Title: Impact of the COVID-19 pandemic on the severity of newly diagnosed cases of head and neck squamous cell carcinoma in southern Brazil

doi:10.21203/rs.3.rs-2436701/v1

Download PDF

Research Article

Title: Impact of the COVID-19 pandemic on the severity of newly diagnosed cases of head and neck squamous cell carcinoma in southern Brazil

https://doi.org/10.21203/rs.3.rs-2436701/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Purpose

Responsible for more than 360 thousand deaths in the world, head and neck squamous cell carcinoma (HNSCC) is an important public health problem worldwide, being more prevalent in men, smokers and alcoholics, aged over 40 years and with lower socioeconomic status. Some of these risk factors are also common to an increased risk of developing severe cases of COVID-19, the pandemic that has been affecting the world since the beginning of 2020. The aim of this study was to retrospectively assess the impact of the COVID-19 pandemic on the HNSCC diagnosis and severity of the disease in a hospital in southern Brazil.

Methods

All new cases diagnosed with HNSCC from March 11, 2019 to March 10, 2020 (pre-COVID-19 group) and all new cases diagnosed from March 11, 2010 to March 10, 2021 (COVID-19 group) were included. Data were obtained through histopathological reports and medical records.

Results

There was no difference in the number of new diagnoses in the COVID-19 group (n = 45) compared to the pre-COVID-19 group (n = 47). Patients' sociodemographic profile, time between diagnosis and treatment, and overall TNM staging were similar. However, the clinical N classification was more severe in the COVID-19 group (p = 0.021). Patients diagnosed during the COVID-19 pandemic were 4.05 times more likely to have more severe lymph node involvement (95% CI:1.62–10.12).

Conclusion

Although there was no reduction in the new diagnosis of HNSCC in the period of greater restriction of COVID-19 pandemic, the diagnosed cases showed lymph node metastasis in more advanced stages.

Squamous Cell Carcinoma of Head and Neck. Diagnosis. Lymph Nodes. COVID-19 pandemics

Until November 2022, there were 637.404.847 confirmed cases of COVID-19 and 6.608.893 deaths from the disease worldwide. In Brazil, the first cases were confirmed in February 2020 and, by the end of November 2022, there were 35.104.673 confirmed cases of COVID-19 and 689 341 deaths reported to the World Health Organization. [1] The mortality rate due to SARS-CoV-2 infection in 2020 in Brazil was estimated at 0.032% in the population under 30 years old; 0.22% in individuals aged 30 to 49 years, 1.2% (50–69 years) and 3.0% in patients aged 70 years or older. [2] Studies that evaluated the predictive factors that could be associated with a worse prognosis and greater risk for the development of severe cases and death from COVID-19 concluded that older male smokers, mainly over 65 years of age and/or those with comorbidities were at increased risk of developing a critical or fatal COVID-19 condition. [3–5]

The COVID-19 pandemic has led to interruption and/or delay in the diagnosis and treatment of other diseases, including neoplastic disorders. Authors estimated that the delay in diagnosis of breast, lung, stomach, pancreatic, prostate, esophageal and colorectal cancer due to the COVID-19 pandemic may result in more advanced disease stages, worse prognosis and substantial increases in the number of deaths. [6–8]

The restrictions imposed by the COVID-19 pandemic also had an impact on reducing the number of new diagnoses of head and neck cancer. [9, 10] With the social distancing measures adopted to control the spread of the COVID-19 pandemic in Brazil, it is believed that, as in other countries, many patients stopped seeking care to evaluate head and neck injuries, resulting in a delay in the diagnosis and, consequently, a worse prognosis for the patient. [11] There is little evidence on the impact of COVID-19 on the diagnosis and extent of head and neck cancer in low-income countries, especially considering confounding variables. Our hypothesis is that there would be a reduction in the number of patients diagnosed with head and neck squamous cell carcinoma (HNSCC) during the period of greater restriction and social distancing imposed by COVID-19, and that these cases would be related to indicators of more advanced stages of the disease. Thus, the objective of this study was to evaluate the impact of the COVID-19 pandemic on the number of new diagnoses of HNSCC and the severity of cases diagnosed in a tertiary care center, a reference for the treatment of head and neck cancer in southern Brazil.

