Page 124 - Portuguese Journal - SPORL - Vol 61. Nº1

led to the temporary suspension of routine study which involved the review of the clinical
hospital activity and changes in the clinical records of all adult patients (>18 years) with
management of all patients, including those an initial diagnosis of HNC in the department
being considered for priority treatment such as of otorhinolaryngology (ORL) of the Vila Nova
cancer patients. In addition to the restrictions de Gaia/Espinho Hospital Center between
imposed by the COVID-19 pandemic in terms September 2018 and September 2021.
of access to health care services, the fear
among the population, especially during the Study variables:
first pandemic phase, led to a decrease in the The patients were divided into two groups:
number of people seeking medical care . Group A (pre-COVID-19) – patients who started
5,6
Thus, there were concerns about possible treatment before the COVID-19 pandemic
delays in the diagnosis and start of treatment (between September 1, 2018, and March 10,
of patients with HNC. The objective of this study 2020); Group B (post-COVID-19) – patients
was to compare patients with HNC who were who started treatment after the start of
treated in the pre- and post-COVID-19 period the COVID-19 pandemic (between March 11,
with regard to the duration of symptoms, time 2020, and September 30, 2021). The analyzed
to diagnosis and treatment, type of treatment, variables included sex, age, functional capacity
and prognosis. Accordingly, patients who (according to the Karnofsky and ECOG scales;
started treatment 18 months before the Figure 1), presenting symptoms of the disease,
beginning of the COVID-19 pandemic were location of the first medical evaluation, tumor
compared with those who were treated in the site, histological type of the tumor, primary
18 months following the start of the pandemic. treatment, and mortality one year after the
The main objective was to assess the impact histological diagnosis. Tumor clinical staging
of the COVID-19 pandemic on the diagnosis was performed according to the 8 edition
th
and management of patients with HNC. of the American Joint Committee on Cancer
(AJCC) staging (2017). In addition, the following
Materials and Methods time intervals were analyzed (in weeks), as
Study design and population: shown in Figure 2. Patient-related delay was
This was a single-center retrospective cohort defined as the interval of time since symptom

Figure 1
Karnofsky and ECOG functional scale

KARNOFSKY FUNCTIONAL SCALE ECOG PERFORMANCE SCALE
100% Without signs or complaints; without evidence of disease Normal activity, without
0
90% Able to carry on normal activities with some effort limitations
80% Normal activity with effort Limitation of activities
1
70% Can care for self, but unable to work requiring great physical effort
60% Requires occasional assistance; unable to work
Requires considerable assistance and frequent 2 Out of bed > 50% of the time
50%
medical care
40% Requires special medical care In bed > 50% of the time; only
Severely disabled, hospitalization necessary but 3
30% able to care for self
death not imminent
20% Very sick, requires active supportive treatment Bedridden; unable to care
4
10% Moribund, imminent death for self
Abbreviation: ECOG - Eastern Cooperative Oncology Group

124 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery