Head and neck oncologists and surgeons are among the highest risk specialties for COVID-19 exposure because they routinely perform nasal and mucosal procedures and examinations.

The highest concentration of viral particles is found in the nasopharynx, part of the upper throat behind the nose, and during procedures head and neck physicians can easily aerosolize viral particles and cause airborne transmission of the disease.

“We have had to carefully balance the safety of patients and staff during this pandemic without compromising cancer care,” said Dr. Caitlin McMullen, a surgical oncologist in the Head and Neck Oncology Program at Moffitt Cancer Center. “Without established data regarding coronavirus, physicians have had to find ways to continue providing care safely in real-time. Using electronic platforms, we have been in touch with our colleagues across the globe, allowing us to learn from their experiences and incorporate that information into our own practices.”

Hoping to update practices to optimize patient care during times of crisis, head and neck surgeons from 14 institutions in the United States complied their practice patterns in a shared spreadsheet. The results, published here, show the COVID-19 pandemic has caused a reduction in head and neck care across the country, and that rapid COVID-19 testing is critical to resume care of these patients.

Fortunately, so far Moffitt has been relatively less affected by COVID-19 than other institutions and has been able to continue caring for patients with head and neck cancers.

“Some of the procedures that we do are considered to be higher risk for aerosolizing the virus, such as nasal fiberoptic scoping, so we are delaying these procedures unless absolutely necessary,” said McMullen. “Elective surgery, such as secondary reconstructive procedures, have been delayed to preserve resources and protect our patients and staff.”

The operating room has also taken several steps to maintain the safety of patients and staff. The operating room team is wearing a higher level of personal protective equipment when appropriate, and most patients are tested for COVID-19 prior to surgery. Thanks to Moffitt’s in-house COVID-19 test, patients can receive same-day results.  

All but one of the 14 institutions were utilizing telemedicine to prevent interruptions in patient care.

“Virtual visits allow us to check in with our patients and ensure they are doing well while avoiding any of the risks of travelling,” said McMullen. “I think the adjustment to virtual visits, urgently required for public health reasons, is welcomed by many patients, and they will become a more consistent part of patient care in the future.”