Experts have developed a new tool for surgical prioritization and ranking for patients with head and neck cancer in scarce-resource settings associated with the COVID-19 pandemic.

“Surgical prioritization tools or algorithms offer decision-making transparency and provide equitable and time-sensitive access to care to the patients who need it most,” the experts wrote.

To establish the tool, 2 separate expert panels were formed that included international head and neck cancer surgeons. They developed a point-based scoring algorithm (SPARTAN-HN) that rated 62 indications for surgical priority. Each indication was assigned a score from -4 to +4. Negative scores indicated low priority and positive scores indicated high priority.

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For example, patient factors included comorbidities and performance status that could be scored. An ECOG performance status of 0 to 2 earned a score of 0 whereas a performance status of 3 to 4 earned a -3 score. Other ranking categories included tumor factors (histology, stage, nodal disease), treatment factors (previous radiotherapy, alternative treatments, extent of surgery), resource availability (expected length of surgery, expected length of stay), and wait time factors.

The algorithm demonstrated preliminary reliability and validity, with good agreement between raters and the algorithm.

“With established validity, this algorithm may be ready for preliminary clinical use, although further testing against real-world data to validate it with other cancer outcomes, such as survival, is needed,” the researchers wrote.


de Almeida JR, Noel CW, Forner D, et al. 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. Cancer. Published online August 11, 2020. doi:10.1002/cncr.33114.