The impact of Coronavirus (COVID-19) on head and neck cancer patients' care

De Felice, Francesca

Polimeni, Antonella

Valentini, Vincenzo

English

Archivio della ricerca- Università di Roma La Sapienza

Radiotherapy and Oncology 147 (2020) 84–85Contents lists available at ScienceDirectRadiotherapy and Oncologyjournal homepage: www.thegreenjournal .comLetter to the EditorThe impact of Coronavirus (COVID-19) on headand neck cancer patients’ carehttps://doi.org/10.1016/j.radonc.2020.03.0200167-8140/ 2020 Elsevier B.V. All rights reserved.To monitor and defeat further progression of the novel Coron-avirus (COVID-19) infection, a strong public health vigilance hasbeen adopted in Italy [1]. By March 18, 31,772 cases were con-firmed, with 2390 deaths [2]. The median age of patients whoare infected is 63 years and more than two-thirds of deaths haveoccurred in elderly patients (aged 70 years) [2]. Hospitals’ workregimes have been re-prioritized, but Coronavirus does not reallyaffect the cancer clinics. Although radiation oncologists are notfighting on the front line, they have to guarantee treatment –radiotherapy with or without concomitant chemotherapy ((C)RT)– and, in the meantime, protect patients from the COVID-19infection.In this scenario, (C)RT has a crucial role in head and neck cancer(HNC) management. It is the mainstay of treatment for most of theHNC sites, because of its proven curative intent assuring an organpreservation strategy [3–4]. HNC is a relatively rare cancer in Italy,with 9300 new cases and 3216 deaths described per year [5]. Mostof the patients are diagnosed in a locally advanced stage diseaseand should receive treatment as soon as possible. Therefore, duringthis pandemic period, HNC patients represent a major clinicalproblem with treatment decision-making process. Due to the com-plexity in optimal strategy plan and patients’ support care throughtreatment, the multidisciplinary team should weigh the risks andthe benefits to patients in deciding whether to modify patients’work-up and treatment approach. We cannot provide specificguidance on any other protocol of therapy – at this time, no clinicalHNC-specific data on COVID-19 are available – but we can statethat each decision requires an individualized risk/benefit assess-ment. The aim should be to protect HNC patients without compro-mising their oncologic outcome. It is paramount to stress openchannels of communication between administrators, clinicians,patients and caregivers [6]. In order to assist shared decision-mak-ing, multidisciplinary team meetings should be promoted usingweb-platforms. A reasonable treatment strategy between anti-cancer therapy and epidemic prevention should be selected. Itshould be considered to: i) omit systemic therapy for patients70 years or younger with co-morbidities, such as diabetes andcardiovascular diseases. On the one hand, the updated meta-anal-ysis of chemotherapy in head and neck cancer (MACH-NC) did notshow any survival benefit resulting from the addition ofchemotherapy for elderly patients [3]. On the other hand, theserelevant co-morbidities are linked to a higher risk of death in caseof COVID-19 infection [7]. ii) omit cisplatin-based inductionchemotherapy. A definitive benefit in overall survival with theincorporation of induction chemotherapy compared to standard(C)RT has not been proven in randomized studies [8]. iii) shortoverall treatment time. Definitive (C)RT should be limited tosimultaneous integrated boost (SIB) techniques in the standard(5 fractions per week) or accelerated schedule (6 fractions perweek), in order to achieve a 1-week reduction compared tosequential technique. SIB technique represents an optimum bal-ance between tumor control and prevention of late toxicity excess[9]. iv) delay post-operative RT in patients with salivary glandtumors until 12 weeks after surgery. Time factor is not strictlylinked to adverse effect in these cases [10]. v) develop an onlinesurveillance plan. At present HNC patients deal with the doubleordeals of disease and pandemic situation. Patients should be edu-cated to properly identify those symptoms and signs that poten-tially signify a recurrence (increased local pain and difficulty inswallowing, unexplained weight loss and development of newlump in the head and neck region). For sure, patients should beinformed regarding the Coronavirus symptoms (mainly fever, dys-pnea and cough) and educated in proper hand washing and allother measures to limit viral transmission (avoid touching youreyes, nose and mouth; cover your nose and mouth with a tissuewhen you cough or sneeze; clean and disinfect high touch surfacesregularly; stop shaking hands or kissing as a greeting; reduceexposure to sick contacts and large crowds). Psychological coun-seling should be paid attention to through seeking alternativeschemes.It must be appreciated that this document is an attempt to pro-vide practical suggestions on how to define a reasonable treatmentstrategy and mitigate the COVID-19 impact on HNC patients underthe current pandemic conditions. It is necessary to offer adequateindividualized treatment recommendations based on both the epi-demic situation and the patient’s own condition. We significantlyhope to help HNC patients to survive this difficult period.AcknowledgementNone.Conflict of interestNo.References[1] https://www.gazzettaufficiale.it[2] https://www.epicentro.iss.it/coronavirus/bollettinoLetter to the Editor / Radiotherapy and Oncology 147 (2020) 84–85 85[3] Pignon JP, le Maître A, Maillard E, Bourhis J. MACH-NC Collaborative Group.Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): anupdate on 93 randomised trials and 17,346 patients. Radiother Oncol 2009;92(1):4–14.[4] National Comprehensive Cancer Network (NCCN). Guidelines Head and NeckCancers, Version 1.2020. available at http://www.nccn.org.[5] AIOM (2019). AIRTUM. I numeri del cancro in Italia. Il Pensiero Scientifico;2019.[6] National Comprehensive Cancer Network (NCCN). How to Manage Cancer Careduring COVID-19 Pandemic. available at http://www.nccn.org.[7] Remuzzi A, Remuzzi G. COVID-19 and Italy: what next?. Lancet 2020. pii:S0140-6736(20)30627-9.[8] Blanchard P, Bourhis J, Lacas B, Posner MR, Vermorken JB, Cruz Hernandez JJ,et al. Taxane-cisplatin-fluorouracil as induction chemotherapy in locallyadvanced head and neck cancers: an individual patient data meta-analysisof the meta-analysis of chemotherapy in head and neck cancer group. J ClinOncol 2013;31(23):2854–60.[9] Overgaard J, Hansen HS, Specht L, Overgaard M, Grau C, Andersen E, et al. Fivecompared with six fractions per week of conventional radiotherapy ofsquamous-cell carcinoma of head and neck: DAHANCA 6 and 7 randomisedcontrolled trial. Lancet 2003;362(9388):933–40.[10] Terhaard CH, Lubsen H, Rasch CR, Levendag PC, Kaanders HH, Tjho-HeslingaRE, et al. The role of radiotherapy in the treatment of malignant salivary glandtumors. Int J Radiat Oncol Biol Phys 2005;61(1):103–11.Francesca De Felice⇑Department of Radiotherapy, Policlinico Umberto I, ‘‘Sapienza”University of Rome, Viale Regina Elena 326, 00161 Rome, Italy⇑ Address: Department of Radiotherapy, Policlinico Umberto I,‘‘Sapienza” University of Rome, Viale Regina Elena 326, 00161 Rome,Italy.E-mail address: fradefelice@hotmail.itAntonella PolimeniDepartment of Oral and Maxillo Facial Sciences, Policlinico Umberto I,‘‘Sapienza” University of Rome, Via Caserta 6, 00161 Rome, ItalyVincenzo ValentiniDepartment of Radiotherapy, Policlinico Umberto I, ‘‘Sapienza”University of Rome, Viale Regina Elena 326, 00161 Rome, ItalyReceived 19 March 2020Received in revised form 20 March 2020Accepted 20 March 2020Available online 24 March 2020

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The impact of Coronavirus (COVID-19) on head and neck cancer patients' care

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