This was a retrospective observational study conducted at the largest public hospital in the central region of the state of Rio Grande do Sul, Brazil, which is a reference center for the treatment of head and neck cancer. Data were collected by a single researcher from November 2021 to June 2022 and were obtained through histopathological reports and electronic medical records. The study was approved by the Research Ethics Committee of the Federal University of Santa Maria (CAAE: 52381921.2.0000.5346 / Approval Opinion number: 5.046.605).

All new cases diagnosed with squamous cell carcinoma of the mouth, oropharynx, hypopharynx or larynx from March 11, 2019 to March 10, 2021 were included in the study. Cases of recurrent disease were excluded from the sample. The groups were divided as follows: pre-COVID-19 group (cases diagnosed between March 11, 2019 and March 10, 2020); COVID-19 group (cases diagnosed between March 11, 2020 and March 10, 2021). This date, which marks the beginning of data collection in the COVID-19 group, was chosen because it was the day on which the World Health Organization declared that COVID-19 was now characterized as a pandemic. [12] From that date, several measures to mitigate the spread of SARS-CoV-2 were implemented in Brazil. [13]

The data collected were: date of the histopathological diagnosis, sociodemographic data of the patients (gender, ethnicity, age and level of education), place of residence (inside or outside the municipality where the hospital was located), habits (smoking and alcoholism), data related to the tumor (location of the primary tumor, size of the primary tumor, lymph node involvement, distant metastasis and TNM clinical staging) and time elapsed between the histopathological diagnosis and the start of treatment. With regard to alcoholism, patients were classified as non-alcoholic (no alcohol consumption or sporadic consumption) or alcoholic (consumption of one or more drinks per day). [14] The TNM clinical staging of the tumors was performed according to the 8th edition of the AJCC. [15]

Data analysis

Data were analyzed descriptively, with description of means, standard deviations and medians. The primary outcome was the number of cases diagnosed in the two periods (pre-COVID-19 and COVID-19) and the secondary outcome was the extent of the disease.

The Kolmogorov-Smirnov or Shapiro-Wilk test was used to determine the homogeneity of the sample. For statistical purposes, some variables were dichotomized. Age was dichotomized by the median (≤ 61 years old / > 61 years old); level of education was categorized into < 8 years of study / ≥ 8 years of study; ethnicity was categorized as white/non-white; the location of the primary tumor was dichotomized into mouth and oropharynx / hypopharynx and larynx. The TNM was evaluated individually (clinical T classification, clinical N classification and distant metastasis) and also the final staging (I, II, III and IV). Pearson's chi-square and Fisher's exact tests were used to assess associations between pre-COVID-19 and COVID-19 groups and categorical variables; Student's t-test and Mann-Whitney test were used to compare the means of continuous variables in the two groups. Logistic regression models were run to assess the odds ratio of greater severity in the extent of regional lymph node metastasis in relation to clinical and demographic variables. For this, the N classification was dichotomized into N0/N1 (absence or lesser severity of lymph node involvement) and N2/N3 (more severe lymph node involvement). The following categorical variables were evaluated in the crude model: sex, age, education, ethnicity, place of residence, smoking, alcoholism, location of the primary tumor, period of diagnosis (pre-COVID-19 / COVID-19). Only the variables that presented a value of p < 0.20 in the crude model were included in the adjusted model; at the and, a p-value less than 0.05 was considered significant. All statistical tests were performed using SPSS software (Statistical Package for the Social Sciences, PASW, Chicago), version 21.

Between March 11, 2019 and March 10, 2020 (pre-COVID-19 group) 47 new cases of squamous cell carcinoma of the mouth (20), oropharynx (7), hypopharynx (5) and larynx (15) were diagnosed. In the COVID-19 group (March 11, 2020 to March 10, 2021) 45 new cases were diagnosed (14 in the mouth, 7 in the oropharynx, 6 in the hypopharynx and 18 in the larynx). The mean time elapsed between the definitive diagnosis (histopathological) and the start of treatment was similar in both groups: 94.46 ± 55.99 days in the pre-COVID-19 period and 80.81 ± 47.09 days in the COVID-19 period (p = 0.264). The mean age of patients was also similar in both groups: 62.28 ± 10.64 years old in the pre-COVID-19 group and 60.27 ± 7.50 in the COVID-19 group (p = 0.300). There was no statistical difference between the groups in the other sociodemographic variables, nor in relation to habits (Table 1).

