Development and validation of a Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN-HN) in a scarce resource setting: Response to the COVID-19 pandemic.
| Title: | Development and validation of a Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN-HN) in a scarce resource setting: Response to the COVID-19 pandemic. |
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| Authors: | de Almeida JR; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; Noel CW; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; Forner D; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.; Zhang H; Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada.; Nichols AC; Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.; Cohen MA; Department of Otolaryngology-Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.; Wong RJ; Department of Otolaryngology-Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.; McMullen C; Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida.; Graboyes EM; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.; Divi V; Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California.; Shuman AG; Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.; Rosko AJ; Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.; Lewis CM; Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.; Hanna EY; Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.; Myers J; Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.; Paleri V; Head and Neck Unit, The Royal Marsden Hospital, London, United Kingdom.; Miles B; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.; Genden E; Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.; Eskander A; Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.; Enepekides DJ; Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.; Higgins KM; Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.; Brown D; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.; Chepeha DB; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.; Witterick IJ; Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada.; Gullane PJ; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.; Irish JC; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.; Monteiro E; Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada.; Goldstein DP; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.; Gilbert R; Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada. |
| Source: | Cancer [Cancer] 2020 Nov 15; Vol. 126 (22), pp. 4895-4904. Date of Electronic Publication: 2020 Aug 11. |
| Publication Type: | Journal Article; Validation Study |
| Language: | English |
| Journal Info: | Publisher: Wiley Country of Publication: United States NLM ID: 0374236 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-0142 (Electronic) Linking ISSN: 0008543X NLM ISO Abbreviation: Cancer Subsets: MEDLINE |
| Imprint Name(s): | Publication: : Hoboken, NJ : Wiley; Original Publication: New York [etc.] Published for the American Cancer Society by J. Wiley [etc.] |
| MeSH Terms: | Betacoronavirus* ; Health Resources*; Coronavirus Infections/*epidemiology ; Head and Neck Neoplasms/*surgery ; Pneumonia, Viral/*epidemiology ; Triage/*methods; Coronavirus Infections/virology ; Pneumonia, Viral/virology ; Algorithms ; COVID-19 ; Clinical Decision-Making ; Consensus ; Humans ; International Cooperation ; Pandemics ; Reproducibility of Results ; Research Design ; SARS-CoV-2 ; Surgeons |
| Abstract: | Background: In the wake of the coronavirus disease 2019 (COVID-19) pandemic, access to surgical care for patients with head and neck cancer (HNC) is limited and unpredictable. Determining which patients should be prioritized is inherently subjective and difficult to assess. The authors have proposed an algorithm to fairly and consistently triage patients and mitigate the risk of adverse outcomes.; Methods: Two separate expert panels, a consensus panel (11 participants) and a validation panel (15 participants), were constructed among international HNC surgeons. Using a modified Delphi process and RAND Corporation/University of California at Los Angeles methodology with 4 consensus rounds and 2 meetings, groupings of high-priority, intermediate-priority, and low-priority indications for surgery were established and subdivided. A point-based scoring algorithm was developed, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN-HN). Agreement was measured during consensus and for algorithm scoring using the Krippendorff alpha. Rankings from the algorithm were compared with expert rankings of 12 case vignettes using the Spearman rank correlation coefficient.; Results: A total of 62 indications for surgical priority were rated. Weights for each indication ranged from -4 to +4 (scale range; -17 to 20). The response rate for the validation exercise was 100%. The SPARTAN-HN demonstrated excellent agreement and correlation with expert rankings (Krippendorff alpha, .91 [95% CI, 0.88-0.93]; and rho, 0.81 [95% CI, 0.45-0.95]).; Conclusions: The SPARTAN-HN surgical prioritization algorithm consistently stratifies patients requiring HNC surgical care in the COVID-19 era. Formal evaluation and implementation are required.; Lay Summary: Many countries have enacted strict rules regarding the use of hospital resources during the coronavirus disease 2019 (COVID-19) pandemic. Facing delays in surgery, patients may experience worse functional outcomes, stage migration, and eventual inoperability. Treatment prioritization tools have shown benefit in helping to triage patients equitably with minimal provider cognitive burden. The current study sought to develop what to the authors' knowledge is the first cancer-specific surgical prioritization tool for use in the COVID-19 era, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN-HN). This algorithm consistently stratifies patients requiring head and neck cancer surgery in the COVID-19 era and provides evidence for the initial uptake of the SPARTAN-HN.; (© 2020 American Cancer Society.) |
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| Grant Information: | P30 CA008748 United States CA NCI NIH HHS; P30 CA016672 United States CA NCI NIH HHS |
| Contributed Indexing: | Keywords: coronavirus disease 2019 (COVID-19); delivery of health care; head and neck cancer; health priorities; patient selection; surgical procedures; waiting lists |
| Entry Date(s): | Date Created: 20200812 Date Completed: 20201106 Latest Revision: 20210625 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC7436362 |
| DOI: | 10.1002/cncr.33114 |
| PMID: | 32780426 |
| Database: | MEDLINE |
Journal Article; Validation Study