10.14639/0392-100X-N0941
In this letter to the Editor the Authors present the protocol adopted by the most important departments of Otolaryngology specialized in head and neck surgery of the Puglia region for the management of head and neck cancer patients during the COVID-19 pandemic (Foggia, San Giovanni Rotondo, Barletta, Bari “Aldo Moro”, Bari “Di Venere”, Brindisi, Tricase).
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Collaborators - Apulian Working Group
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ACTA Otorhinolaryngologica Italica
laryngology
The importance of head and neck counselling in the COVID-19 era
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Letters to the Editor-in-Chief
2020-12-29
2020-06-22
2021-05-17
2021-05-17
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Collaborators - Apulian Working Group
2021
10.14639/0392-100X-N0941
192
Francesco  Barbara,  Michele  Barbara, Giada Cavallaro, Aurelio d’Ecclesia, Maria Luisa Fiorella,  Renato  Franza,  Matteo  Gelardi,  Francesco  Lon-go,  Pier  Gerardo  Marano,  Raffaele  Marfelli,  Domenico  Petrone, Paolo Petrone, Nicola Quaranta, Gianluca Ronca, Emanuele Scarano
1827-675X
laryngology
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The importance of head and neck counselling in the COVID-19 era
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ACTA OTORHINOLARYNGOLOGICA ITALICA 2021;41:192-194; doi: 10.14639/0392-100X-N0941




Letter to the Editor


The importance of head and neck counselling
in the COVID-19 era
L’importanza del “counselling” nei tumori testa-collo nell’era COVID-19
Luciano Magaldi1, Anna Eugenia Salzo2, Eleonora M.C. Trecca1, Lucia Iannuzzi2, Francesca Fortunato3,
Michele Cassano1
Apulian Working Group
1
 University Hospital of Foggia, Department of Otolaryngology - Head and Neck Surgery, Foggia, Italy; 2 University of Bari “Aldo
Moro”, Department of Otolaryngology - Head and Neck Surgery, Bari, Italy; 3 University of Foggia, Department of Medical and
Surgical Sciences, Foggia, Italy


KEY WORDS: coronavirus, infection, prevention, head and neck, laryngology
PAROLE CHIAVE: coronavirus, infezione, prevenzione, testa-collo, laringologia



Dear Editor,
We truly appreciated the editorial entitled “Surgical management of head and
neck tumours during the SARS-CoV (COVID-19) pandemic” 1 presenting an
effective action plan of an Ear, Nose and Throat (ENT) regional cancer hub
during the COVID-19 pandemic. Given the fragility of patients affected by                Received: June 22, 2020
head and neck cancer together with the importance for otolaryngologists to               Accepted: August 13, 2020
                                                                                         Published online: December 29, 2020
work in a safe environment, we found the strategy described in the present
editorial highly recommended during these unprecedented times. Although the              Correspondence
Puglia region has not been hit as severely as others in northern Italy such as           Eleonora M.C. Trecca
Lombardy, COVID-19 has led to a profound reorganisation of the activities                University Hospital of Foggia, Department of Oto-
                                                                                         laryngology- Head and Neck Surgery, viale Pinto 1,
carried out by the head and neck departments that were forced to suspend all             71122 Foggia, Italy
elective clinical activities and surgeries 2. In our region, the National Institute      E-mail: eleonora.trecca@unifg.it
of Health (ISS) ordered that all scheduled follow-up visits of non-urgent pa-
tients affected by head-neck cancer should be postponed, and that “virtual”              Funding
                                                                                         None.
clinics should be organised according to the guidelines of the Canadian As-
sociation of Head & Neck Surgical Oncology (CAHNSO) 3. Virtual follow-up                 Conflict of interest
visits and telephone counselling allow monitoring patients and establish “in-            The Authors declare no conflict of interest.
person” visits for a restricted number of patients. This was the case for pa-
tients with poor prognosis due to the advanced status of their cancers, patients           How to cite this article: Magaldi L, Salzo AE,
who developed new or alarming symptoms, such as dysphonia, dyspnoea and                    Trecca EMC, et al. The importance of head and
                                                                                           neck counselling in the COVID-19 era. Acta
dysphagia, and the occurrence of new lesions that needed to be investigated                Otorhinolaryngol Ital 2021;41:192-194. https://
through endoscopic examination and/or biopsy confirmation. The scheduling                  doi.org/10.14639/0392-100X-N0941
of “in-person” visits rarely depended on the preferences of the patient.
                                                                                         © Società Italiana di Otorinolaringoiatria
According to the Sunnybrook Health Center experience, a centralised database             e Chirurgia Cervico-Facciale
was created in order to contact and monitor patients, while four experienced
head and neck surgeons rotated every four-weeks from March 15 to May 15,                                OPEN ACCESS
2020, in order to guarantee at least monthly phone consultation. Through the             This is an open access article distributed in accordance with
                                                                                         the CC-BY-NC-ND (Creative Commons Attribution-Non-
implementation of the plan, the surgeons guaranteed prompt assistance even to            Commercial-NoDerivatives 4.0 International) license. The
patients who were quarantined or hospitalised for COVID-19, always respect-              article can be used by giving appropriate credit and mentio-
                                                                                         ning the license, but only for non-commercial purposes and
ing formal regulations, correct use of personal protective equipment (PPE) and           only in the original version. For further information: https://
social distancing 4.                                                                     creativecommons.org/licenses/by-nc-nd/4.0/deed.en




