# The effect of the COVID-19 pandemic on TNM status among head and neck cancer patients in Hungary

## TL;DR

This study examines how the COVID-19 pandemic affected head and neck cancer patients in Hungary, finding more advanced nodal disease after the pandemic began.

## Contribution

The study is one of the few in Europe to compare head and neck cancer outcomes before, during, and after the pandemic in Hungary.

## Key findings

- A higher proportion of patients had N+ status after the pandemic onset compared to before.
- No significant changes in T status or overall survival were observed during the pandemic.
- Patients with hemoptysis experienced a significant increase in delay time.

## Abstract

Hungary ranks among the countries with both the highest incidence and mortality of head and neck cancers worldwide. The COVID-19 pandemic, caused by the SARS-CoV-2 virus placed a significant burden on the healthcare system. Our study aims to investigate its impact on Hungarian head and neck cancer patients by analyzing changes in stage at presentation, patient delay and overall survival due to the viral pandemic.

A retrospective cohort study was performed analyzing patients’ medical records from a tertiary head and neck surgical center in Hungary. The inclusion criteria required the tumor to be a squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Based on the timing of restrictive measures due to the pandemic, patients were divided into two groups: Group A: “pre-COVID-19” (3 September 2012 – 11 March 2020) and Group B: “post-COVID-19 onset” (12 March 2020 – 5 December 2022) The latter group was further subdivided into Group C: “during-COVID-19” (12 March 2020 – 13 June 2021) and Group D: “post-COVID-19” (14 June 2021 – 5 December 2022).

620 patients met the inclusion criteria. Group A had 427 patients, Group B had 193, Group C had 69, and Group D had 124. Compared to Group A (54.1%), there was a higher proportion of N+ status patients in Group B (69.6%), Group C (63.8%), and Group D (73.0%), with a significant difference throughout. Changes in T status and patient delay time was not present. Analyzing symptoms, there was a significant increase in delay time for patients with hemoptysis (from 2.1 to 16.3 weeks). No significant difference in overall survival was observed between the study groups.

There are limited publications available on this topic in Europe, particularly in Hungary, especially studies that compare the periods before, during, and after the COVID-19 pandemic. Head and neck cancer patients were found to have more advanced clinical nodal disease after the COVID-19 onset, despite no changes in patient delay time and overall survival. Our findings highlight the importance of further studies on how viral infections and pandemics affect oncology care pathways to improve preparedness for future public health crises.