The Impact of COVID-19 on Head and Neck Cancer Outpatient Care: Our Experience at a Tertiary Care Center in Southern Taiwan

Objective: During the COVID-19 pandemic, outpatient visits have decreased due to the risk of exposure to aerosolized respiratory secretions, especially in the otorhinolaryngologic clinic. Delay in diagnosis and treatment for head and neck cancer was a major concern. We tried to assess the impact of COVID-19 on outpatient care for patients with head and neck cancers at E-Da Hospital. Methods: We reviewed the medical records of all outpatients with newly diagnosed head and neck cancers and those diagnosed with head and neck cancers at the Department of Otorhinolaryngology of E-Da Hospital between January and June, 2020. The medical records of patients with their head and neck cancers diagnosed between January and June, 2019 were scrutinized for comparison. We utilized SigmaPlot 13 (Systat Software, San Jose, CA) with Chi-squared test for statistical analysis with significance set at p ＜0.05. Results: There were a total of 24,346 outpatient visits at our otorhinolaryngologic department between January and June, 2019 in comparison with 18,983 visits (22% reduction) during the COVID-19 pandemic in 2020. The total numbers of head and neck cancer outpatients were 6,386 in 2019 and 5,915 in 2020, and the proportion of head and neck cancer outpatients to total outpatients showed significant increase during the COVID-19 pandemic (31.2% in 2020 vs. 26.2% in 2019, p ＜0.001). A significant increase in the proportion of patients with newly diagnosed head and neck cancers to the total number of outpatients was also noted in 2020 compared to that in 2019 (1.3% vs. 1.0% of total outpatient cases, p=0.007). The proportion of patients with newly diagnosed late-stage head and neck cancers to the total number of outpatients has slightly increased in 2020 compared to that in 2019 (0.64% vs. 0.62% of the total number of outpatient cases, p=0.864). Conclusions: The impact of COVID-19 on head and neck cancer care E-Da Hospital is negligible due to effective infection control policies, a trusting relationship between the patients and the medical professionals, adequate recognition of the need for timely treatment of head and neck cancers among the general public, as well as a strong sense of social responsibility among physicians. Nevertheless, a flexible ambulatory care program for patients with head and neck cancers according to the severity of the pandemic is still warranted for maintaining a delicate balance between the delivery of optimal care and the risk of nosocomial infect