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DOI: 10.4103/ijmpo.ijmpo_134_20
Management of Head-and-Neck Cancer during COVID-19 Crisis: A Medical Oncology Perspective
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The ongoing COVID-19 pandemic is posing unique challenges to our health-care system. Oncology practices and protocols are adapting to the situation to help our patients. Head-and-neck squamous cell cancers are a huge burden in our country and need multidisciplinary care. This document shares some pragmatic ideas for medical oncologists on how to use systemic therapy for this disease in these challenging times.
The ongoing COVID-19 pandemic represents an unprecedented time in medicine and oncology in particular. Both current and former cancer patients are at a greater risk of being infected with COVID-19.[1],[2],[3] The rate of “severe events” (defined as admission to the intensive care unit, the need for ventilation, or death) among cancer patients infected with COVID-19 exceeds that of the noncancer patients.[1],[2],[3] The pandemic has added another layer of stress to cancer patients as there will be significant disruptions in their planned treatment protocols and consequent care, and things won't be normalized for quite sometime as per the statistical prediction of this pandemic.
In this “new normal” situation, health-care systems are being stretched to the maximum and the resources are being marshaled to provide good care to everyone, even though the care may look different than the conventional standards. Every specialty is thinking out of the box with innovative strategies adapted to the resource constraints and abiding by the norms of lockdown and social distancing. Our medical oncology practice has also been required to modify its pattern of care and bend around the established standards of care, to provide solutions to our patients. In many cases, these may be desperate measures without enough evidence backing them.
This novel rational model of care is based on the following key principles: (1) Does the benefit of a particular chemotherapy cycle exceeds the risk of morbidity and mortality from COVID-19? (2) Can we decrease the patient's hospital visits for the next few weeks of lockdown? (3) Can we reduce the number of emergency visits for oncology patients, as the emergency services are saturated and they may be triaged out? In simple words: “Do not overburden the overstretched health-care system.”
Based on these basic principles, we have compiled some of our thoughts on how to manage chemotherapy in head-and-neck cancer patients in this unforeseen situation. These are neither guidelines nor consensus statements, rather our thoughts as a scientific association, to provide a helping framework for the oncology community to adapt to this unforeseen pandemic.
Head-and-neck cancers, especially squamous cell carcinoma (head-and-neck squamous cell carcinoma [HNSCC]), is the most common cancer among Indian males, accounting for 16.1% of cancer cases in them and accounted for 92,000 new cases in 2018.[4],[5] Worldwide, it is the 6th leading cause of cancer, with an annual incidence of 550,000 and death of 300,000 cases.[6] HNSCCs are highly aggressive malignancies with high recurrence rates among locally advanced cancers even after curative therapy.[7] Surgery plays a major role in oral cavity and tongue cancers, whereas concurrent chemoradiation is used for definitive therapy at most other sites. The role of chemotherapy is restricted to concurrent chemoradiotherapy (CTRT) in adjuvant/definitive settings and palliative chemotherapy for recurrent/metastatic settings.
Publication History
Received: 04 April 2020
Accepted: 19 April 2020
Article published online:
23 May 2021
© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
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