Table 1

Sociodemographic data and habits according to the period of diagnosis (pre-COVID-19 / COVID-19)
Variables	Pre-COVID-19 N (%)	COVID-19 N (%)	P-value*
Sex
Woman	4 (8.5)	5 (11.1)	0.737**
Man	43 (91.5)	40 (88.9)
Age
≤ 61 years old	21 (44.7)	27 (60.0)	0.141
> 61 years old	26 (55.3)	18 (40.0)
Place of residence
Within the municipality	22 (46.8)	19 (42.2)	0.658
Outside the municipality	25 (53.2)	26 (57,8)
Schooling
< 8 years of study	34 (72.3)	31 (68.9)	0.716
≥ 8 years of study	13 (27.7)	14 (31.1)
Ethnicity
White	41 (87.2)	39 (86.7)	0.936
Not white	6 (12.8)	6 (13.3)
Smoking
No	4 (8.5)	2 (4.4)	0.677**
Yes	43 (91.5)	43 (95.6)
Alcoholism
No	19 (40.4)	12 (26.7)	0.163
Yes	28 (59.6)	33 (73.3)
Total	47 (100)	45 (100)

*Chi-Square Test; **Fisher’s Exact Test

Data referring to the disease are described in Table 2. There was no statistically significant difference between the analyzed variables, except for the variable clinical N classification, in which a smaller number of cases diagnosed with N0 and N1 and a larger number of cases with N2 and N3 were verified during the period of the COVID-19 pandemic (p = 0.021).

Table 2

Data referring to the disease according to the period of diagnosis (Pre-COVID-19 / COVID-19)
Variables	Pre-COVID-19 n (%)	COVID-19 n (%)	P-value*
Tumor location
Mouth	20 (42.6)	14 (31.1)	0.710
Oropharynx	7 (14.9)	7 (15.6)
Hypopharynx	5 (10.6)	6 (13.3)
Larynx	15 (31.9)	18 (40.0)
Clinical T Classification***
T1	7 (14.9)	6 (13.3)	0.644**
T2	10 (21.3)	5 (11.1)
T3	11 (23.4)	11 (24.4)
T4	19 (40.4)	21 (46,7)
Clinical N Classification***
N0	19 (40.4)	10 (22.2)	0.021
N1	9 (19.2)	3 (6.7)
N2	14 (29.8)	25 (55.5)
N3	4 (8.5)	7 (15.6)
Distant metastasis***
No	41 (87.2)	43 (95.6)	0.434**
Yes	5 (10.6)	2 (4.4)	0.434**
TNM clinical staging***
I	7 (14.9)	5 (11.1)	0.248
II	5 (10.6)	1 (2.2)
III	9 (19.2)	6 (13.3)
IV	26 (55.3)	32 (71.1)
Total	47	45
Chi-Square Test; Fisher’s Exact Test; ** Missing data

Table 3 shows the results of the binary logistic regression model (crude and adjusted) that was run to determine the odds ratio of diagnosing cases with a greater extent of lymph node involvement during the period of the COVID-19 pandemic. After adjustment, patients diagnosed during the COVID-19 pandemic were 4.05 times more likely to have more severe lymph node involvement (N2 and N3) when compared to patients diagnosed in the pre-COVID-19 period (95% CI: 1.62–10.12).

Table 3

Evaluation of the extent of the disease, determined by the degree of lymph node involvement (absent or less severe versus more severe) and associated variables.
Clinical variables	Crude OR (95% CI)	p*	Adjusted OR (95% CI)	p**
Tumor location
Mouth / oropharynx	1.0	0.191	1.0	0.083
Hypopharynx / larynx	0.57 (0.25–1.32)		0.45 (0.18–1.11)
Alcoholism
No	1.0	0.135	-	-
Yes	1.95 (0.81–4.70)
Period of diagnosis
Pre-COVID-19	1.0	0.005	1.0	0.003
COVID-19	3.50 (1.46–8.36)		4.05 (1.62–10.12)

Crude binary logistic regression* and adjusted binary logistic regression**; OR: odds ratio; (-): variables not maintained in final model; CI: confidence interval.

