Introduction
The COVID-19 pandemic due to SARS-CoV-2 (severe acute respiratory
syndrome coronavirus 2) has disrupted and transformed the delivery of
healthcare in ways that few would have imagined or thought possible.
Clinicians, healthcare administrators, insurance companies, policy
makers, researchers, and patients are all grappling with how to deliver
and access medical care in the COVID-19 era while planning for an
unpredictable future contingent on several unknowns (e.g. viral
seasonality, vaccine development). The various stakeholders are charting
a course for healthcare delivery during a time of unprecedented resource
scarcity, relatively uncertain but potentially significant personal risk
(for clinicians and patients), and massive economic upheaval. In
response to the COVID-19 pandemic, best practices in healthcare delivery
for head and neck cancer (HNC) have been upended amid urgent efforts to
protect patients, providers, and communities while stewarding scarce
resources.
As the pandemic has unfolded across the world, it has become
increasingly clear that COVID-19 is a disease with varying incidence and
mortality in racial/ethnic subgroups.1,2 While the
causes for COVID-19-related racial and ethnic differences are still
being examined, they seem to stem from 1) long-standing systemic
inequities and differences in social determinants of health, access to
care, and quality of care; and 2) biologic determinants such as
comorbidity burden, genetics, and immune phenotype.3-5COVID-19 reminds us that determinants of health are multifactorial.
Thought leaders in global public health have recently called for
development of polysocial risk scores, adapted from the polygenic risk
modeling to quantify social determinants of health.6In that sense, the COVID-19 pandemic has been described as a magnifying
glass that has brought attention yet again to stark racial/ethnic
disparities in health outcomes in the US.3
We have long recognized that HNC is a disease with marked racial/ethnic
disparities in outcomes.7-11 Although the reasons
underlying observed racial/ethnic differences in mortality for patients
with HNC are multifactorial, disparities in both access to care and
timely cancer care are major drivers for poor
outcomes.8,11-15 While the calls to view healthcare
delivery as science that informs national improvement priorities are not
new,16 the disruptive forces of the COVID-19 pandemic
regarding crisis standards of care are unprecedented. It is imperative
that we consider how COVID-19-related changes to healthcare delivery
exacerbate existing disparities in access to care and may worsen
oncologic outcomes for patients with HNC. Many health care system
changes attributable to COVID-19 will likely persist long after the
pandemic has waned.17 We must explore strategies to
mitigate disparities in care for HNC patients that have arisen from this
“stress test” on our healthcare delivery system.