Causes and impact of delays during the COVID-19 pandemic on head and neck cancer diagnosis

Maru Gete; Shao Hui Huang; Jolie Ringash; Jonathan Irish; Jie Su; Yashi Ballal; John N Waldron; Ian Witterick; John de Almeida; Ali Hosni; Andrew J Hope; Eric Monteiro; John Cho; Brian O'Sullivan; John Kim; Scott Bratman; David P Goldstein; Andrew McPartlin; Jillian Tsai; Li Tong; Wei Xu; Ezra Hahn

doi:10.1002/hed.27784

Causes and impact of delays during the COVID-19 pandemic on head and neck cancer diagnosis

Head Neck. 2024 Apr 25. doi: 10.1002/hed.27784. Online ahead of print.

Authors

Maru Gete¹, Shao Hui Huang^{2

3

4}, Jolie Ringash⁴, Jonathan Irish³, Jie Su⁵, Yashi Ballal^{2

6}, John N Waldron⁴, Ian Witterick¹, John de Almeida³, Ali Hosni⁴, Andrew J Hope⁴, Eric Monteiro¹, John Cho⁴, Brian O'Sullivan⁴, John Kim⁴, Scott Bratman⁴, David P Goldstein³, Andrew McPartlin⁴, Jillian Tsai⁴, Li Tong⁴, Wei Xu⁵, Ezra Hahn⁴

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
² Department of Radiation Therapy, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
³ Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
⁴ Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
⁵ Department of Biostatistics, Princess Margaret Cancer Centre / University of Toronto, Toronto, Canada.
⁶ The Michener Institute / University of Toronto, Toronto, Canada.

PMID: 38665037
DOI: 10.1002/hed.27784

Abstract

Background: The causes for delays during the COVID19 pandemic and their impact on head and neck cancer (HNC) diagnosis and staging are not well described.

Methods: Two cohorts were defined a priori for review and analysis-a Pre-Pandemic cohort (June 1 to December 31, 2019) and a Pandemic cohort (June 1 to December 31, 2020). Delays were categorized as COVID-19 related or not, and as clinician, patient, or policy related.

Results: A total of 638 HNC patients were identified including 327 in the Pre-Pandemic Cohort and 311 in the Pandemic Cohort. Patients in the Pandemic cohort had more N2-N3 category (41% vs. 33%, p = 0.03), T3-T4 category (63% vs. 50%, p = 0.002), and stage III-IV (71% vs. 58%, p < 0.001) disease. Several intervals in the diagnosis to treatment pathway were significantly longer in the pandemic cohort as compared to the Pre-Pandemic cohort. Among the pandemic cohort, 146 (47%) experienced a delay, with 112 related to the COVID-19 pandemic; 80 (71%) were clinician related, 15 (13%) were patient related, and 17 (15%) were policy related.

Conclusions: Patients in the Pandemic cohort had higher stage disease at diagnosis and longer intervals along the diagnostic pathway, with COVID-19 related clinician factors being the most common cause of delay.

Keywords: COVID‐19; delay; diagnosis; head and neck cancer; staging.