Page 130 - Portuguese Journal - SPORL - Vol 61. Nº1

odynophagia were referred to areas dedicated surgical procedures during the pandemic
to respiratory patients and COVID-19 (ADR)
and consequently, were not observed by an
otorhinolaryngologist.
With regard to clinical tumor staging, tumors
were larger (T3 or T4) and regional node
involvement was more advanced (N3) in the
post-COVID-19 period, which is in line with
other reports in the literature (8-10) . In fact,
according to the study conducted by Kiong
et al ., 39.4% of tumors were classified as T3/4
in the pre-COVID-19 period, compared to 52%
of tumors in the post-COVID-19 period (p =
0.025) . In addition, according to Stevens et
10
al., the risk of advanced node involvement
at diagnosis (N3, N3a, and N3b) was twice as
high in the post-COVID-19 period as in the
pre-COVID-19 period (odds ratio [OR]=2.14;
p=0.011) .
8
The delay in the diagnosis and management
of patients with HNC has been classically
attributed to:
1) patient-related factors: fear of diagnosis,
illiteracy, and low socioeconomic status; 2)
factors related to the nature of the disease,
such as the duration of the asymptomatic
period and tumor location; 3) factors related
to the healthcare system . The COVID-19 surge
11
forced a reduction in routine care, creating
another barrier to timely access to health care.
Moreover, the mandatory lockdown and fear
of contracting COVID-19, especially in the first
phase of the pandemic, contributed to the
exacerbation of this situation (6).
In fact, as other authors have described 9,12 ,
in the post-COVID-19 period, there was a
significant increase in the number of weeks
elapsed between symptom onset and the first
medical assessment (A=8.6; B=12.9) (p=0.009).
However, in our sample, the time interval
between the histological diagnosis and the
start of treatment was significantly shorter in
the post-COVID-19 period (A=8; B=6) (p=0.008).
This difference was due to the reduced time
interval until the intervention in the subgroup
of patients selected for surgery (A=9; B=5)
(p=0.009), which may be a consequence of
the suspension of the majority of scheduled
130 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
period, with mostly only priority interventions,
such as cancer surgeries, being performed.
Nevertheless, the proportion of patients
undergoing surgery was lower during this
period, which may in part be explained by the
fact that the patients in the post-COVID-19
group had more advanced diseases.
Our findings are in line with those of a study
published by Schoonbeek et al., in which
8,468 patients with an initial diagnosis of HNC
were evaluated over the period encompassing
2018, 2019, and 2020. The authors observed
that regardless of the type of treatment, the
time interval from the first medical evaluation
to the start of treatment was considerably
shorter in the year of the COVID-19 pandemic
(2020), including during the first pandemic
wave (March–June, 2020) (p<0.001) .
13
The main limitations of the present study are
its retrospective nature and small size of the
sample. In addition, this was a single-center
study; therefore, it may not accurately reflect
the real situation in the entire country.
The present study demonstrated that during
the COVID-19 pandemic, the clinical capacity
to manage and treat patients with an initial
diagnosis of HNC was maintained. However,
further multicenter and prospective studies
are necessary to assess the true impact of
the COVID-19 pandemic on the long-term
prognosis of patients with HNC.
Conclusion
During the COVID-19 pandemic, patients with
HNC significantly delayed seeking medical
care. However, there was a reduction in the
time interval between the diagnosis of the
disease and the start of treatment. Thus,
despite the overloading and restructuring of
the healthcare services due to the emergence
of the COVID-19 pandemic, this single-
center study showed that patients with HNC
continued to receive effective care.
Conflicts of Interest
The authors declare that there is no conflict
of interests regarding the publication of this
paper.