Skip to main content
. 2020 May 13;42(7):1460–1465. doi: 10.1002/hed.26227

TABLE 3.

Brief of guidelines and recommendations given by FHNO for the management of HNC during COVID‐19 epidemic 15

  • I

    DIAGNOSIS

  • Fiber optic and direct laryngoscopies should be avoided unless absolutely mandatory, to help protect health care workers from aerosol generated during procedure.

  • Biopsies of benign lesions need to be avoided.

  • FNACs from neck nodes should be preferred for obtaining diagnosis, in case of laryngeal/hypopharyngeal primaries, where biopsies will entail some form of endoscopy.

  • II

    TREATMENT

  • A

    Surgery

  • It should be taken in consideration with its likely outcomes, likelihood of curing the cancer, safety considerations and utilization of infrastructure which may be required for management of COVID‐19 related emergencies.

  • All patients should be considered as asymptomatic carriers and adequate precautions to be taken prior to performing any surgical procedure like use of appropriate/best available PPE.

  • Delay or postpone surgery in patients with low grade tumors.

  • Avoid extensive surgery in patients with advanced age (>65 years) with comorbidities.

  • For reconstruction, avoid complex microvascular reconstructive surgery requiring long hours and use of local and regional flaps should be considered.

  • Avoid performing surgeries that require elective tracheostomies.

  • Avoid surgeries that require powered instrumentation (bone cutting instruments, saws, micromotors, drills, and so forth).

  • Avoid surgeries on patients with low hemoglobin to avoid the use of blood and blood products.

  • B

    Radiotherapy

  • Patients should be triaged and prioritized based on their diagnosis, prognosis and urgency for initiating treatment.

  • Hypofractionation schedules have proven to be equivalent in many clinical scenarios in head and neck cancers and should be pursued where appropriate.

  • Palliative radiotherapy treatment for symptomatic relief can be delivered in single fraction or weekly once regimens.

  • B

    Chemotherapy

  • The decision to use concurrent therapies like chemotherapy/targeted therapy should be taken judiciously on the expected benefit of the concurrent therapy to overall outcomes vis a vis the risk of the patient acquiring COVID‐19 infection and succumbing to it.

  • II

    FOLLOW‐UP

  • It is advised to minimize all follow‐up appointments.

  • Defer follow‐up for patients with low risk of recurrence (eg, 18‐24 months posttreatment).

  • Prioritize patients in immediate posttreatment period and those with high risk for recurrence.

  • Consider longer intervals between follow‐ups and consider teleconsultation for follow‐up where possible to triage follow‐up requirements.

Abbreviations: FHNO, Foundation for Head and Neck Oncology; HNC, head and neck cancer; PPE, personal protective equipment.