COVID and head and neck cancers: what impact?

A study published in Frontiers in Public Health tells us how COVID-19 has influenced the diagnosis and treatment of head and neck cancers in Piedmont.

The purpose of the study "The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis" was to use data on the temporal trend of head and neck cancer diagnoses to evaluate the impact of COVID-19 on the timeliness of diagnosis and treatment in the Piedmont Region.

The study was based on two different data sources.

• Thanks to the regional data of the hospital discharge cards (SDO), the incident cases in Piedmont were identified in the period between 1 January 2015 and 31 December 2020. The analysis of interrupted time series was used to model the trend a long term head and neck cancers prior to COVID-19, taking into account seasonal fluctuations.
• Drawing on data from ongoing recruitment in the European HEADSpAcE study, which started before the pandemic, the proportion of patients diagnosed with advanced disease between the pre-COVID-19 recruitment period and post-initiation periods was compared. of the pandemic.

Based on SDO data, in the period January 2015 - December 2019 4811 new cases of head and neck cancer were detected in Piedmont, and 832 cases in 2020, of which 689 occurred since the beginning of the COVID-19 epidemic in Italy (March 2020).

An initial 28% reduction in hospitalizations during the first wave of the COVID-19 pandemic (95% confidence interval: -38%, -16%) was largely addressed by the end of 2020 (4% reduction; range 95% confidence: -11%, + 3%) if we consider the entire population, although there were some heterogeneities.

The gap between observed and expected hospitalizations is particularly evident and had not fully recovered by year-end in older patients (≥75 years) (year-end, -12%; 95% confidence interval: - 24%, + 1%), in patients with a Romano-Charlson comorbidity index of less than 2 (year-end, -9%; 95% confidence interval: -26%, + 0%) and in surgically treated patients (at the end of the year, -12%; 95% confidence interval: -20%, -3%).

In the subgroup of patients eligible for HEADSpAcE recruitment, no shift towards more advanced stages of diagnosis was observed in the first 10 months of the pandemic.

The COVID-19 pandemic has therefore differentially influenced the management of some groups of patients with head and neck cancer, with a more evident impact on older patients, on those treated mainly at surgical level and on those with less comorbidities.