Introduction
In 2006, the Institute of Medicine’s (IOM) report, From Cancer Patient to Cancer Survivor: Lost in Transition, called attention to the need for a structured approach to the care of cancer survivors.1 The need for surveillance for recurrent cancer, as well as prevention of second primaries, has always been essential. However, the report emphasized that cancer survivors experience a multitude of physical and psychosocial consequences stemming from both cancer and its treatment. The IOM report recommends healthcare providers utilize systematic, evidence-based approaches to the identification and management of these treatments.1 Based on a systematic review and consensus expert opinion, the American Cancer Society has provided healthcare providers with clinical practice guidelines for the care of head and neck cancer survivors. These guidelines address five key areas: 1) surveillance for recurrence, 2) screening for second primary cancers, 3) assessment and management of physical and psychosocial effects of cancer and treatment, 4) health promotion, and 5) care coordination.2 In addition to endorsing these clinical practice guidelines, the American Society of Clinical Oncology emphasized the importance of team-based, collaborative care to address the complex needs of HNC survivors.3 While models of survivorship care delivery vary greatly, the overall goal of these programs is to provide comprehensive and tailored follow-up care.4
To optimize the quality of care we provide our HNC survivors, UPMC opened a multidisciplinary, HNC-specific survivorship clinic in December 2016. To tailor care, every patient evaluated in this clinic is surveyed with validated patient-reported outcomes questionnaires (PROs), including the University of Washington Quality of Life. Based on the PROs and patient assessment, the visit is personalized to provide an evaluation of recurrence, prevention of second primaries, identification of treatment-effects, and, subsequently, coordination of care. Our initial report of 238 patients with cancer of the oral cavity, oropharynx, and laryngopharynx demonstrated that over half of patients reported at least three treatment‐related effects that impacted their daily life with in the last seven days.5 To date, we had over 1,100 HNC survivors in our clinic, and our observations regarding late and long-term treatment effects have remained consistent. Through our work, we have also highlighted how health literacy, financial toxicity, and other treatment-related effects can impact the quality of life in post-treatment patients.6-9
The onset of the 2019 novel coronavirus (COVID-19) pandemic has necessitated social distancing and wide-spread efforts to curb medical care, which could be reasonably postponed or delayed. Cancer care, including diagnosis, treatment, and management of side effects and toxicities, remains essential, and delays are not appropriate. However, the pandemic has challenged us to meet the needs of our patients in alternative methods in order to maintain safety and limit the spread of the virus. We have highlighted measures our team has taken to transform care for patients across the care trajectory during this unprecedented time.