Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus

Hisham Mehanna¹, John C Hardman², Jared A Shenson³, Ahmad K Abou-Foul⁴, Michael C Topf³, Mohammad AlFalasi⁵, Jason Y K Chan⁶, Pankaj Chaturvedi⁷, Velda Ling Yu Chow⁸, Andreas Dietz⁹, Johannes J Fagan¹⁰, Christian Godballe¹¹, Wojciech Golusiński¹², Akihiro Homma¹³, Sefik Hosal¹⁴, N Gopalakrishna Iyer¹⁵, Cyrus Kerawala², Yoon Woo Koh¹⁶, Anna Konney¹⁷, Luiz P Kowalski¹⁸, Dennis Kraus¹⁹, Moni A Kuriakose²⁰, Efthymios Kyrodimos²¹, Stephen Y Lai²², C Rene Leemans²³, Paul Lennon²⁴, Lisa Licitra²⁵, Pei-Jen Lou²⁶, Bernard Lyons²⁷, Haitham Mirghani²⁸, Anthonny C Nichols²⁹, Vinidh Paleri², Benedict J Panizza³⁰, Pablo Parente Arias³¹, Mihir R Patel³², Cesare Piazza³³, Danny Rischin³⁴, Alvaro Sanabria³⁵, Robert P Takes³⁶, David J Thomson³⁷, Ravindra Uppaluri³⁸, Yu Wang³⁹, Sue S Yom⁴⁰, Yi-Ming Zhu⁴¹, Sandro V Porceddu⁴², John R de Almeida⁴³, Chrisian Simon⁴⁴, F Christopher Holsinger³

Affiliations

¹ Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK. Electronic address: h.mehanna@bham.ac.uk.
² Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK.
³ Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA.
⁴ Department of Otolaryngology and Head and Neck Surgery, Walsall Manor Hospital, Walsall, UK.
⁵ Department of Otolaryngology, United Arab Emirates University, Alain, United Arab Emirates.
⁶ Department of Otorhinolaryngology and Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China.
⁷ Department of Otorhinolaryngology and Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
⁸ Department of Surgery, The University of Hong Kong, Hong Kong Special Administrative Region, China.
⁹ Department of Ear, Nose and Throat Surgery, University of Leipzig, Leipzig, Germany.
¹⁰ Division of Otolaryngology, University of Cape Town, Cape Town, South Africa.
¹¹ Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark.
¹² Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Centre, Poznan, Poland.
¹³ Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Atilim University Faculty of Medicine, Ankara, Turkey.
¹⁵ Department of Head and Neck Surgery, National Cancer Centre and Singapore General Hospital, Singapore.
¹⁶ Department of Otorhinolaryngology, Yonsei University, Seoul, South Korea.
¹⁷ Department of Otolaryngology, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, School of Medical Science, Kumasi, Ghana.
¹⁸ Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Sao Paulo, Brazil.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine, Northwell Health Cancer Institute, New York, NY, USA.
²⁰ Department of Otolaryngology-Head and Neck Surgery, Cochin Cancer Research Centre, Cochin, India.
²¹ First Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
²² Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
²³ Department of Otolaryngology and Head and Neck Surgery, Amsterdam University Medical Centre, Cancer Center Amsterdam, VU University, Amsterdam, Netherlands.
²⁴ Department of Otolaryngology and Head and Neck Surgery, St James's Hospital and The Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
²⁵ Foundation IRCCS, Division of Medical Oncology, National Institute of Cancer of Milan, University of Milan, Milan, Italy.
²⁶ Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
²⁷ Department of Otolaryngology Head and Neck Surgery, St Vincent's Hospital, Melbourne, VIC, Australia.
²⁸ Department of Otolaryngology and Head and Neck Surgery, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
²⁹ Department of Otolaryngology-Head and Neck Surgery and Department of Oncology, University of Western Ontario, London, ON, Canada.
³⁰ Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
³¹ Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Lucus Augusti, Lugo, Spain.
³² Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
³³ Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, National Institute of Cancer of Milan, University of Milan, Milan, Italy.
³⁴ Department of Medical Oncology, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
³⁵ Department of Surgery, School of Medicine, Universidad de Antioquia-Hospital Universitario San Vicente Fundación, Medellin, Colombia; CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin, Colombia.
³⁶ Department of Otolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands.
³⁷ Department of Clinical Oncology, The Christie National Health Service Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK.
³⁸ Division of Otolaryngology-Head and Neck Surgery, Dana-Farber and Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA.
³⁹ Department of Head and Neck Surgery, Fudan University, Shanghai Cancer Center, Shanghai, China.
⁴⁰ Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
⁴¹ Department of Head and Neck Surgery, National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴² Department of Cancer Services, Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
⁴³ Department of Otolaryngology-Head and Neck Surgery and Department of Surgical Oncology, University Health Network, Toronto, ON, Canada; Department of Otolaryngology-Head and Neck Surgery, Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁴⁴ Department of Otolaryngology and Head and Neck Surgery, Lausanne University Hospital, Lausanne, Switzerland.

