Abstract
ObjectivesThe aim of this study was to evaluate the differences in surgical capacity for head and neck cancer in the UK between the first wave (March‐June 2020) and the current wave (Jan‐Feb 2021) of the COVID‐19 pandemic.DesignREDcap online‐based survey of hospital capacity.SettingUK secondary and tertiary hospitals providing head and neck cancer surgery.ParticipantsOne representative per hospital was asked to report the capacity for head and neck cancer surgery in that institution.Main outcome measuresThe principal measures of interests were new patient referrals, capacity in outpatients, theatres and critical care; therapeutic compromises constituting delay to surgery, de‐escalated surgery and therapeutic migration to non‐surgical primary modality.ResultsData were returned from approximately 95% of UK hospitals with a head and neck cancer surgery specialist service. 50% of UK head and neck cancer patients requiring surgery have significantly compromised treatments during the second wave: 28% delayed, 10% have received radiotherapy‐based treatment instead of surgery, and 12% have received de‐escalated surgery. Surgical capacity has been more severely constrained in the second wave (58% of pre‐pandemic level) compared with the first wave (62%) despite the time to prepare.ConclusionsSome hospitals are overwhelmed by COVID‐19 and unable to offer essential cancer surgery, but all have neighbouring hospitals in their region retaining good (or even normal) capacity. It is noteworthy that very few patients have been appropriately redirected away from the hospitals most constrained by their burden of COVID‐19. The paucity of an effective central or regional strategic response to this evident mismatch between demand and surgical capacity is to the detriment of our head and neck cancer patients.
Highlights
Data were returned from approximately 95% of UK hospitals with a head and neck cancer surgery specialist service. 50% of UK head and neck cancer patients requiring surgery have significantly compromised treatments during the second wave: 28% delayed, 10% have received radiotherapy-b ased treatment instead of surgery, and 12% have received de-escalated surgery
30% of head and neck (HN) teams have had at least some access to other hospital sites to alleviate pressure from their “usual” hospital site, in only 11% has this required transfer of patient care for surgery to be performed by another team
These data show that surgical capacity to treat HN cancer has again been severely impacted during the second wave of COVID-19 during January and February 2021
Summary
For head and neck (HN) cancers treated by surgery in the first wave of the COVID-19 pandemic between March and June 2020, it was evident that surgical and critical care capacity was greatly reduced. The COVIDSurg collaborative established that pulmonary complications and mortality were unacceptably high in postoperative patients who contracted SARS-CoV-2 infection,[4] but data on the safety of HN surgery, even when complex and prolonged, proved comparatively reassuring. The reassuring data on safety in the first wave reinforce that with appropriate testing, PPE and cross-infection measures, HN cancer surgery should continue without fear of excess risk, even through a period of very high community COVID-19 incidence. The aim of this study was to evaluate the differences in surgical capacity for head and neck cancer in the UK between the first (March-June 2020) and the current (Jan-Feb 2021) COVID-19 pandemic waves. We report on efforts in strategic planning and mutual aid between hospitals
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