In this study carried out in a tertiary reference hospital for the treatment of head and neck cancer in southern Brazil, we carried out a retrospective analysis of all new cases diagnosed with HNSCC during a period of 12 months from the global announcement of the COVID-19 pandemic [12], and we have compared it with a similar pre-pandemic period. With a population of approximately 210 million inhabitants, between March 11, 2020 and March 10, 2021 Brazil had accumulated a total of 11.202.305 cases of COVID-19 and 270.656 deaths from the disease, and immunization of the population through vaccination was still in a very incipient stage. [16] During this period, several social distancing measures to combat COVID-19 were adopted by the different federative units of the country, [17] which ended up having an impact on a considerable reduction in the number of new cancer diagnoses in all Brazilian regions. [18]

In this study, we found that there was no reduction in the number of new diagnosed cases of HNSCC during the analyzed period of the COVID-19 pandemic. The overall staging determined by the TNM and the time elapsed between diagnosis and the start of treatment were also similar in both groups studied. However, the extent of disease, determined by lymph node metastasis, was more severe in the COVID-19 group, in which patients had a four times greater chance of having lymph node involvement in more advanced stages (N2 and N3). To the best of our knowledge, in addition to the present study, only one study considered covariates that could be confounding factors in assessing the extent of the disease, considering the pre-COVID-19 and COVID-19 periods, and found an increased risk of more advanced clinical nodal staging during the pandemic. [19] Different from these results, other studies that evaluated the impact of the COVID-19 pandemic on the diagnosis of new cases of HNSCC demonstrated a reduction from 22% to more than 50% of new diagnoses during the pandemic, but the stage of the disease and the time of diagnosis were similar in the groups before and during the pandemic. [9, 20] This suggests that, in our study, although the number of patients who received the diagnosis in both groups was similar, in the COVID-19 group, patients must have taken longer to seek care after the onset of the first signs and/or symptoms, which may have impacted on the delay in diagnosis, and, consequently, the cases, when they were diagnosed, already had greater lymph node involvement.

The definition of delay in diagnosis is complex and involves different aspects. The delay can be attributed to the patient (time between the appearance of the first signs and/or symptoms and the first consultation), to he professional (time between the first consultation and the definitive diagnosis) and to the system (time between the definitive diagnosis and the start of treatment). [11] In general, the delay in diagnosis has been evaluated by the mean or median number of days elapsed between the first signs and/or symptoms reported by the patient and obtaining the definitive diagnosis, and the authors use different criteria and arbitrary cutoff points. [21] In our study, it was not possible to assess the time elapsed between the first signs and/or symptoms reported by the patient and the definitive diagnosis. It was only possible to assess the time elapsed between obtaining the definitive diagnosis and starting treatment, and this time was similar in the two periods analyzed. It must be considered, however, that, although there was no difference in the time between the diagnosis and the start of treatment, the mean time interval verified in the present study was high, mainly considering the results of other studies, which demonstrated a mean time of 20 to 28 days between the first patient visit and initiation of treatment during the COVID-19 period. [10, 22]

The impact of delayed diagnosis and initiation of HNSCC treatment on patient survival has been studied. [23] Previous studies that investigated the association between the time interval between diagnosis and treatment initiation and the overall survival of patients with HNSCC found that the time elapsed between diagnosis and initiation of treatment independently affects patient survival, increasing the 5-year mortality risk. [24, 25] A time interval of more than 30 days can potentially decrease survival, [25] and the risk of death is higher when this time lasts for more than 60 days. [24]

The efforts of professionals and the health system in relation to cancer lie in diagnosing and treating these diseases early, since the stage of the disease reflects on the prognosis. According to Brazilian federal legislation, [26] every patient diagnosed with cancer has the right to have treatment started in the Unified Health System (SUS) within a maximum of 60 days after the diagnosis of the disease. A study that evaluated the maximum time delay for the initiation of oral cancer treatment in the SUS, after the publication of the aforementioned legislation, found that between 2013 and 2019 there was a progressive increase in treatments initiated within 30 days and a reduction in cases with more than 60 days delay in starting treatment, especially in 2019. However, 38% of the cases still took more than 60 days to start treatment in 2019. [27] A concern that occurred to many of those working in this field was that the COVID-19 pandemic would negatively impact HNSCC time of diagnosis, disease progression, time to start treatment, and patient prognosis. [17] Our results reinforce this concern, suggesting that goals previously achieved through efforts that were made to reduce mortality and morbidity related to HNSCC may be negatively impacted by the COVID-19 pandemic.

