Ethical Surgical Triage of Patients with Head and Neck Cancer During the COVID-19 Pandemic

Overview

Journal Head Neck

Specialties General Surgery
Oncology

Date 2020 May 2

PMID 32357378

Citations 11

Authors

Francisco J Civantos

Jason M Leibowitz

David J Arnold

Vanessa C Stubbs

Jennifer H Gross

Giovana R Thomas

Zoukaa Sargi

Roy R Casiano

Elizabeth J Franzmann

Donald Weed

Cesar Perez

Michael Samuels

Kenneth W Goodman

W Jarrard Goodwin

Affiliations

Soon will be listed here.

Abstract

Background: Coronavirus has serially overtaken our metropolitan hospitals. At peak, patients with acute respiratory distress syndrome may outnumber mechanical ventilators. In our Miami Hospital System, COVID-19 cases have multiplied for 4 weeks and elective surgery has been suspended.

Methods: An Otolaryngologic Triage Committee was created to appropriately allocate resources to patients. Hospital ethicists provided support. Our tumor conference screened patients for nonsurgical options. Patients were tested twice for coronavirus before performing urgent contaminated operations. N95 masks and protective equipment were conserved when possible. Patients with low-grade cancers were advised to delay surgery, and other difficult decisions were made.

Results: Hundreds of surgeries were canceled. Sixty-five cases screened over 3 weeks are tabulated. Physicians and patients expressed discomfort regarding perceived deviations from standards, but risk of COVID-19 exposure tempered these discussions.

Conclusions: We describe the use of actively managed surgical triage to fairly balance our patient's health with public health concerns.

Citing Articles

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Oral cancer management in the SARS-CoV-2 Pandemic-Indian scenario.

Carvalho K, Gaunkar R, Nagarsekar A J Family Med Prim Care. 2021; 10(3):1090-1094.

PMID: 34041135 PMC: 8140224. DOI: 10.4103/jfmpc.jfmpc_1948_20.

Palliative Reconstructive Surgery for Advanced Maxillofacial Osteosarcoma in the Peak of COVID-19 Pandemic: A Matter of Ethical Decision-making.

Gasteratos K, Alser O, Hart J, Chaiyasate K Plast Reconstr Surg Glob Open. 2021; 9(3):e3545.

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Impact of Strategies for Mitigating Delays and Disruptions in Cancer Care Due to COVID-19: Systematic Review.

Pacheco R, Martimbianco A, Roitberg F, Ilbawi A, Riera R JCO Glob Oncol. 2021; 7:342-352.

PMID: 33656910 PMC: 8081509. DOI: 10.1200/GO.20.00632.

The Effects of COVID-19 on Cancer Care Provision: A Systematic Review.

Alom S, Chiu C, Jha A, Lai S, Yau T, Harky A Cancer Control. 2021; 28:1073274821997425.

PMID: 33631953 PMC: 8482720. DOI: 10.1177/1073274821997425.

References

Pou A . Hurricane Katrina and disaster preparedness. N Engl J Med. 2008; 358(14):1524. DOI: 10.1056/NEJMc086028. View

Gall C, Wetzel R, Kolker A, Kanter R, Toltzis P . Pediatric Triage in a Severe Pandemic: Maximizing Survival by Establishing Triage Thresholds. Crit Care Med. 2016; 44(9):1762-8. DOI: 10.1097/CCM.0000000000001759. View

Bolkan H, Bash-Taqi D, Samai M, Gerdin M, von Schreeb J . Ebola and indirect effects on health service function in sierra leone. PLoS Curr. 2015; 6. PMC: 4318968. DOI: 10.1371/currents.outbreaks.0307d588df619f9c9447f8ead5b72b2d. View

Ross S, Lauer C, Miles W, Green J, Christmas A, May A . Maximizing the Calm before the Storm: Tiered Surgical Response Plan for Novel Coronavirus (COVID-19). J Am Coll Surg. 2020; 230(6):1080-1091.e3. PMC: 7128345. DOI: 10.1016/j.jamcollsurg.2020.03.019. View

