Triaging New Referrals
Ontario has one of the most mature and regionalized head and neck cancer programs in the world, with all care being provided at one of seven designated cancer centres20-23. To meet the needs of this pandemic, both Wuhan and Toronto initiated a centralized system within their regionalized cancer centres for the intake of new referrals. For example, all new referrals to Sunnybrook Health Sciences Odette Cancer Centre in Toronto are now first virtually reviewed by a team consisting of medical, radiation, and surgical oncologists. Together, the determination is made in regard to any additional testing required prior to patient consultation. If at all possible, patients are seen virtually via the Ontario Telehealth Network (OTN), which allows for two or three-way audio with video support, allowing family members to be present, even if not physically with the patient. This is particularly important within our elderly population, minimizing social contacts, while maintaining physical distancing. The virtual interaction through OTN is particularly useful if the physical examination will not change the next steps in management (i.e. pathology review, discussion of treatment options, or where the need for additional imaging and testing remains). This step allows for the collection of information from patients, while reducing the risk of exposure with face-to-face consultations, and has been shown to be an effective avenue for patient care24. In circumstances that necessitates in person consultation, such as the need for biopsy, patients are seen in person.
Multidisciplinary care is a staple in the effective management of head and neck cancer patients. All patients continue to be discussed weekly through case conferences where staff discuss remotely. Where alterations to the standard of care are necessary based on healthcare constraints, there is increased discussions within the multidisciplinary care team to determine best treatment course, and full disclosures with the patients are provided. In Toronto, multidisciplinary clinics remain active with all essential multidisciplinary allied healthcare professionals present, including speech-language pathology, social work, physiotherapy, dietetics and nutrition services, and all-relevant oncology specialties. We have successfully incorporated our multidisciplinary team in OTN consultations and in-person follow-up are offered under necessary circumstances as outlined above.
As surgical waitlists grow in the face of reduced operating room resources, formalized systems for reviewing patients are necessary to create a dynamic list that is able to accommodate changing disease progression and patient needs. For example, a centralized list is being used at Sunnybrook Health Sciences Centre to contact and monitor patients on a regular basis, while providing them with ongoing reassurance.