# Shorter Time to Biopsy of Patients with Head and Neck Squamous Cell Carcinoma During the COVID-19 Pandemic in Hungary

## TL;DR

This study found that the time to biopsy for head and neck cancer patients in Hungary decreased during the pandemic, possibly due to telemedicine and fewer non-cancer cases.

## Contribution

The study provides new insights into how the pandemic affected cancer care in rural Hungary, particularly for head and neck cancers.

## Key findings

- The median time to biopsy decreased significantly from 6 to 3 days during the pandemic.
- Rural patients had a significant reduction in time to biopsy during the pandemic.
- There was a higher proportion of rural patients diagnosed with oral cavity/oropharyngeal cancers during the pandemic.

## Abstract

The COVID-19 pandemic profoundly affected cancer care. This study aimed to compare waiting times, specifically time to biopsy (TBI) and time to treatment (TTI), for patients with head and neck squamous cell carcinoma (HNSCC) before and during the pandemic. We retrospectively analyzed data from adult HNSCC patients across two periods: 1 January 2017 to 15 March 2020 (pre-pandemic) and 16 March 2020 to 13 May 2021 (pandemic). The median TBI decreased significantly from 6 to 3 days, while the median TTI remained unchanged between the two periods. Residence in a village was associated with a significant reduction in median TBI during the pandemic, and there was a higher proportion of rural patients diagnosed with oral cavity/oropharyngeal cancers (50.3% pre-pandemic vs. 67.4% during the pandemic). Improved TBI likely resulted from the availability of telemedicine, reduced diagnostic demands from non-cancer patients, and an increased incidence of oral cavity/oropharyngeal cancers among rural patients.

Background/objectives: The goal of this investigation was to compare the time to biopsy (TBI) and time to treatment (TTI) for head and neck squamous cell carcinoma (HNSCC) patients before and during the COVID-19 pandemic and to examine the effect of demographic and clinical characteristics on these intervals. Methods: Our retrospective study at a large regional Hungarian cancer center analyzed data from patients aged 18 or older diagnosed with HNSCC between 1 January 2017 and 15 March 2020 (pre-COVID-19 period) and 16 March 2020 to 13 May 2021 (COVID-19 period). We calculated the time from initial physician contact to biopsy (TBI) and from biopsy to treatment initiation (TTI) and performed descriptive and exploratory statistical analyses. Results: The median TBI decreased significantly (6 vs. 3 days; p = 0.008), while the median TTI was not affected significantly (28 vs. 29 days; p = 0.972) pre-pandemic and during the pandemic, respectively. Residence in a village was linked to a significant reduction in median TBI during the pandemic (p = 0.000), coinciding with a higher proportion of rural patients diagnosed with oral cavity/oropharyngeal cancers during the pandemic (50.3% pre-pandemic vs. 67.4% during pandemic, p = 0.044). Median TTI decreased significantly during the pandemic for patients with laryngeal tumors (27.5 vs. 18.5 days; p = 0.012). Conclusions: Our study, one of a few from this region, provides insights into HNSCC patient waiting times. Improvement in TBI likely resulted from the availability of telemedicine, reduced diagnostic demands from non-cancer patients, and an increased incidence of oral cavity/oropharyngeal cancer among rural patients.