 78 PC). The COV cohort included: 74% telehealth, 92% definitive RT (no surgery), and 89% chemoRT. The PC cohort included: 0% telehealth, 88% definitive RT (no surgery), and 94% chemoRT. There was no difference in COV vs. PC median times from consultation to simulation (1.1 [0-6.4] weeks vs. 1.4 [0-10.6] weeks) or simulation to RT start (2.1 [1.3-4.9] weeks vs. 2.0 [1.1-9.9] weeks). There was no difference in 6 month outcomes between COV vs. PC cohorts: local control (100% vs. 100%, P = 0.70), regional control 100% vs. 100%, P = 0.70), distant control (95.2% vs. 97.2%, P = 0.91), cancer-specific survival (100% vs. 98.7%, P = 0.48). There was no difference in outcomes between telemedicine vs. in-person consults. There were numerically more patients with very advanced disease during the pandemic: T4 (13.2% COV vs. 7.7% PC) or N3/M1 (5.2% COV vs. 2.6% PC), but differences were not statistically significant due to limited numbers. More patients treated during the pandemic developed grade 3 dysphagia requiring feeding tubes (10.5% COV vs. 5.1% PC), not significant due to limited numbers. No patients diagnosed with COVID (1 before, 2 during, and 5 after RT) had recurrence at last follow-up.ConclusionThere was no difference in early 6 month outcomes between COV and PC cohorts, no difference in outcomes with telemedicine, and RT delivery was sustained at pre-pandemic timelines. Several important clinical trends were identified in the COV cohort: about half as many consultations were seen during the pandemic, patients appeared more likely to present with very advanced disease, and more patients required feeding tubes during treatment. These findings may have important post-pandemic healthcare delivery implications related to delays in diagnosis, threats to long-term outcomes, and increased supportive care needs.