Diagnostic Patterns and Delays of Headand-Neck Cancer during Coronavirus Disease 2019 Pandemic: A Single-Center Cross-Sectional Study from South Italy
Since a national lockdown was introduced across Italy in early 2020 in response to coronavirus disease 2019 (COVID-19) pandemic, access to health-care services has been limited or suspended. In this cross-sectional study, we examined the delay in the diagnosis and treatment of newly diagnosed head-and-neck cancer (HNC) patients. A total of 59 sequential patients (30 females and 29 males, age 67±14) with HNC were examined between January and September 2020. The average diagnostic delay detected was 152.53 days±62.02 standard deviation (SD) (median 155, range 36–335). Specifically, the average delay between onset of symptoms and first consultation/start of diagnostic pathway (patient delay, D1) was 97.59 days±54.75 SD (median 98, range 13–212), whereas the time needed to reach a final diagnosis (professional delay, D2) was 54.93 days±46.64 SD (median 33, range 4–186). Forty-six patients underwent treatment (surgery, chemotherapy, and/or radiotherapy) within 18.65 days±13.6 SD (median 16, range 1–53) of receiving a diagnosis (treatment delay, D3). Although diagnostic (D1+D2) and treatment (D3) delays were similar for all disease stages and were in line with pre-pandemic data, majority of patients were diagnosed with advanced HNC. Awareness of patterns and delays of HNC diagnosis during COVID-19 pandemic may inform future decisions involving a restricted access to health care.
Bray F, Ferlay J, Soerjomataram I, et al., 2018, Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 68:394–424. DOI: 10.3322/caac.21492
Allegra A, Innao V, Pulvirenti N, et al., 2019, Antiresorptive Agents and Anti-angiogenesis Drugs in the Development of Osteonecrosis of the Jaw. Tohoku J Exp Med, 248:27–9.
DOI: 10.1620/tjem.248.27
Obwegeser HL, 2001, Mandibular Growth Anomalies in Acromegaly. In: Mandibular Growth Anomalies: Terminology Aetiology Diagnosis Treatment. Springer, Berlin Heidelberg, p339–46.
Schutte HW, Heutink F, Wellenstein DJ, et al., 2020, Impact of Time to Diagnosis and Treatment in Head and Neck Cancer: A systematic review. Otolaryngol Head Neck Surg, 162:446–57. DOI: 10.1177/0194599820906387
Gigliotti J, Madathil S, Makhoul N, 2019, Delays in Oral Cavity Cancer. Int J Oral Maxillofac Surg, 48:1131–7. DOI: 10.1016/j.ijom.2019.02.015
Guneri P, Epstein JB, 2014, Late Stage Diagnosis of Oral Cancer: Components and Possible Solutions. Oral Oncol, 50:1131–6. DOI: 10.1016/j.oraloncology.2014.09.005
Bogani G, Ditto A, Bosio S, et al., 2020, Cancer Patients Affected by COVID-19: Experience from Milan, Lombardy. Gynecol Oncol, 158:262–5.
Chiesa-Estomba CM, Lechien JR, Calvo-Henriquez C, et al., 2020, Systematic Review of International Guidelines for Tracheostomy in COVID-19 Patients. Oral Oncol, 108:104844. DOI: 10.1016/j.oraloncology.2020.104844
Lo Giudice R, 2020, The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) in Dentistry. Management of Biological Risk in Dental Practice. Int J Environ Res Public Health, 17:3067. DOI: 10.3390/ijerph17093067
Zakka K, Erridge S, Chidambaram S, et al., 2020, Electrocautery, Diathermy, and Surgical Energy Devices: Are Surgical Teams at Risk during the COVID-19 Pandemic? Ann Surg, 272:e257–62. DOI: 10.1097/SLA.0000000000004112
Jackson T, Deibert D, Wyatt G, et al., 2020, Classification of Aerosol-generating Procedures: A Rapid Systematic Review. BMJ Open Respir Res, 7:e000730. DOI: 10.1136/bmjresp-2020-000730
Smith LK, Pope C, Botha JL, 2005, Patients’ Help-seeking Experiences and Delay in Cancer Presentation: A Qualitative Synthesis. Lancet, 366:825–31. DOI: 10.1016/S0140-6736(05)67030-4
Macdonald S, Macleod U, Campbell NC, et al., 2006, Systematic Review of Factors Influencing Patient and Practitioner Delay in Diagnosis of Upper Gastrointestinal Cancer. Br J Cancer, 94:1272–80. DOI: 10.1038/sj.bjc.6603089
Panzarella V, Pizzo G, Calvino F, et al., 2014, Diagnostic Delay in Oral Squamous Cell Carcinoma: The Role of Cognitive and Psychological Variables. Int J Oral Sci, 6:39–45. DOI: 10.1038/ijos.2013.88
Wang T, Liu S, Joseph T, et al., 2020, Managing Bladder Cancer Care during the COVID-19 Pandemic Using a Team-based Approach. J Clin Med, 9:1574. DOI: 10.3390/jcm9051574
Del Vecchio Blanco G, Calabrese E, Biancone L, et al., 2020, The Impact of COVID-19 Pandemic in the Colorectal Cancer Prevention. Int J Colorectal Dis, 35:1951–4. DOI: 10.1007/s00384-020-03635-6
Ozturk CN, Kuruoglu D, Ozturk C, et al., 2020, Plastic Surgery and the COVID-19 Pandemic: A Review of Clinical Guidelines. Ann Plast Surg, 85:S155–60. DOI: 10.1097/SAP.0000000000002443
