Head and Neck Cancer
Head and neck oncologists have had to face similar decisions, but head
and neck cancer (HNC) presents unique challenges that are different from
those posed by other cancers. With few exceptions, such as small basal
cell cancers of the skin, well-differentiated thyroid cancer in young
patients, low-grade salivary gland carcinomas, and low-grade sarcomas,
most HNC is aggressive and life threatening. Cancer of the upper
aerodigestive tract also has the potential to threaten essential
functions such as breathing, eating, swallowing, speaking, and vision if
allowed to progress to more advanced stages. We also know that delay in
treatment for such cancers and advancing stage negatively impact the
prognosis. To add to these challenges, patients with HNC are generally
elderly and have significant comorbidity, which increases their risk of
COVID-19-related death if they contract the infection. In addition,
treatment for HNC itself, including surgery, radiation, and systemic
therapy, may reduce the patient’s ability to combat a COVID-19
infection, and given the limited available data, the increased risk of
COVID-19-related mortality in cancer patients is still not completely
known. 8-12
Another major challenge in evaluating and treating patients with HNC is
the added risk of potential transmission of COVID-19 virus to providers
caring for such patients. The added risk stems from the high viral load
that resides in the upper aerodigestive tract of infected subjects and
its potential transmission from aerosol-generating procedures (AGPs)
that are frequently needed in the evaluation and management of patients
with HNC. Such procedures include upper aerodigestive endoscopy,
intubation, tracheostomy and tracheostomy care, and surgery of the oral
cavity, pharynx, larynx, and sinonasal region. Such procedures require
added personal protective equipment (PPE) such as N95 masks or Powered,
Air-Purifying Respirator (PAPR) for all health care providers to
minimize the risk of being infected with COVID-19 while caring for
patients with HNC. 13 The Center for Disease Control
(CDC) 14 and the World Health Organization (WHO)15 advocated the use of added PPE such as N95 masks or
PAPR while performing AGPs and recommended that, in times of shortages,
these types of PPE should be prioritized for use during AGPs. Such
strong recommendations were also emphasized by the American Academy of
Otolaryngology, the American Head and Neck Society, the North American
Skull Base Society, the American Rhinologic Society, and the American
Society of Oromaxillofacial Surgery.