In the present study, there was no statistical difference in the staging of the cases diagnosed in the two groups, but it should be considered that, in both groups, more than two thirds of the diagnosed cases had the disease in advanced stages (stages III and IV), as it had already been demonstrated in other studies, [10, 28] and the COVID-19 pandemic may further aggravate this scenario. In South America we are experiencing situations very similar to those experienced by countries in the northern hemisphere in relation to the COVID-19 pandemic, but with a delay in relation to events. The facts that occurred in the countries of the northern hemisphere anticipated and continue to anticipate the events that also end up occurring in South America, more specifically in Brazil. Two recent studies have demonstrated an increase in the size of newly diagnosed tumors in the COVID-19 period compared to the pre-COVID-19 period, [20, 29] and now our results, confirming the findings of another study, [18] have demonstrated a more advanced clinical lymph node staging.

Although in our study the two groups analyzed covered a period of one year, which may better reflect the demographic and seasonal differences normally seen in different months of the year, this work has the limitation of being a retrospective study. It was not possible to evaluate the time elapsed between the manifestation of the first signs and/or symptoms of the patients and the first visit. As this study was carried out in a tertiary care center, many patients may have sought the first care in basic health units, close to their homes. Another consideration is that it was also not possible to obtain data regarding pathological staging (neither the T pathological classification nor the N pathological classification). This probably occurred due to the fact that many patients were not treated surgically, but only with chemo-radiotherapy, either because of the difficulty in performing surgical procedures during the pandemic, or because of the advanced stage of the tumors.

Our results demonstrated that HNSCC cases diagnosed during the COVID-19 pandemic had the disease with greater severity of clinical lymph node involvement, despite the number of diagnosed cases being similar to that of the pre-pandemic period. Longitudinal studies to assess the impact of COVID-19 on HNSCC diagnosis and treatment, morbidity and mortality are important.

Ethical Approval: The present study is in accordance with the precepts stipulated in the Declaration of Helsinki and was approved by the local human research ethics committee (CAAE: 52381921.2.0000.5346 / Approval Opinion number: 5.046.605).

Competing interests: The authors state that they have no conflicts of interest with people or organizations that could inappropriately influence this work.

Authors' contributions: Kívia Linhares Ferrazzo: Conceptualization and design of the article;; acquisition of data; analysis and interpretation of data; writing the manuscript (original draft, review and editing). Cristiane Cademartori Danesi: Substantial contributions to conception and design of the article; critical review of the article. Nara Maria Beck Martins: Substantial contributions to conception and design of the article; critical review of the article. Raquel Pippi Antoniazzi: Analysis and interpretation of data; critical review of the article. All authors gave final approval of the article.

Funding: Not applicable.

