Discussion/Conclusion
The Institute of Medicine has established the goals of quality-based
healthcare: safe, effective, patient-centered, timely, efficient and
equitable for all patients20. In our head and neck
program, we strive to provide patients with highly coordinated and
efficient care. However, the current pandemic has significantly impacted
our ability to meet these goals for care delivery. An urgent effort was
needed to mitigate the impact of the pandemic on patient care requiring
an assessment of our available resources in the context of this
widespread communicable disease.
Using these guidelines has led to a significant shift in the management
of head and neck cancer patients at our institution21.
Advanced oral cavity lesions requiring a mandibulectomy and/or
maxillectomy currently represent the majority of head and neck surgical
cases. More in depth analyses on the overall effect of the COVID-19
pandemic on surgical volume, case deferral, and use of alternative
therapeutic options are being described in the
literature21,22 and are beyond the scope and purpose
of this current report. These recommendations are intended to provide a
concise set of guidelines for the practicing head and neck clinician
during a healthcare crisis, such as the COVID-19 pandemic, and may serve
as a foundation to be modified in the event of future pandemics.
Furthermore, these guidelines should be used in the context of
individual institutional priorities, healthcare personnel safety,
pandemic intensity, and availability of resources. Lastly, we continue
to advocate for consideration of individual cases in a multidisciplinary
fashion based on patient circumstances, and risk of disease progression.