Systematic review of international guidelines for head and neck oncology management in COVID-19 patients

European Archives of Oto-Rhino-Laryngology https://doi.org/10.1007/s00405-021-06823-4 HEAD AND NECK Systematic review of international guidelines for head and neck oncology management in COVID‑19 patients Laurence Gascon1,2 · Isabelle Fournier1,2 · Carlos Chiesa‑Estomba1,3 · Gennaro Russo1,4 · Nicolas Fakhry1,5 · Jérôme R. Lechien1,6 · Lisa Burnell1,7 · Sebastien Vergez1,8 · Osama Metwaly1,9 · Pasquale Capasso1,4 · Tareck Ayad1,2 Received: 19 August 2020 / Accepted: 11 April 2021 © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021 Abstract Purpose The coronavirus pandemic has redefined the practice of head and neck surgeons in the management of oncology patients. Several countries have issued practice recommendations in that context. This review is a collaboration of the YOIFOS (Young Otolaryngologists of the International Federation of Otolaryngological Societies) group in order to summarize, in a systematic way, all available guidelines and provide clear guidelines for the management of head and neck cancer patients in the COVID-19 pandemic. Methods This systematic review was performed according to the PRISMA statements. Inclusion criteria for the systematic review were based on the population, intervention, comparison, and outcomes according to (PICO) framework. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to assess quality of all practice guidelines included in this review. Results Recommendations include adjustments regarding new patients’ referral such as performing a pre-appointment triage and working in telemedicine when possible. Surgical prioritization must be adjusted in order to respect pandemic requirements. High-grade malignancies should, howeve,r not be delayed, due to potential serious consequences. Many head and neck interventions being aerosol-generating procedures, COVID-19 testing prior to a surgery and adequate PPE precautions are essential in operating rooms. Conclusion These recommendations for head and neck oncology patients serve as a guide for physicians in the pandemic. Adjustments and updates are necessary as the pandemic evolves. Keywords COVID-19 · Coronavirus · Head and neck cancer · Oncology · Guidelines Laurence Gascon and Isabelle Fournier have equally contributed to this work and should be regarded as joint first authors. * Tareck Ayad 1 Task Force COVID-19 of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France 2 Division of Otolaryngology‑Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal, 1051, rue Sanguinet, Montréal, QC H2X 0C1, Canada 3 Department of Otorhinolaryngology‑Head and Neck Surgery, Hospital Universitario Donostia, San Sebastián, Spain 4 Otolaryngology Head and Neck Surgery Unit of “Azienda Ospedaliera di Rilievo Nazionale dei Colli, Ospedale Monaldi”, Naples, Italy 5 Otolaryngology‑Head and Neck Surgery Department, University Hospital of la Conception, APHM, Aix-Marseille Univ, Marseille, France 6 Department of Otolaryngology‑Head and Neck Surgery, School of Medicine, Foch Hospital, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France 7 ENT Morningside, Morningside Mediclinic Sandton, Johannesburg, South Africa 8 Head and Neck Surgery Department, University Cancer Institute of Toulouse-Oncopole, Toulouse University Hospital, Toulouse, France 9 Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt 13 Vol.:(0123456789) European Archives of Oto-Rhino-Laryngology Introduction The coronavirus pandemic has forced Otorhinolaryngologists Head and Neck Surgeons (ORL-HNS) to redefine their practice. First, ORL-HNS are faced with an increased risk to be exposed to COVID-19 due to high viral loads in the upper respiratory tract [1]. Second, several hospitals have significantly reduced planned surgeries to avoid overwhelming the healthcare system and to conserve critical resources. However, ORL-HNS have an obligation to ensure that each of their patients can benefit from the most appropriate treatment possible, despite the pandemic. This is even more true for oncologic patients, where the choice of treatment plan can have a direct impact on the patient’s survival outcome and quality of life. To guide ORL-HNS navigate in health systems with limited services and to minimize the patients and otolaryngology team’s exposure to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), several countries have issued practice recommendations regarding oncologic patients. The objective of this study is to systematic review all available guidelines and assess their quality. As an initiative of the “Young Otolaryngologist Group of the International Federation of Otolaryngologic Societies” (YO-IFOS), this review aims to summarize in a systematic way the available recommendations for management of H&N cancer in the COVID-19 pandemic era and assess the quality of available guidelines. These recommendations are mostly oriented for otolaryngologists but could be useful for any physician treating and following head and neck oncology patients. Materials and methods This systematic and qualitative review was performed according to the PRISMA template for systematic reviews and meta-analyses [2, 3]. The following clinical databases were consulted to collect information: PUBMED, Google Scholar, Ovid Medline and Scopus. International ORLHNS societies, and association websites were reviewed to find guidelines and recommendation documents regarding the COVID-19 pandemic. Search terms included “SARSCoV-2”, “COVID-19”, “guidelines/practice guidelines/clinical guidelines,” “recommendations” “consensus,” “ENT,” “head and Neck surgery”, “oncology surgery”, “head and neck cancer”. Researches were also performed on all the international societies and associations’ websites in order to obtain their guidelines and recommendations if available. Research was conducted from January 2020 to May 2020. Two reviewers (L.G. and I.F.) examined available guidelines and only included those that were relevant to oncology surgery. They both independently performed title and 13 abstract screening and full text reviews. Citations that did not meet the inclusion criteria were discarded. The most recent version or update of each clinical guideline was included and analyzed. Reviewers resolved disagreements through discussion. Inclusion criteria for the systematic review were based on the population, intervention, comparison, and outcomes according to (PICO) framework [4]. Populations Inclusion criteria consisted of COVID-19 guidelines for otolaryngologist and head and neck surgeons, for head and neck oncology treatment strategies and for oncology surgeries. Guidelines in French, English, Spanish and Portuguese were included. Intervention and comparison Reviewed guidelines and recommendation docume (...truncated)