The Impact of COVID-19 on Diagnosis and Treatment of Head and Neck Squamous Cell Carcinoma
After the World Health Organization declared COVID-19 a pandemic in March 2020, stay-at-home orders were issued across the United States, leading to delays in patient care and screening. Cancer care at Houston’s county-run safety-net hospital was halted by clinic shutdowns and closure of operating rooms for all but emergent cases.
To evaluate how care delivered to head and neck squamous cell cancer (SCC) patients changed at the county hospital before and after stay-at-home orders were issued, researchers in the Department of Otorhinolaryngology at McGovern Medical School at UTHealth Houston conducted a retrospective review of 105 patients with SCC diagnosed 365 days before and after the orders were issued. They collected data on demographics, cancer subsite, stage at presentation, time to diagnosis and treatment, and mortality from May 14 to June 18, 2020, and compared it to a similar pre-pandemic period in 2019.
“The majority of these patients were late stage when they finally got through the clinic door,” says Ibrahim “Trey” Alava III, MD, associate professor of otorhinolaryngology, chief of otolaryngology-head and neck surgery at Lyndon B. Johnson Hospital, and medical director of the hospital’s 32 specialty clinics. “Sixty-five patients were diagnosed before the orders were issued, and 40 patients were diagnosed afterwards. Eighty percent of those who presented after stay-at-home orders had stage IV disease at diagnosis, compared to 58% of those presenting beforehand.”
The one-year mortality rate was 23% in patients treated prior to stay-at-home orders and 25% in those treated afterward. “Although those in our cohort who were diagnosed after the stay-at-home orders were issued presented with a more advanced stage, there was no significant difference in mortality rates of the two groups,” Dr. Alava says. “But our study highlights the vulnerabilities of patients when we as a nation make quick decisions to contain a virus. Not permitting access particularly impacts patients with lower socioeconomic status, who also face income issues. We hope these findings will help prepare physicians and hospitals to provide better care for patients during future pandemics.”
The abstract was presented by David Z. Allen, MD, a postgraduate year 4 resident, at the 2023 meeting of the American Head & Neck Society in Montreal, and was recently accepted for publication in the American Journal of Otolaryngology.
Allen DZ, Ahmad JG, McKee SP, Suarez N, Basmaci UN. The Impact of the COVID-19 Pandemic on Stage at Diagnosis and Time to Diagnosis and Treatment of Head and Neck Squamous Cell Carcinoma at a County Hospital. Presented at the 2023 meeting of the American Head & Neck Society in Montreal, Canada.