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COVID-19 and Head/Neck Cancer: International Consensus on Surgical Practice

By: Joshua Swore
Posted: Thursday, June 25, 2020

A host of international societies and professional organizations offered consensus guidance on safe practices for head and neck cancer surgery during the COVID-19 pandemic, which were published in The Lancet Oncology. Hisham Mehanna, PhD, of the University of Birmingham, United Kingdom, and colleagues commented: “These recommendations aim to provide urgent guidance to front-line head and neck cancer surgeons who are overworked and stressed by the COVID-19 pandemic.”

A total of 35 head and neck oncology organizations were invited to participate in the survey. These organizations included members representing all clinical trial groups of the head and neck cancer international community, all continents and geographic regions, and multidisciplinary interests. All representatives are currently practicing and considered experts in their field. Given the severe resource constraint associated with COVID-19, members participated in three rounds of survey. A modified Delphi process was used to determine consensus.

In total, 72 items reached consensus and were grouped into guidelines for clinical protocols, treatment protocols, or prioritization of treatment. Among the strongest agreement in clinical protocols was the use of certain procedures only if proper personal protection equipment is available. The COVID-19 status of patients should be seriously considered before any surgery is performed, and follow-up should be done through tele/videoconference if possible.

In general, the guidelines in treatment protocols focus on surgical delay. It is vital to monitor delay, and there was strong agreement that palliation be avoided as primary treatment in the event of surgical delay. In the case of advanced cancers, it was strongly agreed that it is not acceptable to delay surgery beyond 4 weeks and that radiotherapy or chemoradiotherapy should be given immediately. Finally, it was recommended that T3 N2 oral cancer and T4 N1 laryngeal cancer be labeled top priorities for time to surgery.

See the link below for complete details of the consensus findings.

Disclosure: For full disclosures of the study authors, visit thelancet.com.

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