The impact of the COVID-19 pandemic on time to treatment in head and neck cancer management: a systematic review

• Published in: Acta oncologica Vol. 64; pp. 156 - 166
• Main Authors: Grumstrup Simonsen, Malte, Fenger Carlander, Amanda-Louise, Kronberg Jakobsen, Kathrine, Grønhøj, Christian, Von Buchwald, Christian
• Format: Journal Article
• Language: English
• Published: Sweden MJS Publishing on behalf of Acta Oncologica 28.01.2025; Medical Journals Sweden
• Subjects: COVID-19 - epidemiology; delay; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Humans; Neoplasm Staging; Pandemics; Review; SARS-CoV-2; Squamous Cell Carcinoma of Head and Neck - pathology; Squamous Cell Carcinoma of Head and Neck - therapy; Time to treatment initiation; Time-to-Treatment - statistics & numerical data; tumor stage; waiting time
• ISSN: 1651-226X; 0284-186X; 1651-226X
• DOI: 10.2340/1651-226X.2025.41366

Background and purpose: Coronavirus disease 2019 (COVID-19) caused a need for reorganization in the healthcare systems. First, we aimed to determine the impact of the COVID-19 pandemic on time to treatment in head and neck cancer (HNC) patients. Second, we aimed to determine the impact of COVID-19 on tumor stage and changes in treatment regimens used. Material and methods: A systematic search in PubMed and Embase was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were: (1) Studies including patients with head and neck squamous cell carcinomas; (2) Studies containing a comparison of time to treatment; (3) Studies containing a well-defined time interval with restrictions on health care due to COVID-19 and a well-defined time interval without restrictions. Results: A total of 19 studies were included comprising 24,898 patients treated for HNC cancer. Six studies (10.1% of the patients) reported an increase in waiting time within at least one interval, while seven studies reported a decrease (83.2% of the patients), and six studies found no significant effect. No changes in treatment modalities were observed. Seven of 15 studies (12.7% of the patients) observed an increase in either overall stage, size, or tumor node and metastasis classification during the COVID-19 pandemic. Among these, two studies reported increased waiting times as well. Interpretation: The impact of the COIVD-19 pandemic on time to treatment was heterogenous and subject to considerable intercountry and interregional variations. A tendency toward a higher T-classification was observed. In conclusion, otorhinolaryngology departments demonstrated resilience, as the pandemic led to only slight alterations in time to treatment.