The consultant was informed if a patient had a problem and then either a telephone consultation was made or a clinic review arranged. The consultant’s secretary would then phone those whose consultations could be postponed to ascertain if they were accepting of the allocation or if they had a different preference. Allocation was based on the potential risk of recurrence and influenced by factors such as time since treatment, tumour stage, resection margins, and time since last face to face consultation. First, a consultant review of the clinic list was made a couple of weeks in advance of the next scheduled appointment, with patients allocated into groups, either a postponed appointment, telephone consultation or a face to face consultation. New referrals, non-cancer, and palliative patients were not included.Ī three step approach was proposed to manage existing patients. A consecutive series of previously treated head and neck cancer patients were eligible. This study took place from then up to 29th July 2020. Our hope is that, by sharing the patients perspective this might inform not only current out-patient review strategies but also any changes that might occur to stratified follow-up when the pandemic has receded or is over.įollowing lockdown in England on 24th March 2020, the hospital sent all patients expecting review consultations/clinic appointments a standard letter informing them that their clinic had been postponed. The hypothesis is that because of the fear of COVID-19 patients will trade off their fear of recurrence and opt for a postponement of their scheduled review or a non-face to face consultation. Remote review has limitations because it lacks the physical check and patients might feel that a recurrence could be missed without a physical examination and that a remote consultation was less reassuring in this regard.Īs there is the potential for unease between the patients view of recurrence and the benefit of face to face checks compared to their fear of the COVID when venturing out to the hospital clinic, the aim of this study was to report perceptions of fear of cancer and fear of COVID and to report patient preference for follow-up consultation in head and neck survivors during the first months of the COVID-19 pandemic. For HNC patients, their fear of COVID-19 had to be balanced against their perceived risk of recurrence. This psychological threat led to the development of various fear of COVID-19 questionnaires. There was substantial fear of COVID-19 amongst the population including patients, their careers, and staff. To reduce transmission and infection risks, following ‘lockdown’, there was an imperative for non-face to face review either by telephone or telemedicine. For a period, all out-patient consultations were stopped. There was huge disruption of out-patient services. In England on the 24th March 2020, ‘lockdown’ occurred due to the COVID-19 pandemic. Fear of recurrence is a key reason why patients attend and assessment is usually performed by palpation and visual inspection, either directly or via endoscopy. These follow-up consultations traditionally take place face to face in clinic and allow an opportunity to assess treatment response, identify recurrence and manage complications. Outside these hours and at weekends, emergency care is provided by the Royal Hallamshire Hospital, Sheffield via a networked service.There are recommendations concerning the frequency of patient review following treatment of head and neck cancer (HNC).
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