Author: Janet Boyle
Patients with head and neck malignancies have continued to get vital surgery at Queen Elizabeth University Hospital in Glasgow under strict infection vigilance set up by its maxillofacial surgery unit.
More than 40 patients have been treated for head and neck cancer during lockdown. Others have undergone procedures for facial skin cancer and facial injuries.
The Royal College of Surgeons Edinburgh says 87% of its members in cancer surgery had stopped operating altogether or significantly reduced the number of procedures due to the danger of patients contracting the virus. And experts fear deaths from cancer could rise by a fifth over the next year as a result of scores of treatments and consultations being cancelled.
Now it is hoped the protocols followed by the Glasgow team can be adopted to allow more surgery to resume. Critical to the safety of the operations is that the patients are tested for coronavirus twice before the procedure – once 48 hours beforehand, and then again immediately before surgery begins.
Patients are also asked to self-isolate for two weeks before surgery, the surgical team works in a separate building to the main hospital and some surgical techniques have been modified to reduce the risk of infection.
Operating on head and neck malignancies poses considerable risk to theatre teams because the work is closely associated with patients’ faces and respiratory systems, making the virus easily transmissible.
Further risk lies in the head and neck surgeon having to abandon a face shield to use the operating microscope vital to navigate and sew together tiny nerves and blood vessels in the face and throat.
Professor Jim McCaul, a consultant maxillofacial surgeon at the QEUH, said: “We never stopped working for our cancer patients. We have been doing major surgery throughout, with massive support from trainees and all of the outpatient, ward and theatre staff and nurses and administration team.
“Recent announcements about introducing a two-week lockdown on patients is what we have been doing from the start. There has been amazing support in theatre and no one hesitated at all about continuing surgery on patients.
“It would not have happened without the six other maxillofacial head and neck surgeons, outpatient, ward and administrative staff and many others.
“Our theatre nurses all wear full PPE, even though the patients have tested negative. Some staff are even isolating from their families. I cannot wear a visor at the microscope and that raises the risk, but it is a calculated risk.”
Patients will also need radio and chemotherapy, if the disease is more advanced.
“We also very worried about patients sitting on cancer and infection symptoms which will present later. It means more life-changing treatment and we cannot cure them all,” Professor McCaul added.
Survival from head and neck cancer – between 50% and 60% depending on the area of head and neck affected and how advanced when it is diagnosed – has lagged behind other cancers such as breast and leukaemia.
“Cases diagnosed later can need extensive surgery, which can change patients’ appearance and ability to chew, swallow food and speak,” Professor McCaul added.
The Scottish Government is working to resume treatment halted during the Covid pandemic.
Discussions are ongoing as to how to take Scotland’s cancer surgery and other operations forward. Surgeons believe the way ahead almost certainly involves continual testing of staff and patients.
Hospitals in other countries have strived to create Covid-free units but emergency admissions of patients with the virus have made that challenging.
Besides operating on cancer patients, the QEUH’s head and neck cancer team has been treating those with facial injuries caused by trauma.
Professor McCaul said: “Only the super-urgent trauma cases have to go to theatre and we can get a test in 24 hours and wear full PPE for that.
“If we need to use plates and screws we use self-drilling screws because the drill generates aerosol.”
Nursery teacher Mandy Peebles was devastated to be diagnosed with mouth cancer at the age of 30.
“Everyone is scared when they are told they have cancer and I was prepared to go to any lengths to get the surgery needed to remove it,” said Mandy, from Cowglen, Glasgow. “I came across the pea-sized lump by accident, while looking for a wisdom tooth coming through. A referral to Glasgow Dental Hospital and a biopsy in December led to an appointment at the maxillofacial unit at the Queen Elizabeth University Hospital in Glasgow.
“Results confirmed it was cancer in January, just as Covid was spreading across mainland Europe to the UK.”
Mandy had two operations, in March and April. She said: “The government warnings about cancer patients being at extra risk made me lock down at home and when I was told by Professor McCaul that I would have to completely isolate I did everything possible to ensure I remained Covid-free. Catching the virus would mean my operation would be cancelled.
“My fiancé Calum is a railways maintenance engineer who works in isolation with PPE so all possible transmission was sealed off.
“I could only see my parents by waving to them when they passed my garden gate and that was heartbreaking.
“Not being able to hug my mum before undergoing surgery was painful for us both. But that’s what it took to get the surgery and I can only thank the surgical team for everything they did.
“I was fully aware that mouth cancer was a hill to climb and early treatment was vital.
“I was isolated in hospital for two days before the op and tested before going into theatre.
“The minutes seemed like hours as I waited for the Covid test results. When they returned negative the feeling of relief was amazing.”
Mandy added: “Calum and I are marrying in exactly a year and I now have everything to live for.”