Physical Examination
On March 23, 2020, Pennsylvania’s governor issues his first stay at home
order, which included the county where UPMC’s flagship hospital and
cancer center are located. Stay at home orders are meant to flatten the
pandemic curve, and for many cancer survivors, monitoring via
telemedicine is feasible. However, for many patients, physical
examination and, possibly, flexible laryngoscopy may be needed. When a
biopsy is required, a gown, eye protection, and N95 mask are used. Many
of our newly diagnosed HNC patients will need to be discussed in a
multidisciplinary conference. To conduct treatment discussions and
planning, we have transitioned to a virtual multidisciplinary
conference.10
When symptom burden is impacting health, we have selectively invited
patients to the HNC Survivorship Clinic for face to face evaluation and
coordination of care. Symptoms most likely to result in a recommendation
for a face to face visit are increasing pain or deterioration in
function. Face masks, eye protection, and gloves are routinely employed.
We continue to use functional endoscopic evaluation of swallowing (FEES)
selectively employing personal protective equipment. We have been able
to continue to have patients provided physical therapy at establishments
local to them, and we have provided swallowing therapy using a televideo
technology.