World Health organizadion, 2022. WHO Coronavirus (COVID-19) Dashboard. Disponível em: < https://covid19.who.int/?adgroupsurvey={adgroupsurvey}&gclid=Cj0KCQiA-JacBhC0ARIsAIxybyMNcgNnuQjtRuUlyVBtP-tHQEHwDpy6XPW2F4a9EkbO0hn9zo7cZDoaAhtJEALw_wcB > Acessado em 28 de novembro de 2022.
Marra V, Quartin M. A Bayesian estimate of the early COVID-19 infection fatality ratio in Brazil based on a random seroprevalence survey. Int J Infect Dis. 2021;111:190–195. Doi: 10.1016/j.ijid.2021.08.016.
Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, Li Q, Jiang C, Zhou Y, Liu S, Ye C, Zhang P, Xing Y, Guo H, Tang W. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. 2020;81(2):e16-e25. doi: 10.1016/j.jinf.2020.04.021.
Ou M, Zhu J, Ji P, Li H, Zhong Z, Li B, Pang J, Zhang J, Zheng X. Risk factors of severe cases with COVID-19: a meta-analysis. Epidemiol Infect. 2020;148:e175. doi: 10.1017/S095026882000179X.PMID:
Izcovich A, Ragusa MA, Tortosa F, Lavena Marzio MA, Agnoletti C, Bengolea A, Ceirano A, Espinosa F, Saavedra E, Sanguine V, Tassara A, Cid C, Catalano HN, Agarwal A, Foroutan F, Rada G. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One. 2020;15(11):e0241955. doi: 10.1371/journal.pone.0241955.
Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R, Rachet B, Aggarwal A. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol. 2020;21(8):1023–1034. doi: 10.1016/S1470-2045(20)30388-0.
Kaufman HW, Chen Z, Niles J, Fesko Y. Changes in the Number of US Patients With Newly Identified Cancer Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic. JAMA Netw Open. 2020 Aug 3;3(8):e2017267. doi: 10.1001/jamanetworkopen.2020.17267.
Van Wyk AC, De Jager LJ, Razack R, Van Wyk SS, Kleinhans W, Simonds HM, Schubert PT. The initial impact of the COVID-19 pandemic on the diagnosis of new cancers at a large pathology laboratory in the public health sector, Western Cape Province, South Africa. S Afr Med J. 2021;111(6):570–574.
Crossley JR, Nelson LL, VanDolah H, Davidson BJ, Maxwell JH. The impact of COVID-19 on presentation and diagnosis of head and neck squamous cell carcinoma. Laryngoscope Investig Otolaryngol. 2022 Aug 12;7(5):1436–40. doi: 10.1002/lio2.893.
Yao P, Cooley V, Kuhel W, Tassler A, Banuchi V, Long S, Savenkov O, Kutler DI. Times to Diagnosis, Staging, and Treatment of Head and Neck Cancer Before and During COVID-19. OTO Open. 2021 Nov 22;5(4):2473974X211059429. doi: 10.1177/2473974X211059429.
Güneri P, Epstein JB. Late stage diagnosis of oral cancer: components and possible solutions. Oral Oncol. 2014;50(12):1131–6. doi: 10.1016/j.oraloncology.2014.09.005.
Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157–160. doi: 10.23750/abm.v91i1.9397.
Albani VVL, Albani RAS, Bobko N, Massad E, Zubelli JP. On the role of financial support programs in mitigating the SARS-CoV-2 spread in Brazil. BMC Public Health. 2022;22(1):1781. doi: 10.1186/s12889-022-14155-z.
Giraldi L, Leoncini E, Pastorino R, Wünsch-Filho V, de Carvalho M, Lopez R, Cadoni G, Arzani D, Petrelli L, Matsuo K, Bosetti C, La Vecchia C, Garavello W, Polesel J, Serraino D, Simonato L, Canova C, Richiardi L, Boffetta P, Hashibe M, Lee YCA, Boccia S. Alcohol and cigarette consumption predict mortality in patients with head and neck cancer: a pooled analysis within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. Ann Oncol. 2017;28(11):2843–2851. doi: 10.1093/annonc/mdx486.
Amin MB, Edge SB, Greene FL, et al. AJCC Cancer Staging Manual. 8th ed. New York: Springer; 2017.
Ministério da Saúde. COVID-19 no Brasil. Disponível em: < https://infoms.saude.gov.br/extensions/covid-19_html/covid-19_html.html > Consultado em 12 de dezembro de 2022.
Aquino EML, Silveira IH, Pescarini JM, Aquino R, Souza-Filho JA, Rocha AS, Ferreira A, Victor A, Teixeira C, Machado DB, Paixão E, Alves FJO, Pilecco F, Menezes G, Gabrielli L, Leite L, Almeida MCC, Ortelan N, Fernandes QHRF, Ortiz RJF, Palmeira RN, Junior EPP, Aragão E, Souza LEPF, Netto MB, Teixeira MG, Barreto ML, Ichihara MY, Lima RTRS. Social distancing measures to control the COVID-19 pandemic: potential impacts and challenges in Brazil. Cien Saude Colet. 2020 Jun;25(suppl 1):2423–2446. doi: 10.1590/1413-81232020256.1.10502020.