PMID: 32534633
PMCID: PMC7289563
DOI: 10.1016/S1470-2045(20)30334-X

Review

Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus

Hisham Mehanna et al. Lancet Oncol. 2020 Jul.

. 2020 Jul;21(7):e350-e359.

doi: 10.1016/S1470-2045(20)30334-X. Epub 2020 Jun 11.

Authors

Affiliations

¹ Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK. Electronic address: h.mehanna@bham.ac.uk.
² Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK.
³ Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA.
⁴ Department of Otolaryngology and Head and Neck Surgery, Walsall Manor Hospital, Walsall, UK.
⁵ Department of Otolaryngology, United Arab Emirates University, Alain, United Arab Emirates.
⁶ Department of Otorhinolaryngology and Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China.
⁷ Department of Otorhinolaryngology and Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India.
⁸ Department of Surgery, The University of Hong Kong, Hong Kong Special Administrative Region, China.
⁹ Department of Ear, Nose and Throat Surgery, University of Leipzig, Leipzig, Germany.
¹⁰ Division of Otolaryngology, University of Cape Town, Cape Town, South Africa.
¹¹ Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark.
¹² Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Centre, Poznan, Poland.
¹³ Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Atilim University Faculty of Medicine, Ankara, Turkey.
¹⁵ Department of Head and Neck Surgery, National Cancer Centre and Singapore General Hospital, Singapore.
¹⁶ Department of Otorhinolaryngology, Yonsei University, Seoul, South Korea.
¹⁷ Department of Otolaryngology, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, School of Medical Science, Kumasi, Ghana.
¹⁸ Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Sao Paulo, Brazil.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine, Northwell Health Cancer Institute, New York, NY, USA.
²⁰ Department of Otolaryngology-Head and Neck Surgery, Cochin Cancer Research Centre, Cochin, India.
²¹ First Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
²² Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
²³ Department of Otolaryngology and Head and Neck Surgery, Amsterdam University Medical Centre, Cancer Center Amsterdam, VU University, Amsterdam, Netherlands.
²⁴ Department of Otolaryngology and Head and Neck Surgery, St James's Hospital and The Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
²⁵ Foundation IRCCS, Division of Medical Oncology, National Institute of Cancer of Milan, University of Milan, Milan, Italy.
²⁶ Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
²⁷ Department of Otolaryngology Head and Neck Surgery, St Vincent's Hospital, Melbourne, VIC, Australia.
²⁸ Department of Otolaryngology and Head and Neck Surgery, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
²⁹ Department of Otolaryngology-Head and Neck Surgery and Department of Oncology, University of Western Ontario, London, ON, Canada.
³⁰ Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
³¹ Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Lucus Augusti, Lugo, Spain.
³² Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
³³ Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, National Institute of Cancer of Milan, University of Milan, Milan, Italy.
³⁴ Department of Medical Oncology, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
³⁵ Department of Surgery, School of Medicine, Universidad de Antioquia-Hospital Universitario San Vicente Fundación, Medellin, Colombia; CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin, Colombia.
³⁶ Department of Otolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands.
³⁷ Department of Clinical Oncology, The Christie National Health Service Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK.
³⁸ Division of Otolaryngology-Head and Neck Surgery, Dana-Farber and Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA.
³⁹ Department of Head and Neck Surgery, Fudan University, Shanghai Cancer Center, Shanghai, China.
⁴⁰ Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
⁴¹ Department of Head and Neck Surgery, National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴² Department of Cancer Services, Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
⁴³ Department of Otolaryngology-Head and Neck Surgery and Department of Surgical Oncology, University Health Network, Toronto, ON, Canada; Department of Otolaryngology-Head and Neck Surgery, Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁴⁴ Department of Otolaryngology and Head and Neck Surgery, Lausanne University Hospital, Lausanne, Switzerland.

PMID: 32534633
PMCID: PMC7289563
DOI: 10.1016/S1470-2045(20)30334-X

Abstract

The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.

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Figures

**Figure**
HNCIG modified Delphi process HNCIG=Head and Neck Cancer International Group.

See this image and copyright information in PMC

Comment in

Head and neck surgery recommendations during the COVID-19 pandemic.
Galloway TJ, Kowalski LP, Matos LL, Junior GC, Ridge JA. Galloway TJ, et al. Lancet Oncol. 2020 Sep;21(9):e416. doi: 10.1016/S1470-2045(20)30440-X. Lancet Oncol. 2020. PMID: 32888466 Free PMC article. No abstract available.
Head and neck surgery recommendations during the COVID-19 pandemic - Author's reply.
Mehanna H. Mehanna H. Lancet Oncol. 2020 Sep;21(9):e417. doi: 10.1016/S1470-2045(20)30480-0. Lancet Oncol. 2020. PMID: 32888467 Free PMC article. No abstract available.

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Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus

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Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus

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