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Editorial
Head and neck cancer in times of COVID-19: Emotion-based medicine
Cáncer de cabeza y cuello en tiempos de COVID-19: Medicina basada en las emociones
J. Alexander Sistiaga Suáreza,
Corresponding author
, Fernando López Álvarezb, Eduardo Ferrandis Perepérezc, Pablo Parente Ariasd, Pedro Díaz de Cerio Canduelae, on behalf of the Head and Neck and Skull Base Commission, SEORL-CCC
a Unidad de Oncología de Cabeza y Cuello, Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, Gipuzkoa, Spain
b Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Spain
c Servicio de Otorrinolaringología, Instituto Valenciano de Oncología, Valencia, Spain
d Servicio de Otorrinolaringología, Hospital Universitario Lucus Augusti, Lugo, Spain
e Servicio de Otorrinolaringología, Hospital San Pedro, Logroño, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We are living in uncertain times&#46; Right now&#44; with the first peak of the pandemic over&#44; where massive efforts were made to salvage the structure and prevent the collapse of the healthcare system&#44; we find ourselves with the consequences of events and a setting filled with unresolved doubts&#46; We have to admit here&#44; we are not good at this type of situation&#46; The medical profession is used to working within an environment of supposed certainties&#44; the fruit of a scientific method&#44; and the least inexact we know&#46; Evidence-based medicine is proudly practised and we are forever emphasizing this praxis&#44; creating a sensation of certainty which has now&#44; more than ever&#44; been demonstrated not to exist&#46; The medical community needs to work by basing its decisions on the highest evidence available and this inevitably means that it is a sector which poorly tolerates and handles uncertainty&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Just 6 months after notification of the existence of the first SARS-CoV-2 infection case&#44; it is easy to understand that there is no solid evidence regarding any aspect related to the virus&#46; The lack of data forces us to take decisions based on the precarious and dubious method of trial and error&#46; This leads to precipitated decisions and the use of patterns of behaviour prior to those which method allows&#44; with rapid conclusions being reached which are based on scarce scientific evidence&#46; To sum up&#44; we can fight uncertainty by sacrificing our inflexibility&#46; Although it is obvious that one is forced to act&#44; we must not forget that the first of our aims should always be not to harm our patients&#46; The physician is above all a person&#44; exposed to multiple biases&#44; and must be aware of his or her condition and accept it&#44; so as to fight against them&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We are also experiencing an unprecedented biopsychosocial crisis&#46; In addition to the absence of consistent scientific data due to the novelty of the infection we are undergoing a state of social&#44; political&#44; economic and healthcare emergency which has roughly shaken us up&#46; Inevitably&#44; this even further conditions our perception of reality in highly diverse ways and obstructs appropriate decision-making&#46; Public health is being mixed with individual health&#44; with the macro economy and social pressure from the magnitude of the tragedy&#46; No university taught anyone to be prepared for this&#46; However&#44; we must take a stand&#46; In fact we have to guide by example and become the voice of reason&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Head and neck cancer is an aggressive disease and its prognosis is directly dependent upon time of response&#46; Without any active treatment&#44; half of the patients are destined to a fatal end within 4 months&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> All clinicians know that its impact is extremely high in terms of survival but also in terms of the quality of life of these people and their families&#46; Although we are aware that we cannot refuse them the healthcare they deserve&#44; we must not forget that neither should we offer them suboptimal care&#44; except in the event of force majeure and for the briefest possible period&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">During these weeks there have been many publications in highly prestigious international journals &#40;The Lancet&#44; New England Journal of Medicine &#91;NEJM&#93;&#44; Oral Oncology&#44; Head and Neck&#44; etc&#46;&#41;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> from different scientific societies and workgroups in the form of recommendations&#44; protocols or clinical guidelines for the management of patients with head and neck cancer during the COVID-19 pandemic&#46; These documents are essential&#44; because in view of the lack of clinical trials to provide reliable data&#44; they are of greatest aid to the medical community for patient management&#46; In contrast&#44; one has to know how to interpret them and be aware of their tremendous limitations&#44; due to the context in which they have been written&#46; It is important to underline that most of them either focus on decision-making in the context of extreme scarcity of healthcare resources&#44; or are limited to preventing and combating virus expansion&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">However&#44; little is yet known yet about the impact these measures are having and will have in the vital prognosis of the population with head and neck tumours&#46; There are already several publications which speak of a foreseeable increase in the mortality of these patients of between 10&#37; and 35&#37;&#44; due to the measures adopted to combat COVID-19&#46; Since the duration of the &#8220;new normality&#8221; has not yet been defined&#44; and in view of possible new future waves of infection&#44; it is crucial to consider to what extent we should change the way in which we care for patients&#46; The suspension of surgical activity&#44; the suspension and&#47;or modification of surgical treatments&#44; delay in diagnosis&#44; scarcity of access to the healthcare system&#44; fear of going into hospitals&#44; the reduction in number of oncological reviews&#44; the establishment of non face-to-face attendance&#44; the absence or limitation of professional multidisciplinary meetings&#44; the prohibition of attendance at scientific reunions&#44; the impossibility of access to training for students and interns&#44; etc&#46;&#44; are all realities which we have not just all experienced but which we have also recommended&#44; in the interest of avoiding a greater evil&#46; Given this situation&#44; the burning and simple question is&#58; when will these measures stop preventing a greater evil and actually cause one&#63; Obviously the answer is uncertain and highly complex&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We are thus living through a time which is full of opportunities to learn&#44; to improve and to correct the errors now deeply rooted in our everyday practice&#46; To do so we must leave emotions to one side&#44; and be ever more controlled&#44; rational&#44; prudent and committed to our profession&#46; Good will and effort are insufficient&#46; We have to be professionals in the widest sense of the word&#46; Cooperative work&#44; free access to scientific evidence and embracing uncertainty to generate hypothesis which will lead us to research and provide answers is more necessary now than ever&#46; Cancer will wait for no one&#46;</p></span>"
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Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos