Introduction
The COVID-19 pandemic has created unprecedented new challenges for the healthcare system, including a unique set of challenges for patients with head and neck cancer. While multiple prior studies have outlined indications and risk-mitigation strategies for tracheotomy in patients with COVID-19, there remains no clear consensus for inpatient and outpatient management of head and neck cancer patients with tracheostomy and/or total laryngectomy (TL) during the pandemic.[1-3] Given the highly contagious nature of the virus from respiratory droplets and aerosolization,[4] patients with tracheostomy and TL have a particularly high risk of transmission to others and merit special attention in terms of strategies to minimize viral spread.
While elective surgery across the United States has come to a halt, urgent and emergent tracheostomy and total laryngectomy continue for patients with head and neck cancer.[5] Unlike in traditional acute respiratory distress syndrome (ARDS) patients, practices emerging from China where the pandemic began suggest that long-term intubation alone should not be a justification for tracheostomy in SARS-CoV-2 positive patients.[6]However, there are tens of thousands of head and neck cancer patients with long-standing tracheostomy and TL who continue to require medical care both in the inpatient and outpatient contexts.[7] This commentary compiles best available evidence to provide recommendations aimed at minimizing transmission of COVID-19 when caring for head and neck cancer patients with tracheostomies and TL. Policies are bound to vary by institution and specific patient requirements and available resources. Global transparent communication may help to reduce risk to health-care workers and improve outcomes for individual patients and societies facing this unprecedented pandemic.