Ginsburg KB, Curtis GL, Timar RE, et al., 2020, Delayed Radical Prostatectomy is not Associated with Adverse Oncologic Outcomes: Implications for Men Experiencing Surgical Delay due to the COVID-19 Pandemic. J Urol, 204:720–5. DOI: 10.1097/JU.0000000000001089
Arduino PG, Conrotto D, Broccoletti R, 2020, The Outbreak of Novel Coronavirus Disease (COVID-19) Caused a Worrying Delay in the Diagnosis of Oral Cancer in North- West Italy: The Turin Metropolitan Area Experience. Oral Dis, 27:742–3. DOI: 10.1111/odi.13362
Topf MC, Shenson JA, Holsinger FC, et al., 2020, Framework for Prioritizing head and Neck Surgery during the COVID-19 Pandemic. Head Neck, 42:1159–67. DOI: 10.1002/hed.26184
Barca I, Cordaro R, Kallaverja E, et al., 2020, Management in Oral and Maxillofacial Surgery during the COVID-19 Pandemic: Our Experience. Br J Oral Maxillofac Surg, 58:687–91. DOI: 10.1016/j.bjoms.2020.04.025
Kowalski LP, Sanabria A, Ridge JA, et al., 2020, COVID-19 Pandemic: Effects and Evidence-based Recommendations for Otolaryngology and Head and Neck Surgery Practice. Head Neck, 42:1259–67. DOI: 10.1002/hed.26164
Brar S, Ofo E, Hyde N, et al., 2020, Outcomes of Elective Head and Neck Confirmed or Suspected Cancer Surgery during the COVID-19 Pandemic. Eur Arch Otorhinolaryngol, 278:1277–82. DOI: 10.1007/s00405-020-06194-2
Allevi F, Dionisio A, Baciliero U, et al., 2020, Impact of COVID-19 Epidemic on Maxillofacial Surgery in Italy. Br J Oral Maxillofac Surg, 58:692–7. DOI: 10.1016/j.bjoms.2020.04.035
Lee AK, Cho RH, Lau EH, et al., 2020, Mitigation of Head and Neck Cancer Service Disruption during COVID-19 in Hong Kong through Telehealth and Multi-institutional Collaboration. Head Neck, 42:1454–9. DOI: 10.1002/hed.26226
Forner D, Noel CW, Wu V, et al., 2020, Nonsurgical Management of Resectable Oral Cavity Cancer in the Wake of COVID-19: A Rapid Review and Meta-analysis. Oral Oncol, 109:104849. DOI: 10.1016/j.oraloncology.2020.104849
Civantos FJ, Leibowitz JM, Arnold DJ, et al., 2020, Ethical Surgical Triage of Patients with Head and Neck Cancer during the COVID-19 Pandemic. Head Neck, 42:1423–47. DOI: 10.1002/hed.26229
Butler D, Davies-Husband C, Dhanda J, et al., 2020, Head and Neck Oncological Ablation and Reconstruction in the COVID-19 Era our Experience to Date. Br J Oral Maxillofac Surg, 58:1008–13. DOI: 10.1016/j.bjoms.2020.06.011
Thomson DJ, Palma D, Guckenberger M, et al., 2020, Practice Recommendations for Risk-adapted Head and Neck Cancer Radiotherapy during the COVID-19 Pandemic: An ASTRO-ESTRO Consensus Statement. Radiother Oncol. 151:314–21. DOI: 10.1016/j.radonc.2020.04.019
Marella GL, Raschellà F, Solinas M, et al., 2018, The Diagnostic Delay of Oral Carcinoma. Ig Sanita Pubbl, 74:249–63.
Lucidi D, Valerini S, Federici G, et al., 2022, Head and Neck Cancer during Covid-19 Pandemic: Was there a Diagnostic Delay? Indian J Otolaryngol Head Neck Surg:1–7. DOI: 10.1007/s12070-021-03050-5
Polesel J, Furlan C, Birri S, et al., 2017, The Impact of Time to Treatment Initiation on Survival from Head and Neck Cancer in North-Eastern Italy. Oral Oncol, 67:175–82. DOI: 10.1016/j.oraloncology.2017.02.009
Signorelli C, Scognamiglio T, Odone A, 2020, COVID-19 in Italy: Impact of Containment Measures and Prevalence Estimates of Infection in the General Population. Acta Biomed, 91:175–9. DOI: 10.23750/abm.v91i3-S.9511
Lau H, Khosrawipour V, Kocbach P, et al., 2020, The Positive Impact of Lockdown in Wuhan on Containing the COVID-19 Outbreak in China. J Travel Med, 27:taaa037. DOI: 10.1093/jtm/taaa037
Tobias A, 2020, Evaluation of the Lockdowns for the SARS-CoV-2 Epidemic in Italy and Spain after one Month Follow up. Sci Total Environ, 725:138539. DOI: 10.1016/j.scitotenv.2020.138539
Moris D, Schizas D, 2020, Lockdown during COVID-19: The Greek Success. In Vivo, 34:1695–9. DOI: 10.21873/invivo.11963
Alfano V, Ercolano S, 2020, The Efficacy of Lockdown Against COVID-19: A Cross-Country Panel Analysis. Appl Health Econ Health Policy, 18:509–17. DOI: 10.1007/s40258-020-00596-3
Gallo O, Bruno C, Locatello LG, et al., 2021, The Impact of the COVID-19 Pandemic on the Quality of Life of Head and Neck Cancer Survivors. Support Care Cancer, 29:6297–304. DOI: 10.1007/s00520-021-06198-6
Singh A, Garg A, Mandlik D, et al., 2021, Assessing the Quality of Life of Head and Neck Healthcare Workers during the COVID-19 Pandemic-A Self-reported Global Cross-Sectional Questionnaire Study by the International Federation of Head and Neck Oncologic Societies. J Surg Oncol, 124:476–482. DOI: 10.1002/jso.26571