Abstract

Inoperable Advanced Head and Neck Cancers: Is COVID-19 Pandemic the Culprit? Our Analysis at a Tertiary Care Hospital

Objectives: To study the effect of the COVID-19 pandemic on Head and neck cancers and its impact on upgrading the stage and in-operability due to delay in seeking health care provision. Study design: This is a retrospective crosssectional study. Settings: Institutional medical record database. Methods: The number of HNC cases that visited our health care facility for a period of 14 months during the pandemic from March 2020 to May 2021 were studied, these cases were compared with HNC cases who attended the facility before the pandemic for an equal number of 14 months, until 1st lockdown was announced in March 2020 by the Government of India. Information about patients was extracted and gathered from the medical records of the hospital and supplemented by telephone interviews. Results: Most of the cases were males above 40 years of age with a male: female ratio of 4.25:1. The most common site of origin was the oral tongue (40%). The total number of new head and neck cancer cases visiting our facility in pandemic and pre-pandemic times were similar with no major difference (63 vs. 65). However, during the lockdown, these numbers dropped to less than half (6 per 3 months). Most of the patients presented with advanced stages (III/IV) of disease during both pandemics as well as pre-pandemic times with no significant difference observed (68.25% vs. 60%). However, a higher incidence of unresectable/inoperable (IVb) advanced cases was seen during pandemic months (30%) compared to pre-pandemic months (7.6%) and these findings were statistically significant (p-value of 0.011). Two third (n=8/12) among these advanced inoperable (IVb) cases had a delay of more than 3 months and one third (4/12) had a delay of more than 6 months in seeking medical advice. Moreover, there was no delay in diagnosing the cases after their contact with our health care facility as almost all cases were diagnosed histopathologically within the first 2 weeks. Conclusion: The author concludes that the COVID-19 pandemic has had a drastic effect on the comprehensive management of Head and Neck cancers. Delay in seeking medical advice and thus diagnosis and initiation of treatment render a huge number of cases inoperable.

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