key: cord-0828021-qjd31m8l
authors: Singh, Mark; Ghaly, Ghaly; Mumtaz, Shadaab; Hughes, Ceri; Thomas, Steve
title: Triaging algorithm for Head & Neck oncology follow-up patients in COVID-19 climate
date: 2020-06-11
journal: Surgeon
DOI: 10.1016/j.surge.2020.06.001
sha: 6699bb77d1dadbdac5c2db507db25cb46d623b0a
doc_id: 828021
cord_uid: qjd31m8l

Abstract The current climate is one of uncertainty and immeasurable tragedy for people afflicted by the pandemic of SARS-CoV-2 virus infection. As professionals, we have a duty of care towards all patients especially the vulnerable and those suffering with life-threatening illnesses such as oral cancer. We present a safe & objective triaging method for afflicted with this disease in the prevailing morbid situation.

Since the advent of the pandemic of SARS-CoV-2 infection (COVID-19), a number of changes have ensued in terms of patient assessment & management. It is apparent that the care of the elderly and vulnerable patients has been severely compromised. Amongst them are the head & neck oncology patients who need regular and rigorous evaluation to ensure that new and/or recurrent pathologies are not missed & that their anxiety is alleviated.

in the form of remote or virtual clinics including telephone and/or video consultations to provide continuity of care so that these patients do not have to attend high-risk environments such as hospitals & surgeries and hence prevent spread of disease. Although, avoiding face-to-face (F2F) reviews has proven advantages in the present scenario, there is increased anxiety amongst surgeons due to the uncertainty and fear of missing cancer diagnosis using remote aids. (Table.2 ). An algorithm was then constructed utilising these variables to safely triage patients who need F2F assessment as outlined (Table. 3).

A balanced approach for safe triaging & to ascertain the need for complete assessment of the head & neck oncology patients is necessary to reduce the risk of spread of infection as well as to prevent harm to this vulnerable cohort. In many cases, F2F evaluation remains the only satisfactory option to achieve adequate assessment and reduce anxiety amongst patients.

The risk factors associated with oral cancer are well known. A number of factors which heighten the risk of recurrence have been extensively documented in the literature 3,4,5 . The chances of patients developing COVID-19 & it's morbid consequences increase significantly with age, comorbidities & immunosuppression. Needless to say, the patients in the 'vulnerable category' have been advised to 'shield' themselves for up to 12 weeks to prevent contagion & it's sequelae 6 . It is therefore, counterproductive to bring these patients for F2F review without risk stratification and triaging except in emergency situations.

We understand that algorithms have their limitations such as being complex, time consuming & associated difficulties with compliance. However, for many clinicians this will be a valuable tool which would provide an objective method of triaging and hence reducing the risk significantly in this vulnerable population. In our unit, we have successfully used the algorithm for our patients with encouraging results. Local modifications may be required to assimilate the working pattern of different units. The authors hope that this novel risk stratification & triaging algorithm will be useful in the head and neck surgery units promoting safe practice as well as preventing harm to the patients.

Ethical approval -N/A 

BAHNO statement on COVID-19

Guidance on social distancing for everyone in the UK

The recurrence and survival of oral squamous cell carcinoma: a report of 275 cases

Prognostic value of the nodal yield in head and neck squamous cell carcinoma: A systematic review

Neck recurrence in clinically node-negative oral cancer: 27-year experience at a single institution