Daugherty Biddison L, Berkowitz K, Courtney B, De Jong C, Devereaux A, Kissoon N . Ethical considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014; 146(4 Suppl):e145S-55S. DOI: 10.1378/chest.14-0742. View

Demmler G, Ligon B . Severe acute respiratory syndrome (SARS): a review of the history, epidemiology, prevention, and concerns for the future. Semin Pediatr Infect Dis. 2003; 14(3):240-4. PMC: 7128384. DOI: 10.1016/s1045-1870(03)00056-6. View

Kanter R . Would triage predictors perform better than first-come, first-served in pandemic ventilator allocation?. Chest. 2014; 147(1):102-108. DOI: 10.1378/chest.14-0564. View

Pou A . Ethical and legal challenges in disaster medicine: are you ready?. South Med J. 2012; 106(1):27-30. DOI: 10.1097/SMJ.0b013e31827ca40c. View

Vilar-Compte D, Shah D, Vanichanan J, Cornejo-Juarez P, Garcia-Horton A, Volkow P . Influenza in patients with hematological malignancies: Experience at two comprehensive cancer centers. J Med Virol. 2017; 90(1):50-60. PMC: 5761331. DOI: 10.1002/jmv.24930. View

10.

Hasan S, Ahmad S, Masood R, Saeed S . Ebola virus: A global public health menace: A narrative review. J Family Med Prim Care. 2019; 8(7):2189-2201. PMC: 6691429. DOI: 10.4103/jfmpc.jfmpc_297_19. View

11.

Civantos A, Carey R, Lichtenstein G, Lukens J, Cohen R, Rassekh C . Care of immunocompromised patients with head and neck cancer during the COVID-19 pandemic: Two challenging and informative clinical cases. Head Neck. 2020; 42(6):1131-1136. PMC: 7262192. DOI: 10.1002/hed.26165. View

12.

Ahn D, Shin H, Kim M, Lee S, Kim H, Myoung J . Current Status of Epidemiology, Diagnosis, Therapeutics, and Vaccines for Novel Coronavirus Disease 2019 (COVID-19). J Microbiol Biotechnol. 2020; 30(3):313-324. PMC: 9728410. DOI: 10.4014/jmb.2003.03011. View

13.

Pottie K . Cancer in a time of Ebola. CMAJ. 2016; . PMC: 4938696. DOI: 10.1503/cmaj.151363. View

14.

Azhar E, Hui D, Memish Z, Drosten C, Zumla A . The Middle East Respiratory Syndrome (MERS). Infect Dis Clin North Am. 2019; 33(4):891-905. PMC: 7127753. DOI: 10.1016/j.idc.2019.08.001. View

15.

Prachand V, Milner R, Angelos P, Posner M, Fung J, Agrawal N . Medically Necessary, Time-Sensitive Procedures: Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic. J Am Coll Surg. 2020; 231(2):281-288. PMC: 7195575. DOI: 10.1016/j.jamcollsurg.2020.04.011. View

16.

Christian M . Triage. Crit Care Clin. 2019; 35(4):575-589. PMC: 7127292. DOI: 10.1016/j.ccc.2019.06.009. View

17.

Kowalski L, Sanabria A, Ridge J, Ng W, de Bree R, Rinaldo A . COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice. Head Neck. 2020; 42(6):1259-1267. PMC: 7262203. DOI: 10.1002/hed.26164. View

18.

Falzone E, Pasquier P, Hoffmann C, Barbier O, Boutonnet M, Salvadori A . Triage in military settings. Anaesth Crit Care Pain Med. 2016; 36(1):43-51. DOI: 10.1016/j.accpm.2016.05.004. View

19.

Schmitz J, Tang Y . The GenMark ePlex: another weapon in the syndromic arsenal for infection diagnosis. Future Microbiol. 2018; 13:1697-1708. PMC: 6439521. DOI: 10.2217/fmb-2018-0258. View

20.

Wang S, Lifson M, Inci F, Liang L, Sheng Y, Demirci U . Advances in addressing technical challenges of point-of-care diagnostics in resource-limited settings. Expert Rev Mol Diagn. 2016; 16(4):449-59. PMC: 4943866. DOI: 10.1586/14737159.2016.1142877. View