Dustin A. Silverman, MD1*; Chen Lin, MD1*; Akina Tamaki, MD1 ; Sidharth V. Puram, MD, PhD 2 ; Ricardo L. Carrau, MD 1 ; Nolan B. Seim, MD 1 ; Antoine Eskander, MD, ScM3 ; James W. Rocco, MD, PhD 1 ; Matthew O. Old, MD 1 ; Stephen Y. Kang, MD1
Author Affiliations: 1 Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Oncology, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, OH, USA 2 Department of Otolaryngology-Head & Neck Surgery and Department of Genetics, Washington University School of Medicine, Ear, Nose & Throat Center, 4921 Parkway Place, 11th Floor, St. 14 Louis, MO 63110
Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, 16 2075 Bayview Avenue, Suite M1-102, Toronto, ON, M4N 3M5
*These authors contributed equally to this manuscript
Word Count: 3188
Funding: None
Conflicts of Interest: Antoine Eskander MD, ScM is a paid consultant for Bristol-Myers and has received research support from Merck. “None declared” for all remaining authors.
Corresponding Author:
Stephen Y. Kang, MD
Department of Otolaryngology–Head & Neck Surgery
The James Cancer Hospital and Solove Research Institute
460 W 10th Avenue, 5th Floor
Columbus, OH 43210
Telephone: 614-685-6778 40 Fax: 614-293-7292 (Attn: Elaine Ortiz)
ABSTRACT:
Background: Pulmonary complications and infections frequently affect patients with head and neck squamous cell carcinoma (HNSCC). Common characteristics can predispose these patients to the development of severe respiratory illness, which may be particularly relevant during the 2019 coronavirus disease (COVID-19) pandemic.
Methods: A scoping review was performed to assess the impact of pulmonary comorbidities and adverse respiratory outcomes in HNSCC patients.
Results: Advanced age, history of tobacco and alcohol abuse, and cardiopulmonary comorbidities are significant risk factors for the development of adverse respiratory outcomes. Treatment toxicities from radiation or chemoradiation therapy significantly increase these risks.
Conclusion: Respiratory complications are a frequent cause of morbidity and mortality among HNSCC patients, and the COVID-19 pandemic may disproportionately affect this population. Interventions designed to decrease smoking and alcohol use, improve oral hygiene, and aggressively manage medical comorbidities are important to the long-term management and health of these patients.
INTRODUCTION:
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
and associated 2019 coronavirus disease (COVID-19) pandemic has created
unique challenges for all healthcare providers and patients.
Complications resulting from COVID-19 infection are significant, and
immunocompromised patients, including cancer patients, appear
particularly susceptible. Limited data regarding the effect on
immunocompromised patients is available. Early reviews indicate that
severe respiratory events including pneumonia, need for mechanical
ventilation, intensive care unit (ICU) admission, and increased risk of
death may be experienced by a significant proportion of patients with
cancer.1,2
Patients with head and neck squamous cell carcinoma (HNSCC) share common
characteristics, namely upper aerodigestive tumors, advanced age,
history of tobacco and alcohol abuse, and multiple cardiopulmonary
comorbidities which predispose to severe adverse respiratory outcomes.
Moreover, potential toxicities conferred by chemotherapy and radiation
therapy (RT) have been demonstrated to significantly increase rates of
dysphagia, aspiration, and pneumonia within this
population.3-6 Recent studies have sought to identify
sources of mortality and characterize long-term morbidity following
HNSCC treatment.6-8 An understanding of the various
adverse respiratory outcomes experienced among head and neck patients
following treatment, particularly during the COVID-19 pandemic, is
critical in treatment algorithms and medical decision-making.
A scoping review9 was performed to assess the impact
of pneumonia, aspiration pneumonitis, and other select viral and
bacterial infectious etiologies in patients with HNSCC. An appraisal of
risk factors, sources of competing mortality, pathophysiology, and
respiratory outcomes is also provided.