Impact of COVID-19 on Head and Neck Cancer Advancement Measured by Increasing Numbers of Urgent Dyspnea Cases-What Could Be Improved in the Event of Subsequent Pandemics?

Wioletta Pietruszewska; Paweł Burduk; Oskar Rosiak; Paulina Podlawska; Bartosz Zakrzewski; Magda Barańska; Magdalena Kowalczyk; Jakub Piątkowski; Grzegorz Śmigielski; Paweł Solarz; Marta Staszak; Małgorzata Wierzbicka; Bogusław Mikaszewski

doi:10.3390/jcm11216385

Impact of COVID-19 on Head and Neck Cancer Advancement Measured by Increasing Numbers of Urgent Dyspnea Cases-What Could Be Improved in the Event of Subsequent Pandemics?

J Clin Med. 2022 Oct 28;11(21):6385. doi: 10.3390/jcm11216385.

Affiliations

¹ Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, 22 Kopcińskiego Str., 90-153 Lodz, Poland.
² Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 75 Ujejskiego, 85-168 Bydgoszcz, Poland.
³ Balance Disorder Unit, Department of Otolaryngology, Medical University of Lodz, 22 Kopcińskiego Str., 90-153 Lodz, Poland.
⁴ Department of Otolaryngology and Laryngological Oncology, University of Medical Sciences, 49 Przybyszewskiego Str., 60-357 Poznań, Poland.
⁵ Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego, 80-214 Gdańsk, Poland.
⁶ Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479 Poznan, Poland.

Abstract

The COVID-19 pandemic has altered all aspects of the healthcare system's organization and impacted patients with head and neck cancer (HNC) who have experienced delayed diagnosis and treatment. The pandemic resulted in the admission of patients with severe dyspnea and a need for tracheotomy due to extremely advanced HNC. This study's objective was to evaluate the clinical characteristics of two multi-center cohorts, "pre-COVID-19" and "COVID-19", of HNC patients admitted as emergencies for dyspnea. The therapeutic activity of HNC patients in four University Departments of Otolaryngology was studied over two time periods: September-February 2019/2020 and 2020/2021. A group of 136 HNC patients who underwent a tracheotomy in two-time cohorts, pre-COVID-19 (N = 59) and COVID-19 (N = 77), was analyzed. The mean tracheotomies incidence proportion was 1.82 (SD: 1.12) for the pre-COVID-19 and 3.79 (SD: 2.76) for COVID-19 period. A rise in the occurrence of emergency dyspnea was observed in the COVID-19 cohort, and the greatest increase was seen in the centers with the highest limitations on planned surgeries. In the pre-COVID-19 period, 66% of patients presented with symptoms for more than a month in comparison to 78% of patients in the COVID-19 period (p = 0.04). There was a higher incidence of laryngeal and laryngopharyngeal cancer in the COVID-19 period (63% vs. 75%, respectively). The number of tracheotomies performed under general anesthesia dropped in favor of local anesthesia during COVID-19 (64% vs. 56%, respectively) due to extremely advanced HNC. In the COVID-19 cohort, most patients received a telemedicine consultation (N = 55, 71%) in comparison to the pre-COVID-19 period (N = 14, 24%). Reorganization of the referral system, adjustment of treatment capacity for an increased number of HNC, and a reserve for more extensive resection and reconstruction surgeries should be made in the profile of otorhinolaryngological departments, ensuring future HNC treatment is not hampered in case of a new pandemic wave.

Keywords: COVID-19; dyspnea; head and neck cancer; telehealth; urgent tracheotomy.

Grants and funding

This research received no external funding.