The pattern of care in head-and-neck cancer: Comparison between before and during the COVID-19 pandemic

Abstract

Background: Coronavirus disease 2019 (COVID-19) has led to a redistribution of the medical resources. However, there are limited data on the treatment patterns in head-and-neck cancer during this pandemic. Therefore, this study was aimed at comparing the pattern of care in head-and-neck cancer before and during the pandemic.Methods: This was a retrospective study of patients visiting the adult medical head-and-neck cancer unit of our hospital, between February 01, 2020, and April 15, 2020. The patients were divided for analysis into three groups: pre-COVID (February 01, 2020–February 29, 2020), start-COVID (March 01, 2020–March 31, 2020), and established-COVID (April 01, 2020–April 15, 2020). The patient footfalls, baseline characteristics, and pattern of treatment during the three time periods were compared. A two-sided P = 0.05 was considered statistically significant.Results: The number of patients in the pre-COVID, start-COVID, and established-COVID time periods was 219, 281, and 57, respectively. The median number of footfalls per working day in the pre-COVID, start-COVID, and established-COVID time periods was 84 (interquartile range [IQR], 70.5–89), 47 (IQR, 41.25–57.75), and 24 (IQR, 22.5–28), respectively (P = 0.000). There was no difference in the tumor-related baseline characteristics. In patients receiving neoadjuvant chemotherapy, the proportion of patients receiving the three-drug regimen was lowest in the established-COVID period (29.3% vs. 35.9% vs. 7.7%, respectively; P = 0.000). There was no difference in the pattern of selection of concurrent radio-sensitizing agents (P = 0.779). In patients receiving palliative treatment, the proportion of those receiving oral metronomic chemotherapy was higher in the established-COVID period than that in the pre-COVID and start-COVID periods (47.4% vs. 34.3% vs. 69.2%, respectively; P = 0.192).Conclusion: The early trend suggests that the number of patients visiting the hospital has decreased during the COVID-19 pandemic. The treatment pattern during the pandemic may be different for palliative regimens and neoadjuvant chemotherapy regimens.