RESUMEN
PURPOSE: The rapid spread of the SARS-CoV-2 pandemic around the world caused most healthcare services to turn substantial attention to treatment of these patients and also to alter the structure of healthcare systems to address an infectious disease. As a result, many cancer patients had their treatment deferred during the pandemic, increasing the time-to-treatment initiation, the number of untreated patients (which will alter the dynamics of healthcare delivery in the post-pandemic era) and increasing their risk of death. Hence, we analyzed the impact on global cancer mortality considering the decline in oncology care during the COVID-19 outbreak using head and neck cancer, a known time-dependent disease, as a model. METHODS: An online practical tool capable of predicting the risk of cancer patients dying due to the COVID-19 outbreak and also useful for mitigation strategies after the peak of the pandemic has been developed, based on a mathematical model. The scenarios were estimated by information of 15 oncological services worldwide, given a perspective from the five continents and also some simulations were conducted at world demographic data. RESULTS: The model demonstrates that the more that cancer care was maintained during the outbreak and also the more it is increased during the mitigation period, the shorter will be the recovery, lessening the additional risk of dying due to time-to-treatment initiation. CONCLUSIONS: This impact of COVID-19 pandemic on cancer patients is inevitable, but it is possible to minimize it with an effort measured by the proposed model.
Asunto(s)
COVID-19 , Carcinoma de Células Escamosas/epidemiología , Atención a la Salud , Neoplasias de Cabeza y Cuello/epidemiología , SARS-CoV-2 , Tiempo de Tratamiento , Carcinoma de Células Escamosas/etiología , Carcinoma de Células Escamosas/mortalidad , Salud Global , Neoplasias de Cabeza y Cuello/etiología , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Modelos Teóricos , Factores de RiesgoRESUMEN
The 2019 novel coronavirus disease (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2 that is spread human-to-human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities. There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists, and otolaryngologists. Health workers represent between 3.8% and 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter). All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55 to 65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases, and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Health care facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case-by-case basis for patients with cancer. For those who are working with COVID-19 infected patients' isolation is compulsory in the following settings: (a) unprotected close contact with COVID-19 pneumonia patients; (b) onset of fever, cough, shortness of breath, and other symptoms (gastrointestinal complaints, anosmia, and dysgeusia have been reported in a minority of cases). For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (eg, rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia), it is strongly recommended that all health care personnel wear personal protective equipment such as N95, gown, cap, eye protection, and gloves. The procedures described are essential in trying to maintain safety of health care workers during COVID-19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID-19 positive subjects, and their protection should be considered a priority in the present circumstances.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Otolaringología , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , COVID-19 , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , SARS-CoV-2RESUMEN
PURPOSE OF REVIEW: Conservative surgical procedures, radiotherapy and chemoradiotherapy can all be considered in organ preservation strategies for patients with head and neck squamous cell carcinoma. In spite of the contribution of well designed clinical trials, in clinical practice, especially in developing countries, results are related to variables that were usually not considered in such trials. RECENT FINDINGS: The results of most organ preservation studies are focused on survival and larynx preservation, but an evaluation of quality of life and function of the organ is still lacking. We performed a systematic search on the MEDLINE database and could not find any such studies conducted in developing countries. In the present review we consider the possible problems associated with the application of organ preservation strategies in developing countries in some critical areas: advanced stage, comorbidities, nutritional status, long distance to travel, availability of chemotherapy and radiotherapy facilities, tolerance, adherence to protocol standards and expertize in performing salvage surgery. Recent publications strongly suggest that chemoradiation should not be indicated in all patients with advanced laryngeal and hypopharyngeal cancer, but that an individualized treatment strategy should be recommended. SUMMARY: Organ preservation treatments depend on factors related to the physician and the institutions providing healthcare, and also on patients and health systems and socioeconomic factors that make it impossible to extrapolate these results. Only after a meticulous evaluation of the final results of the application of these protocols in each specific environment can they be recommended for carefully selected patients.