Factors affecting laryngectomy rate during the COVID-19 pandemic

Background: The coronavirus disease 2019 (COVID-19) resulted in significant challenges to the delivery of healthcare in Australia. Despite the efforts of state governments to ensure continuity of care particularly in relation to known cancer screening programs during the pandemic, the Head and Neck Department at the Austin Hospital in Melbourne Australia, noticed a significant increase in the laryngectomy rate at our institution over the pandemic period. The aim of this study was to assess the impact of the pandemic on the laryngectomy rate and to identify the underlying factors contributing to these changes. Methods: In a retrospective electronic medical record (EMR) audit, patients were identified as having undergone a total laryngectomy (TL) or laryngopharyngectomy (LP) for management of squamous cell carcinoma (SCC) at Austin Health between December 2016 and September 2023. Patients were stratified into ‘pre-pandemic’, ‘pandemic’, and ‘post-pandemic’ groups based on the date of surgical intervention. Comparative analyses were performed to assess differences in demographics, disease characteristics, treatment strategies, and timing of key events across these periods. Results: During and post the pandemic, the incidence of advanced (T4a/b) disease was 54% (n=7) and 75% (n=3), respectively compared to 45% (n=5) pre-pandemic period. The rate of TL/LP surgeries increased to 6.5 annually during the pandemic, compared to 3.5 and 2.5 in the pre- and post-pandemic periods. A significant rise in neck dissection frequency was also revealed in the pandemic and post-pandemic groups (85%, n=11; and 100%, n=4, respectively), compared to pre-pandemic (45%, n=5) (χ2=6.34; P=0.01). Additionally, the mean time from symptom onset to general practitioner (GP) referral extended from 52 days pre-pandemic to 215 days during the pandemic, before returning to 32 days post-pandemic. Conclusions: This study suggests that the COVID-19 pandemic significantly delayed referrals for laryngeal carcinoma in Australia, likely due to patients’ reluctance to present with upper respiratory symptoms to GP services. Despite unchanged referral-to-treatment times, the delay in initial GP referrals appear to have resulted in an increased incidence of advanced disease at presentation. These findings underscore the critical need for uninterrupted access to primary healthcare to prevent delays in cancer diagnosis and treatment.