192
                                                                                                                                   Head and neck counselling and COVID-19




The protocol was adopted by the most important depart-                                       a nasopharyngeal swab; one tested positive and was im-
ments of Otolaryngology specialised in head and neck sur-                                    mediately hospitalised at the COVID-19 regional reference
gery of our region (Foggia, San Giovanni Rotondo, Barletta,                                  hub “Miulli”.
Bari “Aldo Moro”, Bari “Di Venere”, Brindisi, Tricase).                                      Regarding oncological status, 7 patients (2.7%) were consid-
A group of 340 patients who underwent head and neck surgi-                                   ered as suspect and in-person ENT visits and radiological ex-
cal procedures from 2001 to 2020 were considered potential-                                  aminations were consequently scheduled; out of this group,
ly eligible for counselling and, therefore, included. Eighty-                                four subjects (1.5%) were disease free. Three patients who
three patients (24.4%) did not answer and, after two attempts                                underwent parotidectomy referred the onset of a cervical
to reach them by phone, were therefore excluded. A total of                                  swelling and one had a disease relapse confirmed by ultra-
257 patients (75.6%) were contacted by phone (221 males,                                     sound and computed tomography (CT) of the head and neck.
36 females; mean age 70.59 ± 12.76). Of this group, 168 pa-                                  Another patient who underwent transoral robotic supraglot-
tients (65.4%) underwent total laryngectomy, 35 partial lar-                                 tic laryngectomy had a disease relapse and was submitted
yngectomy (13.6%) and 54 other types of surgery (21.0%).                                     to the regional referral centre for electrochemotherapy and
Mean follow-up time from surgery was 5 years.                                                immunotherapy. Finally, three patients who underwent laser
During the first phone call, patients were invited to answer                                 cordectomy for glottic carcinoma reported positive margins;
a simple questionnaire aimed at assessing the current con-                                   two of these were scheduled for open supraglottic laryngec-
dition of their disease and the eventual presence of new                                     tomy, while another received radiotherapy.
symptoms. Additionally, they were questioned about sus-                                      The decision to monitor these patients with such attention
pected COVID-19 symptoms 5; key questions concerned                                          was given by their fragility 6. In fact, patients affected by
family history of SARS-CoV-2 infection (reverse tran-                                        head and neck cancer are at high risk of COVID-19 and re-
scription polymerase chain reaction [RT-PCR] confirmed                                       lated complications because of immunodeficiency, the high
cases), body temperature check, occurrence or worsening                                      prevalence of risk factors and treatments such as chemo-
of suspected symptoms in the last 30 days, such as cough,                                    therapy/radiotherapy 7. This is particularly evident in elder-
dyspnoea, fatigue, myalgia, cephalalgia and smell and taste                                  ly patients affected by head and neck cancer who tend to be
alterations. Patients were invited to rate their symptoms by                                 more susceptible to severe complications of SARS-CoV-2
using a 0-5 scale, where 0 indicated ‘no problem’ and 5 a                                    infection 8.
‘very intense problem’. Results of the counselling are pre-                                  COVID-19 will probably change the management of head
sented in Table I.                                                                           and neck cancer patients by implementing systems of tel-
Answers were analysed in cooperation with the section of                                     ehealth and online/phone consultations. Even though pa-
Hygiene of the Department of Medical and Surgical Sci-                                       tients suffering from COVID-19 and other urgent and
ence of Foggia University Hospital. When patients gave a                                     emergent conditions have been considered as a priority
score ³ 2 to more than 2 questions, they were considered                                     during the current pandemic, it is extremely important to
as suspect and invited to contact their family physician.                                    not overlook oncologic patients 9. Our experience confirms
Through this phone counselling, 11 patients (4.3%) were                                      the importance of head and neck counselling, especially in
considered at risk of SARS-CoV-2 infection and underwent                                     this new COVID-19 era that has just begun.


