DIAGNOSIS
Fibreoptic and direct laryngoscopies should be avoided unless absolutely mandatory, to help protect healthcare workers from aerosol generated during procedure. Biopsies of benign lesions need to be avoided. FNACs from neck nodes should be preferred for obtaining diagnosis, in case of laryngeal/ hypopharyngeal primaries, where biopsies will entail some form of endoscopy.
TREATMENT
Surgery It should be taken in consideration with its likely outcomes, likelihood of curing the cancer, safety considerations and utilisation of infrastructure which may be required for management of COVID-19 related emergencies. All patients should be considered as asymptomatic carriers and adequate precautions to be taken prior to performing any surgical procedure like use of appropriate/best available PPE. Delay or postpone surgery in patients with low grade tumours. Avoid extensive surgery in patients with advanced age (>65 years) with co-morbidities, For reconstruction, avoid complex microvascular reconstructive surgery requiring long hours and use of local and regional flaps should be considered. Avoid performing surgeries that require elective tracheostomies. Avoid surgeries that require powered instrumentation (bone cutting instruments, saws, micromotors, drills etc.). Avoid surgeries on patients with low haemoglobin to avoid the use of blood and blood products. Radiotherapy Patients should be triaged and prioritized based on their diagnosis, prognosis and urgency for initiating treatment. Hypo-fractionation schedules have proven to be equivalent in many clinical scenarios in head and neck cancers and should be pursued where appropriate. Palliative radiotherapy treatment for symptomatic relief can be delivered in single fraction or weekly once regimens. CHEMOTHERAPY The decision to use concurrent therapies like chemotherapy/ targeted therapy should be taken judiciously on the expected benefit of the concurrent therapy to overall outcomes vis a vis the risk of the patient acquiring COVID-19 infection and succumbing to it.
FOLLOW UP
It is advised to minimise all follow up appointments. Defer follow up for patients with low risk of recurrence (e.g. 18-24 months post treatment). Prioritise patients in immediate post-treatment period and those with high risk for recurrence. Consider longer intervals between follow ups and consider tele-consultation for follow up where possible to triage follow up requirements