Introduction
The COVID-19 pandemic has created unprecedented new challenges for the
healthcare system, including a unique set of challenges for patients
with head and neck cancer. While multiple prior studies have outlined
indications and risk-mitigation strategies for tracheotomy in patients
with COVID-19, there remains no clear consensus for inpatient and
outpatient management of head and neck cancer patients with tracheostomy
and/or total laryngectomy (TL) during the
pandemic.[1-3] Given the highly contagious nature
of the virus from respiratory droplets and
aerosolization,[4] patients with tracheostomy and
TL have a particularly high risk of transmission to others and merit
special attention in terms of strategies to minimize viral spread.
While elective surgery across the United States has come to a halt,
urgent and emergent tracheostomy and total laryngectomy continue for
patients with head and neck cancer.[5] Unlike in
traditional acute respiratory distress syndrome (ARDS) patients,
practices emerging from China where the pandemic began suggest that
long-term intubation alone should not be a justification for
tracheostomy in SARS-CoV-2 positive patients.[6]However, there are tens of thousands of head and neck cancer patients
with long-standing tracheostomy and TL who continue to require medical
care both in the inpatient and outpatient
contexts.[7] This commentary compiles best
available evidence to provide recommendations aimed at minimizing
transmission of COVID-19 when caring for head and neck cancer patients
with tracheostomies and TL. Policies are bound to vary by institution
and specific patient requirements and available resources. Global
transparent communication may help to reduce risk to health-care workers
and improve outcomes for individual patients and societies facing this
unprecedented pandemic.