Year : 2021 | Volume
: 9 | Issue : 2 | Page : 67--68
Head and neck oncology practise in the post-COVID era
Prathamesh S Pai
Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
Dr. Prathamesh S Pai
Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai - 400 012, Maharashtra
|How to cite this article:|
Pai PS. Head and neck oncology practise in the post-COVID era.J Head Neck Physicians Surg 2021;9:67-68
|How to cite this URL:|
Pai PS. Head and neck oncology practise in the post-COVID era. J Head Neck Physicians Surg [serial online] 2021 [cited 2022 Jan 20 ];9:67-68
Available from: https://www.jhnps.org/text.asp?2021/9/2/67/332730
Innovations in education, practice, novel diagnostics, and therapeutics!
COVID pandemic has changed our lives in many more ways than one can imagine. Whilst it wreaked havoc on unsuspecting people, it may have been in some discordant way, beneficial in highlighting the gaps in our health-care systems. The pandemic forced us to rethink and move out of our comfort zone.
The pandemic highlighted the lacunae in our systems, putting the physicians and the patients at risk during the delivery of care. Head and Neck cancer patients require examination of the oral and nasal cavity putting the treating team at risk to exposure to several pathogens. COVID has forced us to take adequate steps to protect ourselves. Many high-risk procedures such as oral examination done with regular masks are now done with face shields using flexible laryngoscopes. The sterilization of instruments which was done grudgingly is now enforced strictly as per protocol. We were rudely awakened from our slumber.
COVID brought a grinding halt to travel. New cancer case diagnosis reduced as the patients could not travel. The average delay in diagnosis increased from the average of 6 months. Those with symptoms were the most affected. Telemedicine started off and has become more refined since then. With teleconsultation, those with obvious signs and symptoms could be flagged off for physical consults.
When there is a concern of cancer, patients immediately seek treatment in tier-1 cities. With travel restrictions, the patients were forced to seek treatments in their vicinity. People came to know about the locally available health-care resources. There is a need for increasing public awareness of the availability of specialized, accredited treatment facilities across the country.
Patients on long-term follow-up were counseled for delaying their visits. This brought back to focus on the follow-up strategy, from active surveillance to reactive check-up. Cost-effectiveness of follow-up examinations and routine investigations such as chest X-rays to detect a recurrence is questionable and its resulting impact on overall survival is not known. Rarely would we pick up a recurrence on follow-up which is not symptomatic and a chest X-ray misses about 25% of cancer lesions. Hence, if the patients are reliable for follow up then counseling for recurrence detection may make better sense in terms of cost and clinical man-hours.
The much-touted telemedicine serves little in the arena of head and neck cancers requiring detailed examination and endoscopy for diagnosis. We realized that the teleconsults were more to assuage the patient's desire for physician contact and to prompt a personal visit for obvious cancer-related symptoms.
Multidisciplinary team meetings remained more important than ever. The virtual environment appears to be more conducive for all consultants to join in and ensure that the patient gets a balanced treatment plan. COVID further enhanced the need to triage outpatients into those with the immediate need for treatment and those that could wait. This information should be used for optimizing allocation in our resource-constrained centers.
COVID was a scare but no more than cancer. Cancer required to be treated. In head and neck cancers surgery is the cornerstone of treatment. It has to be done and we need to prevail on administrators to continue cancer care despite all odds in future such events. Proper guidelines, discipline in the hospital processes ensure the continuation of vital services.
COVID forced cancer physicians to plan for more definitive and curative options. Already available information was enforced in practice.
Radiotherapy to be initiated within 4–6 weeksHypofractionated regimens only if resources limited (fractions of 2.2-3 Gy)Concurrent chemoradiotherapy with more chances of cure preferred to limit overall treatment time and chemotherapy-related immunosuppressionOnly those with defined indications to receive concurrent CTRTHigh-dose 3 weekly cisplatin preferred to low-dose weekly cisplatin to reduce medical visitsConsider omitting concomitant chemotherapy only in case of extreme shortness of resourcesConsider replacing weekly on-site patient reviews with video or telephone consultationOral metronomic chemotherapy got a fillip when travel was restricted and patients could not get surgical appointments.
Teleradiology came into its own with more radiologists adapting and reporting from home. This reduces the turnaround time for reports. The mobile screens with their full HD resolution offer more than 2MP resolution which is adequate for viewing computed tomography scans and magnetic resonance imaging scans. The high-speed Internet networks provide comfortable viewing of these images. Telepathology is the newest kid on the block giving pathologists the ability to report remotely. This was used effectively during the pandemic. Going ahead getting expert opinions from tertiary centers will be easier, economical, and faster.
Information and education saw a tsunami. Zoom, Google meet, and other video conferencing technologies led to a paradigm shift in education and dissemination of information. During COVID, for 2 years the students received online lectures of high quality delivered to them at almost no cost. The entrance and exit examinations adapted to remote conduct and have now become better and more convenient. Global leaders could be accessed without worries of time, travel, stay, and costs. Conferences could be conducted at one-tenth the cost. In the new normal we will see a hybrid way which will transform the way we do things in future.
In the post-COVID era then, what should we adopt for the greater good?
Disseminate information of specialized, accredited treatment facilities across the countryRethink our treatment policies to suit our resource constraintsRedefine follow up policies, reducing the financial burden and improving outcomesAdopt IT to increase turnaround time for radiology, pathology.Use Teleconsultation for patient counseling, palliation, and end of life careImprove the delivery of education material and conduct of meetings.
COVID has come in as a great equalizer. There is more democratization of information and that is here to stay. Humans since eternity have used every adversity to progress with more resolve and vigor. Post-COVID we will emerge stronger than ever in our quest to treat head and neck cancer.
This material has never been published and is not currently under evaluation in any other peer-reviewed publication.
Not applicable as this an editorial article with no patients involved.
Not applicable as this is an editorial article with no patients involved.
|1||Shrikhande SV, Pai PS, Bhandare MS, Bakshi G, Chaukar DA, Chaturvedi P, et al. Outcomes of elective major cancer surgery during COVID 19 at Tata memorial centre: Implications for cancer care policy. Ann Surg 2020;272:e249-52.|
|2||Thomson DJ, Palma D, Guckenberger M, Balermpas P, Beitler JJ, Blanchard P, et al. Practice recommendations for risk-adapted head and neck cancer radiation therapy during the COVID-19 pandemic: An ASTRO-ESTRO consensus statement. Int J Radiat Oncol Biol Phys 2020;107:618-27.|
|3||Rao V, Kumar R, Rajaganesan S, Rane S, Deshpande G, Yadav S, et al. Remote reporting from home for primary diagnosis in surgical pathology: A tertiary oncology center experience during the COVID-19 pandemic. J Pathol Inform 2021;12:3.|