Head and Neck Oncology
At tertiary referral centers, many head and neck cancer patients have traditionally traveled far distances for oncologic care. In the setting of the COVID-19 pandemic, concerns exist for exposing patients to COVID-19. Retroactive to January 27, 2020, the federal government has approved unprecedented steps to expand telemedicine services under Medicare and Medicaid with HIPAA flexibilities.33 This provides the ability to discuss pathology results and radiographic imaging findings with patients without direct patient contact, as well as continue important longitudinal cancer care. The more difficult decisions include delay of treatment for patients who are currently undergoing or starting chemoradiation. For solid tumor patients, adjuvant therapy with curative intent should proceed, despite the threat of COVID-19 infection during treatment.34 As outlined in the CMS Adult Elective Surgery and Procedures Recommendations, cancer surgery is categorized as a Tier 3a procedure and should not be postponed.15 Although oncologic procedures may continue as scheduled with preoperative COVID-19 diagnostic testing and quarantine, operative intervention requires prioritization; for example, definitive radiation therapy for a T1/T2 laryngeal carcinoma instead of a high-risk microscopic laryngeal resection using CO2/KTP laser may be appropriate for some patients during the COVID-19 pandemic. Additional consideration may be given to patients undergoing resections requiring microvascular reconstruction due to anticipated postoperative hospitalization and use of hospital resources. Continued multidisciplinary discussions regarding all head and neck oncologic patients are essential. Similar to other otolaryngology procedures in suspected or confirmed patients with COVID-19, enhanced PPE should be used at all times as discussed above.