Fundamental Principles Governing the Development of these Recommendations
  1. Alignment to the extent possible with our established multi-disciplinary practice approaches.
  2. Adhere to the standard of care, and when this is not possible given the current health crisis, then supported to the extent possible by the existing medical literature.
  3. Favor modalities and approaches that minimize the number of visits to PENN Medicine, while not compromising the opportunity for cure.
  4. Favor modalities that minimize immune compromise during and after treatment.
  5. Compliance with the evolving Center for Medicare Services (CMS) recommendations on medical and surgical triage during the COVID-19 pandemic.1
  6. Avoid surgical treatment if patient is immunocompromised unless the risk of the cancer progressing outweighs the risk posed by their immunocompromised state.2
  7. COVID 19 Thyroid Cancer Guidelines as well Skin Cancer Guidelines were created by separate respective Cancer Service Line and are not included in the Head and Neck Cancer COVID 19 guidelines reported herein.
  8. COVID-19 Testing Principles for Patients with Head and Neck Tumors
  9. All patients should undergo standard COVID-19 history taking by team members for possible active infection or exposure and referred for testing per hospital guidelines. The COVID -9 history should be taken at the time of the initial encounter and again the day before treatment begins and on the day of treatment.
  10. Depending on availability, SARS-CoV-2 testing should be done preoperatively and prior to chemotherapy or radiation. It is recommended that this testing be done within 24 hours of starting cancer treatment during the surge and apogee of the COVID-19 curve and 72 hours prior to treatment initiation later in the disease pandemic curve.
  11. Patients that have tested positive for SARS-CoV-2 or are a Patient Under Investigation (PUI) should, in general, have all treatment deferred until the patient is no longer ill or contagious confirmed by two negative tests a
  12. Some patients that have tested positive for SARS-CoV-2 or are a PUI may start/continue radiation treatment; this recommendation is modality specific and has been defined in the general workflow created by the Department of Radiation Oncology for patients undergoing radiation therapy during the COVID-19 pandemic.
  13. For patients who are COVID-19 positive, PUI or unable to determine and present with acute emergencies in need of immediate surgical intervention (e.g., bleeding or airway emergencies), the surgical team should don appropriate Personal Protective Equipment, which in our institution is an N95 face mask, goggles, double gown and gloves or a full Powered Air-Purifying Respirator (PAPR) if for that individual the N95 mask is ill fitting.3,4
  14. For patients who are neither COVID-19 positive or PUI the surgical team should don N95 masks, face shields, surgical gowns and gloves during patient assessment and treatment.