The Utility of Telemedicine for Postoperative Follow-up Care in Head and Neck Cancer Patients during the COVID-19 Pandemic

Introduction: Follow-up care and monitoring of survivorship are key aspects of head and neck cancer management. The unprecedented COVID-19 pandemic has posed an unforeseen challenge before head and neck surgeons and has created an urgent need for deploying processes for triaging patients. This study evaluates the effectiveness of a 3-tiered protocol incorporating principles of "mhealth" proposed by WHO and telemedicine to monitor recurrence, maintain compliance, and address pressing issues in follow-up head and neck cancer patients. Materials and Methods: One hundred and one head and neck cancer patients who have undergone surgery and/or completed chemoradiation between the years 2015 and 2020 were selected. Details of patients who were on regular follow-up until March 2020 were obtained. A 3-tier screening protocol including a telephonic questionnaire, video consultation, and visit to primary care center was utilized to triage patients. Results: Fifty-seven percent of the patients did not require any intervention and were managed through video consultation with specialists. 38% of the patients needed a visit to a nearby health care worker or primary physician along with rehabilitation services. Only 5% of them needed a visit to a tertiary healthcare center for specialist care. The overall dropout from follow-up in this study was 19.8%. There was no significant difference of scores noted between oral cavity and nonoral cavity cancer groups (z = 1.17, P = 0.24, Mann-Whitney Test). Conclusion: The proposed 3-tier screening protocol using telemedicine is a feasible, cost-effective, and time-efficient tool to overcome the negative impact of COVID-19 on follow-up care.