Table 1: Challenges faced by head and neck oncologic practices in the wake of COVID-19 and associated recommendations Table 1: Challenges faced by head and neck oncologic practices in the wake of COVID-19 and associated recommendations
Prevention of Transmission Avoidance of unnecessary procedures and physical exams; Full PPE for all aerosolizing procedures.
Triaging New Patient Referrals Virtual multidisciplinary screening prior to patient assessment; Virtual case conference discussion; In-person consultations limited to instances where procedure/physical examination is essential.
Ongoing Care/Post Treatment Surveillance Virtual follow-up care whenever possible; In-person assessment by a small group of rotating providers.
Pre-Operative Screening Patient to self-isolate prior to surgery; In COVID-19 positive patient, surgery only in emergent cases; In COVID-19 unknown/negative patients, testing should be sought immediately prior to surgery.
Surgical Management In certain instances, treatment with primary (chemo)radiation over surgery may be preferred; Surgical management only in instances where worse oncologic outcome expected if delayed more than four weeks; Limiting operating room personnel to essential team members; Minimization of team member movement in and out of operating room during all surgical cases; Reconstructive options should be considered in the context of a pandemic setting and limited resources; Surgical team can consider staying immediately outside of operating room during intubation/extubation.