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.