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The COVID-19 pandemic caused unprecedented disruption of NHS services. This was compounded by patients’ reluctance to attend hospitals at that time. How this affected the presentation of patients with head and neck cancer is the subject of this study. Head and neck cancers have about five percent incidence rate amongst all cancers and there is the same percentage of mortality. Therefore, timely detection and management of head and neck cancer is of paramount importance. This is a retrospective study in which two cohorts of patients, one attending from June to October 2019 (pre-pandemic) was compared with those attending in the same months in 2020, the pandemic year. The points of interest were patient and cancer demographic data, staging of the cancer at the time of MDT, and duration of symptoms before the time these patients presented. The data were subjected to univariate and then multivariate analysis. In the 2020 (pandemic) cohort, laryngeal cancer was less common but there were more cases of oral cancer and cancer from unknown primary, the differences being statistically significant. Thirty eight percent of patients in the pandemic cohort presented with symptoms for longer than 12 weeks. Forty two percent of these patients presented with stage IV cancer. More patients required emergency care including tracheostomies, hospitalisation and palliative care. Telephonic consultation rate of 83-89%, compared with only 30-31% in the pre-pandemic year probably accounted for the delay in diagnosis. Considering head and neck tumours can double in size in three months and even one month’s delay can advance the TNM staging, thus reducing local control by 10%, timely and effective management of these cancers remains a matter of prime importance.

Advanced head and neck cancer following the coronavirus disease 2019 pandemic.
Flynn W, Maqsood R, Maseland T, et al.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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