key: cord-0911001-eefh0i8h
authors: Pucci, Resi; Cassoni, Andrea; Battisti, Andrea; Valentini, Valentino
title: Covid-19 pandemic and Head and Neck Cancers, what should we expect?
date: 2021-03-15
journal: Oral Oncol
DOI: 10.1016/j.oraloncology.2021.105263
sha: 0ae670f19e9d039d6db0c39d46de6a3f6f2b7373
doc_id: 911001
cord_uid: eefh0i8h

nan

Title:

Resi Pucci

Andrea Battisti Valentino Valentini I attest that the work has been approved by all co-authors and by submitting the manuscript, the authors understand that the material presented in this paper has not been published before or has been submitted for publication to another scientific journal or is it being considered for publication elsewhere.

No funding was received for this investigation. Authors have nothing to disclose. 

To the Editor,

One year after the first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Italy, the COVID-19 emergency has been affecting our country; however, it is early to really understand the social implications of the pandemic. Instead, what we can try to predict is what has already happened in the field of head and neck (HN) oncology and, above all, what we should expect in the coming months. Since February 21, 2020, when the first case of COVID-19 was reported in Italy, [1] [2] the Italian Health System's ability to respond to the COVID-19 emergency has been severely tested in terms of human and economic resources [3] . It is neither known nor foreseeable what effects the pandemic has had on the diagnosis and treatment of these patients [4] . The lockdown has caused a blockage of outpatient visits to general practitioners, dentists, and specialists such as maxillofacial or ENT surgeons, thus significantly limiting access to screening visits for oral cancer patients. The effects of COVID-19 on the population of patients potentially suffering from HN cancer are manifold. Patients suffering from this pathology are often socially marginalized -smokers, alcohol abusers -and unlikely to access private care facilities. Onset symptoms, such as dental or mucous membrane pain and neck swelling, can be confused with the symptoms of an infection of the oral cavity or dental abscess. If these patients are not visited, it is easy to underestimate these symptoms and treat them with antibiotic or corticosteroid therapy. The difficulties in treating patients with HN cancer during this pandemic [5] [6] have been faced and overcome by putting into practice the prevention strategies suggested by the international literature [7] . What has recently been highlighted, both in literature and our clinical practice, is how the diagnostic and therapeutic delay affects the patients' outcomes [8] [9] . This delay is partly due to patient-related factors (social distancing and travel restrictions during the pandemic makes it challenging to attend the hospital for treatment) and partly to healthcare-related factors. The pandemic is affecting both treatment-naive patients, as it worsens survival and quality of life and aggravates psychological impact, and followup patients, as it delays their visits [10] . What caught our attention in these months is the number of outpatient biopsies and new cancer diagnoses, compared to the same period of the previous year. A comparison between the outpatient biopsies performed in our Department from March to December 2019 and those performed in 2020 shows a significant reduction in their number (Table 1 ). In 2019, 268 biopsies were performed, while only 93 in 2020 -a difference of 175 procedures. The decrement is due to the lockdown in the first place, but also to the limited number of procedures that can be performed daily in the clinic to comply with the preventive measures, i.e., by rigorously scheduling appointments. The percentage of malignant tumors diagnosed in 2019 is 34.4% on 268 procedures (92 patients) and 34.5% (32 patients) in 2020; considering this data, the question is: out of all the patients who did not undergo the biopsy, how many are affected by a malignant tumor? Furthermore, patients treated in recent months were frequently at very advanced stages, but further studies are needed to confirm this suggestion. Considering that the incidence of HN cancer cannot be decreased, how many diagnostic delays will be caused by the pandemic? How many patients will undergo less thorough treatments or, even worse, will not be treated surgically and will be referred to palliative care for the extreme stage of the disease? Two admonishments we must learn from the lesson that COVID19 taught us. First, prevention and screening services must always be guaranteed, especially for the weaker social classes. Second, the health-care systems' capacity and financing need to be increased in order to face this new reality, wherein we must live with the virus and all the maneuvers essential to its confinement. To date, we have suffered the short-term effects of this pandemic, but the long-term repercussions are foreseeable and cannot be underestimated. 

Estimation of COVID-19 outbreak size in Italy

Ministry of Health of Italy, Covid-19 -Situazione in Italia

The Italian health system and the COVID-19 challenge

Changes in head and neck oncologic practice during the COVID-19 pandemic

Head and neck cancer cannot wait for this pandemic to end: Risks, challenges and perspectives of oral-maxillofacial surgeon during COVID-19

Head and Neck Cancer Treatment during COVID-19 Pandemic: A Central Experience in Rome. Emergency Management, Infection Prevention and Control

The Early Effects of Coronavirus Disease-2019 on Head and Neck Oncology and Microvascular Reconstruction Practice: A National Survey of Oral and Maxillofacial Surgeons Enrolled in the Head and Neck Special Interest Group

Delay in head and neck cancer care during the COVID-19 pandemic and its impact on health outcomes

A War on Two Fronts: Cancer Care in the Time of COVID-19

Treatment delays in oncology patients during COVID-19 pandemic: A perspective