Time to Surgery and Survival in Head and Neck Cancer

Excerpt

The coronavirus 2019 (COVID-19) pandemic has brought the question of timeliness in the treatment of cancer patients to the forefront of many clinicians’ minds. The need to conserve hospital resources during the pandemic has resulted in delays in many aspects of healthcare. As operating rooms utilize immense resources, there have been greater delays in surgical procedures. The treatment of head and neck cancer during the COVID-19 era has posed a particular challenge as, in addition to resource allocation concerns, there is a high risk of aerosolization during surgical procedures of the aerodigestive tract.1 Furthermore, initial reports from China suggested that cancer patients were at increased risk of morbidity and mortality secondary to COVID-19, citing that these patients were more likely to require ventilators (a precious resource during the peak of the pandemic).2,3 These challenges led to heightened concern about delay in the treatment of head and neck cancer and resulted in publication of consensus guidelines for triaging treatment of these patients.4,5 These guidelines sought to balance use of resources with risk of disease progression and recommended for close observation of early-stage disease, while later-stage cases required in-depth evaluation due to not only the risk of progression but also the risk of utilizing significant resources such as intensive care unit (ICU) beds and blood products. Under resource restrictions, policies for acceptable surgical delays in the treatment of head and neck cancers were developed based on consensus expert opinion and limited retrospective data on the impact of total treatment package delays, which were then extrapolated to establish guidelines on appropriate surgical delays. Acceptable delays ranged from 4 to 8 weeks based on tumor stage and subsite, with recommendations to consider alternate modalities of treatment should surgical delays beyond these guidelines be anticipated.6 The timely work published here in Annals of Surgical Oncology by Rygalski et al.7 examines the impact of surgical delays distinct from generalized treatment delays, addressing an important knowledge gap that will help guide future clinical practice and improve care for head and neck cancer patients. …