Summary
In 2003, SARS was immediately devastating to cancer care in both Canada and China. In Ontario, SARS resulted in many hospitals being closed for 6 weeks, leading to treatment delays and even longer wait times in an already strained system. With this crisis, however, came the opportunity to better cancer care delivery. The SARS pandemic highlighted the shortcomings of Ontario’s public health system and helped catalyze initiatives to improve health care accessibility including regionalization of head and neck cancer care and the establishment of quality metrics39. Periods of immense stress on the health care system can ultimately drive system improvement. They are also periods of reflection on the capacity of a sometimes already stretched system. In Ontario, operating room use, and hospital occupancy, is generally high and reliant on efficient through-put. However, pre-COVID-19 there was very little allowance for large aberrations in volumes. With a large decrease in hospital capacity and operating room resources, surgical delays and rationing have been required.
In the interim, the abovementioned modifications enable head and neck oncology services to continue in the wake of COVID-19, albeit in a subset of patients such as those at greatest risk of progression due to high grade disease. Meeting the system capacity needs of COVID-19 must be balanced with the oncology risk to our patients – both present and future. Despite providing continued care for select, high risk patients, there is an ongoing accumulation of cases that will strain the healthcare system after resources again become available. Learning from past experiences and colleagues at the epicentre of the current pandemic, we present here institutional considerations that reflect the multitude of developing guidelines.