The impact of COVID‐19 on presentation and diagnosis of head and neck squamous cell carcinoma

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Abstract
Objective: To analyze how the COVID‐19 pandemic has influenced trends in head and neck squamous cell carcinoma (HNSCC) presentation and diagnosis—including referral patterns, stage at presentation, and time to diagnosis—over a longitudinal time course.Setting: Multicenter tertiary care academic institution.Methods: A retrospective review of patients with HNSCC presenting between January 1, 2019 and December 31, 2020 was performed. Patients were stratified into pre‐COVID and COVID cohorts based upon presentation date either before or after the COVID pandemic was declared a national emergency. Data was collected on demographics, referral site, symptoms, tumor characteristics, and time to diagnosis.Results: Of 203 patients with HNSCC identified, 77.3% (157/203) were in the pre‐COVID cohort and 22.7% (46/203) were in the COVID cohort. Patients in the COVID cohort were more likely to present through inpatient or ER consultation (26% vs. 11%) than outpatient setting. There was a greater than 50% decrease in new tumor board case presentations per month in the COVID cohort (4.8) relative to the pre‐COVID (10.9) cohort. Cancer stage at presentation was similar between cohorts. Time from presentation to diagnosis was similar between the cohorts at approximately 30 days.Conclusions: These results suggest that patients presenting during the COVID pandemic may have unique referral patterns. A significant decrease in tumor board presentations was noted, which may contribute to more delayed presentations that have yet to be observed. Further investigation with a larger sample size is warranted.Lay Summary: The COVID‐19 pandemic may have changed where and how patients with head and neck cancer initially seek care. We found that patients with newly diagnosed head and neck cancer more often were initially seen in urgent settings than before the pandemic.Level of Evidence: 3

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