Marques NP, Silveira DMM, Marques NCT, Martelli DRB, Oliveira EA, Martelli-Júnior H. Cancer diagnosis in Brazil in the COVID-19 era. Semin Oncol. 2021 Apr;48(2):156–159. doi: 10.1053/j.seminoncol.2020.12.002.
Stevens MN, Patro A, Rahman B, Gao Y, Liu D, Cmelak A, Wiggleton J, Kim YJ, Langerman A, Mannion K, Sinard RJ, Netterville JL, Rohde SL, Topf MC. Impact of COVID-19 on presentation, staging, and treatment of head and neck mucosal squamous cell carcinoma. Am J Otolaryngol. 2022;43(1):103263. doi: 10.1016/j.amjoto.2021.103263.
Solis RN, Mehrzad M, Faiq S, Frusciante RP, Sekhon HK, Abouyared M, Bewley AF, Farwell DG, Birkeland AC. The Impact of COVID-19 on Head and Neck Cancer Treatment: Before and During the Pandemic. OTO Open. 2021 Dec 23;5(4):2473974X211068075. doi: 10.1177/2473974X211068075.
Gómez I, Warnakulasuriya S, Varela-Centelles PI, López-Jornet P, Suárez-Cunqueiro M, Diz-Dios P, Seoane J. Is early diagnosis of oral cancer a feasible objective? Who is to blame for diagnostic delay? Oral Dis. 2010 May;16(4):333–42. doi: 10.1111/j.1601-0825.2009.01642.x.
Schoonbeek RC, de Jel DVC, van Dijk BAC, Willems SM, Bloemena E, Hoebers FJP, van Meerten E, Verbist BM, Smeele LE, Halmos GB, Merkx MAW, Siesling S, De Bree R, Takes RP; Dutch Head, Neck Society, the COVID, Cancer-NL consortium. Fewer head and neck cancer diagnoses and faster treatment initiation during COVID-19 in 2020: A nationwide population-based analysis. Radiother Oncol. 2022 Feb;167:42–48. doi: 10.1016/j.radonc.2021.12.005.
Lauritzen BB, Jensen JS, Grønhøj C, Wessel I, von Buchwald C. Impact of delay in diagnosis and treatment-initiation on disease stage and survival in oral cavity cancer: a systematic review. Acta Oncol. 2021 Sep;60(9):1083–1090. doi: 10.1080/0284186X.2021.1931712.
Murphy CT, Galloway TJ, Handorf EA, Egleston BL, Wang LS, Mehra R, Flieder DB, Ridge JA. Survival Impact of Increasing Time to Treatment Initiation for Patients With Head and Neck Cancer in the United States. J Clin Oncol. 2016 Jan 10;34(2):169 – 78. doi: 10.1200/JCO.2015.61.5906.
Liao CT, Chen HN, Wen YW, Lee SR, Ng SH, Liu TW, Tsai ST, Tsai MH, Lin JC, Lou PJ, Wang CP, Chu PY, Leu YS, Tsai KY, Terng SD, Chen TM, Wang CH, Chien CY, Chen WC, Lee LY, Lin CY, Wang HM, Lin CH, Fang TJ, Huang SF, Kang CJ, Chang KP, Yang LY, Yen TC. Association between the diagnosis-to-treatment interval and overall survival in Taiwanese patients with oral cavity squamous cell carcinoma. Eur J Cancer. 2017 Feb;72:226–234. doi: 10.1016/j.ejca.2016.11.010.
Brasil. Lei nº. 12.732, de 22 de novembro de 2012. Disponível em: « http://www.planalto.gov.br/ccivil_03/_ato2011-2014/2012/lei/l12732.htm »
França MASA, Nery NG, Antunes JLF, Freire MDCM. Tempo máximo para o início do tratamento do câncer de boca no Brasil após a publicação da legislação de 2012: tendência no período 2013–2019 [Timeframe for initiating oral cancer treatment in Brazil since approval of new legislation in 2012: time trend, 2013–2019]. Cad Saude Publica. 2021;37(10):e00293220. doi: 10.1590/0102-311X00293220.
Bonzanini LIL, Soldera EB, Ortigara GB, Schulz RE, Antoniazzi RP, Ardenghi TM, Ferrazzo KL. Clinical and sociodemographic factors that affect the quality of life of survivors of head and neck cancer. Support Care Cancer. 2020 Apr;28(4):1941–1950. doi: 10.1007/s00520-019-05008-4.
Kiong KL, Diaz EM, Gross ND, Diaz EM Jr, Hanna EY. The impact of COVID-19 on head and neck cancer diagnosis and disease extent. Head Neck. 2021 Jun;43(6):1890–1897. doi: 10.1002/hed.26665.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Title: Impact of the COVID-19 pandemic on the severity of newly diagnosed cases of head and neck squamous cell carcinoma in southern Brazil

Status:

Version 1

Abstract

Purpose

Methods

Results

Conclusion

Introduction

Methods

Data analysis

Results

Discussion

Declarations

References

Additional Declarations

Status:

Version 1