Kelten Clements

Impact of COVID-19 on incidence and stage of Head and Neck Cancer in Scotland

COVID-19 pandemic had an extensive impact on healthcare services in Scotland. Many staff and facilities were prioritised to provide care for COVID-19 patients which reduced the cancer diagnosis and treatment capacity. All these measures compounded to severely affect primary, secondary, and tertiary clinical services in Scotland. The aim of this project was to assess whether these large changes in the availability of healthcare services during the COVID-19 pandemic led to upshifting of stage of missed head and neck cancer (HNC) cases, or altered treatment patterns which carries adverse implications for morbidity and mortality.

This were investigated using three substantive studies: a rapid literature review and meta-analysis of currently published studies investigating stage shift during the pandemic; a retrospective cohort study evaluating post-pandemic changes in the treatment received and stage at presentation of HNC patients reviewed at multidisciplinary team (MDT) meetings in the West of Scotland; a population level analysis of demographic and stage data relating to HNC patients collected from the three regional Scottish cancer networks.

This study showed that despite the large disruptive impact of the COVID-19 pandemic on HNC care resulting in an initial disease upshift, this did not resulted in a backlog of undiagnosed HNC cases causing a long-term upshifting of disease stage, as had been predicted. Whether the COVID-19 pandemic has resulted in adverse changes to HNC related morbidity and mortality will remain unclear for many years until survival outcomes are known.

This study highlighted the lack of analysis of population level incidence data on HNC. So, next summer I will be involved in a further research project investigating the impact of demographic and geographic determinants on incidence of subsites of HNC over the past two decades.