Ongoing Head & Neck Cancer Management

Dear Colleagues and Members

Re: Ongoing Head and Neck Cancer Management during the COVID-19 Pandemic.

During the current healthcare climate the traditional management pathway of head and neck cancer patients has been thrown into some disarray as we contend with social distancing, PPE requirements and the varying capacity concerns within our hospitals. These adjustments were necessarily expedited during the early threat of a COVID-19 ‘tsunami’. This inevitably meant the introduction of telephone and video-based clinical assessments for the vast majority of patients in both primary and secondary care.

At the recent BAHNO Council meeting held on the 9 June 2020, the issues regarding a potential return to ‘normality’ were discussed with emphasis on the fact that within our head and neck cancer population there are cohorts of patients where face-to-face clinical reviews remain critical or essential.

These factors include:

Concern over recurrence / second primary cancer and the ability to diagnose and treat this
Airway compromise
Need for clinical correlation with imaging findings
Speech / communication issues
Management of treatment-related toxicities
Assessment of response to SACT

This is not an exhaustive list and it is essential that the risk: benefit ratio is considered for each patient with face-to-face consultations arranged only when they are key to an individual’s care pathway. On the ground, this may mean alternating face-to-face with telephone/video reviews or maintaining a default position with no physical patient interaction but the capacity to accommodate face-to-face consultations as and when the situation warrants this.

We appreciate that a move to more face-to-face consultations will have implications on individual Trusts and their capacity to cope with increased patient movement within hospitals whilst maintaining the rules on social distancing, PPE and aerosol-generating procedures. For this reason, we felt that emphasising the need for a balanced and considered approach in defining which specific patients would benefit from face-to-face consultations will help aid discussions within units to ensure appropriate planning of services moving forward.

We hope this statement will help and support discussion between head and neck clinicians and their Trusts in enabling best patient care during this current pandemic and within future healthcare provision

12/06/2020