The Impact of the COVID-19 Pandemic on a Single Institution's Head and Neck Radiation Therapy Population in New York City

PURPOSE/OBJECTIVE(S): On March 11, 2020, the World Health Organization declared COVID-19 a global pandemic, and on March 16, New York City issued an emergency executive order directing all hospitals to cancel elective surgeries. In the wake of this declaration, non-emergent clinical outpatient care drastically changed. The goal of this study was to understand the impact of the pandemic on treatment of head and neck (H&N) cancers. We hypothesized that the pandemic would lead to difficulties in accessing and delivering cancer care, especially detrimental in the face of curative treatments for H&N cancers. MATERIALS/METHODS: In this retrospective review, radiation treatment (RT) parameters for H&N cancer patients treated at our institution were extracted from March 1 to June 30 of 2019 and 2020. Treatment intent, stage at presentation, time from consultation to start date, and total duration of radiation treatment were compared by year. Results were summarized by month of consult and year, then analyzed by year using Wilcoxon rank sum and Pearson's Chi-squared tests. RESULTS: From March 1 to June 30, 2020, 53 head and neck cancer patients were seen in consultation, a 29% reduction from 2019. Ultimately, 96% of these patients received treatment. In 2020, 62% of patients were treated with definitive RT compared to 56% in 2019. When compared to 2019, there was a 23% and 60% decrease in the number of consultations during April and May, accordingly, with a recovery of these numbers by June. There was no significant difference between stage at presentation, treatment duration, time to treatment start, or number of cancelled appointments between the two groups. CONCLUSION: Consistent with a decrease in presentation of many non-COVID related illnesses, there was a parallel decrease in treatment of H&N cancer patients within our radiation oncology practice, one of the largest H&N centers located in the initial national epicenter of the pandemic. An increase in relative definitive RT regimens demonstrates the increased utilization of radiotherapy once surgical procedures were postponed. Our data highlights that despite significant uncertainties and limitations during this period, successful efforts were made to provide high-quality cancer care without delays in treatment. Future efforts should focus on preparing medical centers to ensure the delivery of essential cancer treatments such as radiotherapy and minimize non-traditional treatment strategies, particularly in the setting of curative treatments for H&N cancers.