Table I. Results of the counselling conducted by the Apulian working group in patients affected by head and neck cancer.
                                                                                  Number of patients                                          Severity of symptoms
                                                                                           (%)                                                       (± SD) *
Family history of COVID-19
(RT-PCR confirmed cases)                                                                            1 (0.4%)                                            N/A
Body temperature (≥ 38°)                                                                            5 (2.0%)                                            N/A
Cough                                                                                              154 (60%)                                         1.5 (± 1.4)
Dyspnoea                                                                                          66 (25.7%)                                         0.4 (± 0.7)
Fatigue                                                                                           56 (21.8%)                                         0.3 (± 0.7)
Myalgia                                                                                           54 (21.0%)                                         0.3 (± 0.7)
Cephalalgia                                                                                       39 (15.2%)                                         0.2 (± 0.6)
Smell/taste impairment (worsening)                                                                101 (39.3%)                                        0.7 (± 1.2)
* Patients were invited to rate their symptoms by using a 0-5 scale, where 0 indicated ‘no problem’ and 5 a ‘very intense problem’. N/A: not applicable; RT-PCR: reverse
transcription polymerase chain reaction.




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L. Magaldi et al.




Apulian Working Group: Francesco Barbara, Michele                         4
                                                                              Wu V, Noel CW, Forner D, et al. Considerations for head and neck
Barbara, Giada Cavallaro, Aurelio d’Ecclesia, Maria Luisa                     oncology practices during the coronavirus disease 2019 (COVID-19)
                                                                              pandemic: Wuhan and Toronto experience. Head Neck 2020;42:1202-
Fiorella, Renato Franza, Matteo Gelardi, Francesco Lon-                       8. https://doi.org/10.1002/hed.26205
go, Pier Gerardo Marano, Raffaele Marfelli, Domenico                      5
                                                                              Chen N, Zhou M, Dong X, et al. Epidemiological and clinical char-
Petrone, Paolo Petrone, Nicola Quaranta, Gianluca Ronca,                      acteristics of 99 cases of 2019 novel coronavirus pneumonia in Wu-
Emanuele Scarano.                                                             han, China: a descriptive study. Lancet 2020;395:507-513. https://doi.
                                                                              org/10.1016/S0140-6736(20)30211-7
                                                                          6
                                                                              Yuen E, Fote G, Horwich P, et al. Head and neck cancer care in the
References                                                                    COVID-19 pandemic: a brief update. Oral Oncol 2020;105:104738.
                                                                              https://doi.org/10.1016/j.oraloncology.2020.104738
1
    Ansarin M. Surgical management of head and neck tumours during
    the SARS-CoV (COVID-19) pandemic. Acta Otorhinolaryngol Ital
                                                                          7
                                                                              Yan F, Nguyen SA. Head and neck cancer: highrisk population for
    2020;40:87-9. https://doi.org/10.14639/0392-100X-N0783                    COVID19. Head Neck 2020;42:1150-2. https://doi.org/10.1002/
                                                                              hed.26209
2
    Gelardi M, Iannuzzi L, Trecca EMC, et al. COVID-19: what happened
    to all of the otolaryngology emergencies? Eur Arch Otorhinolaryngol   8
                                                                              Sharma A, Crosby DL. Special considerations for elderly patients
    2020;277:3231-2. https://doi.org/10.1007/s00405-020-06046-z               with head and neck cancer during the COVID19 pandemic. Head
3
    Canadian Association of Head & Neck Surgical Oncology (CAHN-              Neck 2020;42:1147-9. https://doi.org/10.1002/hed.26216
    SO) Guidelines for Management of Head & Neck Cancer During the        9
                                                                              Adjei Boakye E, Jenkins W, Sharma A. Disproportionate impact of
    COVID-19 Pandemic. Canada: CAHNSO. Accessed April 8, 2020.                COVID-19 pandemic on head and neck cancer survivors. Head Neck
    https://cahnso.com/covid-19 resources/                                    2020;42:1329-31. https://doi.org/10.1002/hed.26170




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