key: cord-0975710-2hhcqs1r authors: José Martelli, Alison; Assis Machado, Renato; Medeiros Pereira, Wilson; Balduino Guimarães Santos, Francis; Pereira Marques, Nelson; Martelli Júnior, Hercílio title: Revaluation of the treatment of head and neck cancer in Brazil during the COVID-19 pandemic - Phase 2 date: 2021-10-28 journal: Oral Oncol DOI: 10.1016/j.oraloncology.2021.105600 sha: 3b7bb7fc20f0016dd093564f9ecf6b9498129722 doc_id: 975710 cord_uid: 2hhcqs1r nan Brazil has become the epicenter of the global COVID-19 pandemic. The country has approximately 604,000 deaths and more than 21.6 million contaminated (https://covid.saude.gov.br/), in addition to a slow and limited vaccination rate. In this adverse scenario, Brazil has presented damage in several health areas. There was a decrease in the number of cancer diagnoses in the country [1] , and increase number of new cases herpes zoster [2] and systemic lupus [3] , in addition to the impact on the treatment of head and neck cancer (HNC) [4] . Although the cancer became mandatory notification in Brazil since 2018 (https://legis.senado.leg.br/norma/27410223), 317 units and care centers, the National Unic System) has as attribution of comprehensive care in a regionalized and decentralized way to cancer patient (https://www.inca.gov.br/onde-tratar-pelo-sus). However, the COVID-19 pandemic has caused reorganized oncology services worldwide to ensure that patients continue to receive essential and care while minimizing the risk contamination [5] . [6] . HNC patients are frequently elderly and have multiple comorbidities, which have been linked to an increased risk of and poor outcomes in COVID-19 patients [7] . The undesirable delays of cancer treatment and exacerbation of oral side effects can worsen the disease prognosis [8] . Thus, treatment delays in patients with malignancies may result in cancer upstaging, exerting a detrimental effect on survival and portend poor outcomes [9] . Thus, the aim of the present study was evaluated the oncological treatment of Table 1 ). In 2019, from August to December, the number of surgeries for HNC was 5,573. In 2020, during the same period, there were 4,965 surgeries, representing a 10.9% decrease during the pandemic period. The greatest decrease was observed in the South region (24.3%). In the other regions, the decrease ranged from 21.6% to 0.5%. Table 1 shows the detailed data. Concomitantly, the number of radiotherapy and chemotherapy procedures increased when comparing the pre-and pandemic periods. In 2019 from the August to December, the number of radiotherapy and chemotherapy procedures was 14,978. In 2020, during the same period, there were 15,906 procedures, representing a 6.2% increase during the pandemic period. The highest increase was observed in the Midwest region (28.2%). In the remain regions, the increase ranged from 9.2% to 0.2% (Table 2) . Cancer patients have a 3.5 times greater risk of needing ICU beds, mechanical ventilation and death [13] . For any stage the surgical resection is the main treatment for HNC, ensuring significant improvement in patient survival but due to the pandemic in many places, the operating room capacity has been curtailed [4, 14] . Making chemotherapy and radiotherapy services have their most sought after services, however both have adverse reactions [15, 16] . The COVID-19 pandemic necessitates a temporary shift in current HNC treatment paradigms, favoring radiation and chemotherapy over surgery and adjuvant therapy. Provoking a considerable decrease in the number of surgeries in the pandemic period in relation to the pre-pandemic period and causing an increase in radiation and chemotherapy. However, some adverse effects may appear after radiotherapy treatment such as hyposalivation, xerostomia, dysphagia, radiation caries, trismus and osteoradionecrosis among others. 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