Triaging New Referrals
Ontario has one of the most mature and regionalized head and neck cancer
programs in the world, with all care being provided at one of seven
designated cancer centres20-23. To meet the needs of
this pandemic, both Wuhan and Toronto initiated a centralized system
within their regionalized cancer centres for the intake of new
referrals. For example, all new referrals to Sunnybrook Health Sciences
Odette Cancer Centre in Toronto are now first virtually reviewed by a
team consisting of medical, radiation, and surgical oncologists.
Together, the determination is made in regard to any additional testing
required prior to patient consultation. If at all possible, patients are
seen virtually via the Ontario Telehealth Network (OTN), which allows
for two or three-way audio with video support, allowing family members
to be present, even if not physically with the patient. This is
particularly important within our elderly population, minimizing social
contacts, while maintaining physical distancing. The virtual interaction
through OTN is particularly useful if the physical examination will not
change the next steps in management (i.e. pathology review, discussion
of treatment options, or where the need for additional imaging and
testing remains). This step allows for the collection of information
from patients, while reducing the risk of exposure with face-to-face
consultations, and has been shown to be an effective avenue for patient
care24. In circumstances that necessitates in person
consultation, such as the need for biopsy, patients are seen in person.
Multidisciplinary care is a staple in the effective management of head
and neck cancer patients. All patients continue to be discussed weekly
through case conferences where staff discuss remotely. Where alterations
to the standard of care are necessary based on healthcare constraints,
there is increased discussions within the multidisciplinary care team to
determine best treatment course, and full disclosures with the patients
are provided. In Toronto, multidisciplinary clinics remain active with
all essential multidisciplinary allied healthcare professionals present,
including speech-language pathology, social work, physiotherapy,
dietetics and nutrition services, and all-relevant oncology specialties.
We have successfully incorporated our multidisciplinary team in OTN
consultations and in-person follow-up are offered under necessary
circumstances as outlined above.
As surgical waitlists grow in the face of reduced operating room
resources, formalized systems for reviewing patients are necessary to
create a dynamic list that is able to accommodate changing disease
progression and patient needs. For example, a centralized list is being
used at Sunnybrook Health Sciences Centre to contact and monitor
patients on a regular basis, while providing them with ongoing
reassurance.