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AIM: The novel coronavirus pandemic presented unique challenges to healthcare organisations on an unprecedented scale. Due to the cessation of routine care, the Humberside Oral and Maxillofacial Surgery department implemented a telephone review service to maintain access to care. This survey study was conducted to gain feedback from patients and staff regarding the recently implemented remote telephone consultation service within the Humberside Oral and Maxillofacial Surgery unit. METHODS: A paper questionnaire comprising 16 questions was posted to 199 patients who underwent telephone review. A further questionnaire was sent via SurveyMonkey (Momentive Inc., San Mateo) to the clinicians involved. RESULTS: From 199 patients, 93 surveys returned were suitable for inclusion; 7 out of 12 staff replied to the survey. The results showed a high level of satisfaction with the service from both groups. There were also suggestions for future additions to the service, including use for new patient consultations, addition of webcam facilities and further streamlining of suitable cases for remote consultation. CONCLUSION: Our study demonstrated high patient and staff satisfaction with telephone consultations. It showed that over one third (37%) of patients were able to be discharged via telephone consultation, helping to maintain access, free up clinical resources and reduce the need for face-to-face clinical attendance, which has been vital throughout the coronavirus disease 2019 (COVID-19) pandemic. We now have suggestions for how this service can be implemented in the longer term within our department, including developing clearer guidelines for inclusion in the service and the possible benefit of video consultation.
RESUMO
Background: Recruiting regulatory CD4 T cells (Tregs) into the tumor microenvironment is an important tumor escape mechanism. Diminishing these suppressive cells is therefore one of the targets of cancer immunotherapy. Selective depletion of Tregs has proven successful in enhancing anti-tumor immunity and therapeutic efficacy in multiple tumor types. However, the role of Tregs in oral/oropharyngeal cancers is unclear with conflicting evidence regarding the effect of these suppressive cells on tumor prognosis. In this study, we sought to review the role of Tregs in oral/oropharyngeal cancer with the aim of deciphering the controversy regarding their effect on tumor progression and prognosis. Methods: A systematic review of the literature pertaining to the role of Tregs in oral/oropharyngeal cancer was performed using Scopus, Embase, and PubMed. Forty-five records were deemed eligible and data describing methodology of Treg detection, tumor type, and association with prognosis were extracted. Results: Of the 45 eligible manuscripts accepted for this systematic review, thirty-nine studies reported data from human subjects while the remaining studies focused on animal models. Sixteen studies were carried out using peripheral blood samples, while samples from the tumor site were analyzed in 18 studies and 11 studies assessed both blood and tumor samples. The transcriptional factor, Foxp3, was the most commonly used marker for Treg identification (38/45). The findings of 25 studies suggested that an increase in Tregs in the tumor microenvironment and/or peripheral blood was associated with poorer prognosis. These conclusions were attributed to the suppression of immune responses and the consequent tumor progression. Conversely, nine studies showed an increase in Tregs in peripheral blood and/or tumor microenvironment was related to a favorable prognosis, particularly in the presence of human papilloma virus (HPV), the status of which was only assessed in 11 studies. Conclusions: This review underlines the importance of host immunity in the behavior of oral/oropharyngeal cancer. Furthermore, we report an apparent lack of clarity regarding the true role Tregs play in oral/oropharyngeal cancer progression which could be attributed to inconsistent detection techniques of Tregs. Our results therefore highlight the need for clearer methodologies and more robust phenotyping when defining Tregs.