COVID-19 Pandemic and Fragmentation of Care
Due to the COVID-19 pandemic, head and neck care coordination has been dramatically altered. In these uncertain times, limitations with clinical resources and healthcare office availability have made it more difficult for head and neck cancer patients to obtain multidisciplinary care. In the usual timeframe, a new head and neck cancer patient would be able to meet all the members of the MDT, finish pre-treatment diagnostic studies, and receive a consensus MDC recommendation within the span of about two to three weeks. In the current scope of telemedicine, there is concern for possible delays along any of these timepoints as well as the time-interval from diagnosis to treatment initiation. The ability of MDT and MDC to modify care coordination is essential in a time of crisis. The MDT framework allows patients to be referred in a timely fashion between a network of specialty providers; this way patients from regions of low resource availability (i.e. personnel, equipment, operating room availability) can be guided to areas which are able to deliver timely oncologic care. The MDC is fundamental to this care coordination model.
At our institution, the University of Pittsburgh Medical Center, there are multiple distant hospital campuses spread out across three states, Pennsylvania, New York, and Maryland (Figure 1). New patients may be referred to the head and neck MDT from any of these locations. However, it is often that such patients may see a local primary care physician or general otolaryngologist before being referred for evaluation by the UPMC Head and Neck MDT. Due to the COVID-19 pandemic, any delays which are associated with this pathway are likely to be exacerbated. In the past few weeks, the MDT has adopted hosting a virtual MDC which is accessible to remote UPMC locations away from Pittsburgh, PA. The concept is to streamline head and neck oncologic care such that patients in any region of the hospital system would be able to obtain timely diagnosis and treatment plans. The virtual MDC offers flexibility for both providers and patients. Regardless of whether patients are awaiting an initial MDT evaluation or definitive treatment, MDC discussions empower patient-centric care so that current needs are matched in an appropriate fashion with available system resources.