COVID-19 pandemic and health care disparities in head and neck cancer: Scanning the horizon

• Authors: Evan Graboyes, Medical University of South Carolina; John Cramer, Wayne State University; Karthik Balakrishnan, Stanford University; David M. Cognetti, Thomas Jefferson University; Daniel Lopez-Cevallos, Oregon State University; John R. de Almeida, University of Toronto; Uchechukwu C. Megwalu, Stanford University; Charles Moore, Emory University; Cherie-Ann Nathan, Louisiana State University; Matthew E. Spector, University of Michigan; Carol M. Lewis, University of Texas MD Anderson Cancer Center; Michael J. Brenner, University of Michigan
• Journal Title: Head & Neck: Journal of the Sciences and Specialties of the Head and Neck
• Volume: Volume 42, Number 7
• Publisher: Wiley | 2020-06-20, Pages 1555-1559
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/hed.26345
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Oncology; Sociology, Ethnic and Racial Studies; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Otorhinolaryngology; Surgery; COVID-19; head and neck cancer; health care delivery; racial and ethnic disparities; social determinants of health; African American; Survival; Outcomes; Impact; Time; Race

Abstract

The COVID-19 pandemic has profoundly disrupted head and neck cancer (HNC) care delivery in ways that will likely persist long term. As we scan the horizon, this crisis has the potential to amplify preexisting racial/ethnic disparities for patients with HNC. Potential drivers of disparate HNC survival resulting from the pandemic include (a) differential access to telemedicine, timely diagnosis, and treatment; (b) implicit bias in initiatives to triage, prioritize, and schedule HNC-directed therapy; and (c) the marked changes in employment, health insurance, and dependent care. We present four strategies to mitigate these disparities: (a) collect detailed data on access to care by race/ethnicity, income, education, and community; (b) raise awareness of HNC disparities; (c) engage stakeholders in developing culturally appropriate solutions; and (d) ensure that surgical prioritization protocols minimize risk of racial/ethnic bias. Collectively, these measures address social determinants of health and the moral imperative to provide equitable, high-quality HNC care.