Results
A total of 16 major head and neck health care facilities were contacted
across India including all regions (Table 1). The majority of the
contacted stakeholders were working in government (public funded)
institutions (75%, n=12) as they have the highest workload of patients
in Indian set up, where treatment is practically free to the patient.
Out of the 16 hospitals, 50% (n=8) were dedicated cancer centres and
other half were tertiary care institutions with head and neck cancer
facilities. A dedicated cancer centre, catering to a large urban
population has been closed indefinitely due to the spread of COVID 19 in
a large number of healthcare professionals. The majority (69%, n=11) of
the institutions have halted outpatient facilities and elective
surgeries, only emergency admissions and surgeries were continued in
these centres (Table 1). Only 5 (31%) institutes were providing all
types of HNC services, but with an increased volume of outpatients
despite a decreased volume of operations due to safety precautions and
limited availability of personal protective equipment (PPE).Four of
these are dedicated cancer centres and were performing the full spectrum
of surgical procedures. Most institutions are surveying patients by
clinic visits or through telephone consultations. Few (12.5%, n=2)
institutions have started telemedicine consultations with patients. As
per the present government regulations, COVID-19 test is not allowed for
patients with no history and symptoms. The majority (69%, n=11) of the
institutes are following institutional guidelines, while others are
either following state or other guidelines. Availability of (PPE) and
N95 mask are limited (63%, n=10) at most of the centres and they are
using them judiciously. Current recommendations by the government of
India, does not allow for pre operative COVID-19 testing, so decision
making for surgery on the basis of COVID-19 status is difficult.
The Ministry of health and family welfare, an apex health care body of
India has categorized all suspected/positive patients into three groups
and are managed in the respective COVID hospitals– Dedicated COVID Care
Centre (DCCC), dedicated COVID Health Centre (DCHC) and dedicated COVID
Hospitals (DCH). Out of 16 institutions contacted, four have been
designated as DCHC and two as DCH.
Currently, there are no guidelines for the management of HNC in India
during COVID-19 pandemic. The Foundation for Head and Neck Oncology
(FHNO), a multi-specialty national society in India has provided
guidelines for the management of HNC patients. These guidelines are
elaborative and cover all aspect of management of HNC cancer patients,
from surgical to non surgical modalities. As this is a non government
body, they have advised to keep abreast of advisories and guidelines
from the government of India, as these will supersede their guidelines.