INTRODUCTION
The novel coronavirus, severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2), is a highly contagious enveloped single stranded sense RNA
virus that results in a life-threatening pulmonary illness known as
COVID-19.1 Today, the COVID-19 pandemic has resulted
in society experiencing unprecedented challenges for healthcare
practitioners and facilities serving at the frontlines of this pandemic.
As healthcare practitioners we are implementing measures that aim to
mitigate the spread of the virus and to conserve resources including
personal protective equipment (PPE) while still caring for patients.
Currently the majority of the mandates on healthcare practitioners have
been to stratify patients based on risk for severe illness per the
Centers for Disease Control and Prevention (CDC) guidelines (Figure 1)
while also considering the necessity for patients to be evaluated in
person in the outpatient setting and to assess the “urgency” of any
surgical procedure(s) to be performed.2
Irrespective of the nature of any healthcare crisis, patients suffering
from cancer always receive significant attention due to the morbidity
and mortality rate associated with cancer, which is the leading cause of
death in countries with developed economies.3 Today,
there is a paucity of literature on the impact of pandemics on the
progression/evolution of cancer with most of the literature being
devoted to the impact of viral illness on cancer
patients.4 For example, Chemaly and colleagues
published a multicenter study evaluating the impact of the 2009 H1N1
influenza pandemic on adult patients with solid tumors and reported a
mortality rate of 9.5% in these patients in comparison to the global
mortality rate which was 0.001 – 0.007%.4 With
regards to oral cancer, there is a complete absence of literature
regarding the long-term impact of pandemics on patients with oral
potentially malignant disorders (OPMDs) and early stage oral cancer.
Therefore, for practitioners who manage OPMDs and oral cancer, a great
concern is the risk of progression of these lesions and the detriments
patients will incur in the long term. Prior to this pandemic, even with
readily available access for the majority of patients to a fully intact
healthcare infrastructure, less than 50% of patients with oral cancer
were diagnosed at an early stage.5 Such concerns for
delays in diagnosis and care of patients with oral cancer have been
extensively addressed in the medical literature in the pre-COVID-19 era.
Murphy and colleagues reported that 25% of patients with head and neck
cancer in the United States experienced treatment
delay.6 Furthermore, an increase in the time to
treatment initiation (TTI) by 46 – 52 days resulted in an increased
risk of death with the most detrimental impact once TTI extends beyond
60 days.6 Therefore, early diagnosis and early time to
treatment are mainstays for the care of patients with oral cancer to
reduce such adverse outcomes, with the most opportune time to prevent
and treat oral cancer in its earliest stage through the methodical
evaluation and management of OPMDs.
OPMDs are a heterogeneous group of lesions with varying clinical
features, risk factors, biologic behavior, and malignant transformation
rates (Figure 2A and 2B)4,5. It is estimated that
OPMDs affect about 2% of the world’s population, with a combined
malignant transformation rate of 7.9%.7,8 Herein, we
describe a collaborative and multidisciplinary (oral and maxillofacial
surgery, otorhinolaryngology, oral medicine) perspectives on our
approach for the evaluation and management of OPMDs during the COVID-19
pandemic.