Affiliation:
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
Abstract
AbstractBackgroundThe causes for delays during the COVID19 pandemic and their impact on head and neck cancer (HNC) diagnosis and staging are not well described.MethodsTwo 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.ResultsA 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.ConclusionsPatients 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.