Expert Advice on Head and Neck Cancer Management Amidst COVID-19

Head & neck cancer accounts for about 650,000 cancer cases and 330,000 cancer deaths worldwide. It is the 6th most common cancer in the world and is more predominant in developing countries. In India, it accounts for 1/3rd of all cancer cases. Covid-19, the pandemic ravaging through the world since late 2019, has not only put the world in shock but, it has also put the lives of cancer patients, including head & neck cancer patients, in jeopardy.

Cancer patients, including head & neck cancer patients, going through cancer treatments that make them immunocompromised are already at a higher risk of getting common infections, in came Covid-19 with its high contagion rate, and the risk doubled. Yes, SOME cancer patients are vulnerable to not only getting infected with the novel coronavirus but also suffering from severe symptoms should they get the infection. But, there are several recommendations offered by experts to combat the fear and decrease the chances of this. 

How to manage head & neck cancer amidst Covid-19?

To understand what the learned cancer doctors like Dr. Manish Singhal, the top head and neck cancer doctor in Noida and Delhi, recommend and follow for head and neck cancer patients, we must divide the types of treatment. But first, let’s look at the general advice.

·   Individual cancer clinics & treatment centers should modify their strategy based on their capacity & structure.

·   Cancer treatment pathways can be altered after discussion with the hospital or clinic’s multidisciplinary team.

·   If there is a need to change individual treatment plans, the cancer doctor in charge should make the changes after a discussion with the patient. Also, the discussion needs to be documented.

·   Whether a patient needs palliative care, cure, or intensive care, the intent of the treatment should be clear. Any misguided decision in these troubled times can prove fatal.

·   Reduce the risk of an emergency admission or emergency cancer care.

Now we can proceed to talk about the recommendations regarding head & neck cancer concerning the different treatments.

Adjuvant Treatment

·   Cancer doctors strongly recommend omitting concomitant chemotherapy.

·   If benefits are limited or if risks outweigh benefits then cancer doctors can choose to omit adjuvant RT.

Curative Treatment

Curative treatment in head and neck cancer refers to health care practices that treat patients with the intent to cure. It can involve surgery, chemotherapy, radiation, hormone therapy, or a combination of any of these treatments. Now, during the Covid-19 pandemic, the risk of taking a curative approach will be higher than normal in older patients or patients with comorbidities. That is why some of the best cancer researchers and the best cancer doctors in Delhi NCR and worldwide are offering recommendations.

·   Hyperfractionated RT regimens can be considered to reduce the number of patient visits to hospitals. Why? To reduce the duration of treatment and the overall burden on the department. For example, 65Gy in 30 fractions is preferable to 70Gy in 35 fractions.

·   Cancer doctors can limit the use of concurrent chemotherapy to those under 60 years of age and without comorbidities. Why? Concurrent chemotherapy is the standard care practice for head and neck cancer patients, but it leads to extensive immunosuppression. That can be dangerous during Covid-19 and should be avoided as much as is possible. However, if concurrent chemotherapy is the only option, head and neck cancer patients can look for expert oncologists offering at-home chemotherapy, like Dr. Manish Singhal, a respected head and neck cancer doctor in Noida.

·   Some form of accelerated fractionation without chemotherapy can be adopted. However, the fact that it increases the burden of radiotherapy departments with limited capacity by requiring twice-daily treatments should also be noted. As an alternate approach, cancer doctors can use a simultaneous integrated boost.

·   Cisplatin/Carboplatin can be used concurrently, according to some of the best cancer doctors. Inpatient and outpatient Cisplatin delivery and rates of consequent admission differ from one center to another; the choice of concurrent chemotherapy may depend on the available resources. However, with specialists like Dr. Manish Singhal, the best cancer specialist in Delhi NCR, and a reputed head and neck cancer doctor adapting to the situation by providing at-home chemotherapy sessions, this problem is being solved now.

Palliative Treatment

·   Palliative treatment is only applicable at the moment if benefits outweigh the risks.

·   If palliative RT is absolutely necessary, then cancer doctors can opt for short fractionation schedule.

·   Palliative chemotherapy or immunotherapy should be delayed unless the benefits outweigh the risks. Starting palliative systemic therapy should only be considered if symptoms are progressive and if the benefits outweigh the risks.

·   For patients already receiving palliative chemotherapy/immunotherapy, stopping treatment or increasing the gap cycles can be considered after discussion. After 2-4 cycles when response is limited, palliative chemo can be stopped.

Infection Prevention

·   Patients who have had laryngectomy or who have a tracheostomy have higher levels of aerosol generation. Therefore, radiographers have to get really close to them for each fraction. Cancer doctors should ensure that these patients are always treated when the staff is equipped with appropriate PPE.

Crossing the finish line

Covid-19 is still rampant, and the pandemic situation is still unfolding. Now guidelines related to the delivery and management of cancer care are being disseminated to flatten the curve of transmission while continuing to provide appropriate guideline-based care for cancer patients, including head and neck cancer patients. Some of the best cancer doctors like Dr. Manish Singhal, one of the best oncologists in Delhi, are adapting every day according to the recommendations and the evolving situation to provide their patients with the best care possible.