key: cord-0962635-v6elj1kb
authors: Lopes, Marcio Ajudarte; Santos-Silva, Alan Roger; Vargas, Pablo Agustin; Kowalski, Luiz Paulo
title: Virtual assistance in oral medicine for prioritizing oral cancer diagnosis during the COVID-19 pandemic
date: 2020-04-18
journal: Oral Surg Oral Med Oral Pathol Oral Radiol
DOI: 10.1016/j.oooo.2020.04.009
sha: f519b3a51ada2abfee698469cd59f167afb6fb1e
doc_id: 962635
cord_uid: v6elj1kb

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Oral cancer has been considered an important health problem in many parts of the world 1 In Brazil, it is one of the top ten most frequent malignancies accounting for about 15,000 news cases per year 2 . In addition, the majority of them are diagnosed at advanced clinical stages impairing tremendously the prognosis 3 Another important measure aiming to reduce the incidence a well as to improve the proportion of oral cancers diagnosed at early stages are the screening campaigns particularly focusing people with known history of risk factors, specially tobacco and alcohol intake 4 .

With the new challenge regarding the pandemic COVID-19, many of these efforts are going to have a negative impact since the population will, of course, pay more attention in this new disease and also there will be a need for the health care system to focus in this emergency situation 5,6 . The COVID-19 pandemic has forced many professional and institutions to adopt innovative approaches to better manage this situation. Since the COVID-19 is highly contagious and able to spread human-to-human by respiratory secretion, health workers, particularly dentists, anesthetists, head and neck surgeons, ophthalmologists and otolaryngologists are at a high risk of infection 7 . infection. Vargas and Servillo (2020) 7 also emphasized that professionals that perform procedures that produce aerosols are at a very high risk and recommended ways to improve safety in patients with tracheostomy.

In addition, many elective procedures have been canceled in order to maintain resources and prevent health system collapse. However, regarding cancer, it is not so simple to decide which elective surgeries can be postponed. Therefore, a framework for prioritizing head and neck surgery during the COVID-19 pandemic was just published by a group from California EUA 9 .

Telemedicine has been used with some benefits, particularly in remote areas where it is difficult to have adequate structure to assist patients. It can be an alternative not only for patient education, but also to contribute on diagnosis and treatment.

Clinical images, radiographs, computed tomography, histopathology reports can be evaluated and tumor board conferences can be performed. The American Academy for Otolaryngology -Head and Neck Surgery are willing to aid physicians to use this technology. In the time of COVID-19, this tool gained special attention 10 . Telemedicine has been used also for diagnosing oral lesions. In this context, Carrard et al. (2018) 11 evaluated the participation of 71 dentists and 18 physicians from primary care services and observed that the intention to refer patients to face-to-face consultation reduced from 96.95% to 35.1%.

In this challenging COVID-19 scenario, virtual assistance to the patients and to the health care professional, particularly to the dentists, could help to prioritize the higher risk cases, avoiding face-to-face contact. In this way, only patients with highly suspicious malignant lesions would be referred to the oral medicine team in order to undergo clinical examination and appropriate procedures, such as an incisional biopsy.

After sending the specimen to the oral pathology laboratory, there is also a risk of diagnostic delay because it is expected that many are working partially. Consequently, there is also a possibility of delay on the referral to head and neck surgeon. During COVID-19 pandemic, patients will face another challenge that is the performance of medical exams necessary for cancer staging and treatment planning. Hospitals will be overcrowded very soon, and an available beds and intensive units for post-operative recovery will become uncommon. Even though it is a multifactorial challenging scenario, telemedicine in Oral Medicine has potential to, at least in part, support clinicians and patients and consequently contributes to reduce futile hospital visits and help preserving the resources for the most needed during this preoccupant period.

Predictors of Survival After Head and Neck Squamous Cell Carcinoma in South America: The Interchange Study

COVID-19 pandemic: effects and evidence-based recommendations for otolaryngology and head and neck surgery practice

Impact of Coronavirus (COVID-19) on Otolaryngologic Surgery: A Brief Commentary

Improving staff safety during tracheostomy in COVID-19 patients

Practical Aspects of Otolaryngologic Clinical Services During the 2019 Novel Coronavirus EpidemicAn Experience in Hong Kong

A Framework for Prioritizing Head and Neck Surgery during the COVID-19 Pandemic

Head and neck virtual medicine in a pandemic era: lessons from COVID-19

Telediagnosis of oral lesions in primary care: The EstomatoNet Program