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Guerriero MK, Redman MW, Baker KK, Martins RG, Eaton K, Chow LQ, Santana-Davila R, Baik C, Goulart BH, Lee S, Rodriguez CP. Racial disparity in oncologic and quality-of-life outcomes in patients with locally advanced head and neck squamous cell carcinomas enrolled in a randomized phase 2 trial. Cancer 2018; 124:2841-2849. [DOI: 10.1002/cncr.31407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/26/2018] [Accepted: 03/17/2018] [Indexed: 11/06/2022]
Affiliation(s)
| | - Mary W. Redman
- Fred Hutchinson Cancer Research Center; Seattle Washington
| | | | | | - Keith Eaton
- University of Washington; Seattle Washington
| | | | | | | | | | - Sylvia Lee
- University of Washington; Seattle Washington
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Jabbour J, Doerfer KW, Robey T, Cunningham MJ. Trends in Pediatric Otolaryngology Disparities Research. Otolaryngol Head Neck Surg 2018; 159:173-177. [PMID: 29611453 DOI: 10.1177/0194599818768496] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To describe trends in disparities research within pediatric otolaryngology as evidenced by major meeting presentations and to compare observed trends with those in the realm of patient safety and quality improvement (PSQI). Study Design Retrospective review of presentations at national otolaryngology meetings. Setting Online review of meeting programs. Subjects and Methods Meeting programs from the American Society of Pediatric Otolaryngology, Triological Society, American Academy of Otolaryngology-Head and Neck Surgery Foundation, and Society for Ear, Nose and Throat Advances in Children from 2003 to 2016 were manually searched for pediatric oral and poster presentations addressing disparities and socioeconomic determinants of health, as well as PSQI. Presentation frequency was compared between categories and within each category over time. Results Of 11,311 total presentations, 3078 were related to the pediatric population, and 1945 (63.2%) of those were oral presentations. Disparities-related presentations increased from 0 in 2003 to 17 in 2016. From 2003 to 2009, 9 of 656 (1.4%) presentations involved disparities, as opposed to 70 of 2422 (2.9%) from 2010 to 2016 ( P = .03). The proportion of presentations regarding PSQI also increased: from 42 of 656 (6.4%) in 2003-2009 to 221 of 2422 (9.1%) in 2010-2016 ( P = .01). PSQI presentations remain more common than disparities presentations (9.1% vs 2.9%, P < .001). Conclusion Health care disparities are increasingly addressed in pediatric otolaryngology meeting presentations. Compared with the well-established realm of PSQI, disparities research remains nascent but is gaining attention. Health care reform and quality improvement efforts should recognize the role of socioeconomic factors and include strategies for addressing disparities.
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Affiliation(s)
- Jad Jabbour
- 1 Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Karl W Doerfer
- 2 Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas Robey
- 2 Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,3 Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael J Cunningham
- 1 Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,4 Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Kılıç S, Samarrai R, Kılıç SS, Mikhael M, Baredes S, Eloy JA. Incidence and survival of sinonasal adenocarcinoma by site and histologic subtype . Acta Otolaryngol 2018; 138:415-421. [PMID: 29205085 DOI: 10.1080/00016489.2017.1401229] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the incidence and survival of sinonasal adenocarcinoma (SNAC) by subsite and histologic subtype. STUDY DESIGN Retrospective database review. METHODS Using the SEER database, we performed a retrospective analysis, identified cases of SNAC diagnosed between 1973 and 2013 and analyzed demographic, histopathology, clinicopathology, and determinants of disease specific survival (DSS). RESULTS A total of 746 patients with SNAC were identified. Median age at diagnosis was 64 years. Overall incidence was 0.44 per million, and was higher among blacks (O.R.:1.10-2.07:1) and males (O.R.:1.38-2.06:1). Nasal cavity (41.5%) was the most common site, followed by maxillary (26.5%), and ethmoid (17.4%) sinuses. Intestinal-type adenocarcinoma was less likely than Adenocarcinoma not otherwise specified (ANOS) to be found in the maxillary sinus (8.8% vs. 30.6%, p < .05). Surgery alone (48.56%) was the most common treatment modality, followed by surgery and radiotherapy (RT) (32.5%), and RT alone (11.6%). DSS at 5, 10, and 20 years were 63.8%, 57.6%, and 47.0%, respectively. DSS was higher for nasal cavity SNAC, lower grade, lower stage, and those receiving surgery only. CONCLUSIONS SNAC is more common among men and blacks. Incidence has not changed significantly in the past 40 years. Survival varies with grade, stage, histology, subsite, and treatment.
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Affiliation(s)
- Suat Kılıç
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ruwaa Samarrai
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sarah S. Kılıç
- Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Mina Mikhael
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Soly Baredes
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
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Parhar HS, Chang BA, Durham JS, Anderson DW, Hayden RE, Prisman E. Post-acute care use after major head and neck oncologic surgery with microvascular reconstruction. Laryngoscope 2018; 128:2532-2538. [DOI: 10.1002/lary.27190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/28/2018] [Accepted: 02/21/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Harman S. Parhar
- Division of Otolaryngology-Head and Neck Surgery; University of British Columbia; Vancouver British Columbia Canada
- T.H. Chan School of Public Health; Harvard University; Boston Massachusetts
| | - Brent A. Chang
- Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona; Phoenix Arizona U.S.A
| | - J. Scott Durham
- Division of Otolaryngology-Head and Neck Surgery; University of British Columbia; Vancouver British Columbia Canada
| | - Donald W. Anderson
- Division of Otolaryngology-Head and Neck Surgery; University of British Columbia; Vancouver British Columbia Canada
| | - Richard E. Hayden
- Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona; Phoenix Arizona U.S.A
| | - Eitan Prisman
- Division of Otolaryngology-Head and Neck Surgery; University of British Columbia; Vancouver British Columbia Canada
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Parasher AK, Workman AD, Kidwai SM, Goljo E, Signore AD, Iloreta AM, Genden EM, Shrivastava R, Navathe A, Govindaraj S. Costs in Pituitary Surgery: Racial, Socioeconomic, and Hospital Factors. J Neurol Surg B Skull Base 2018; 79:522-527. [PMID: 30456019 DOI: 10.1055/s-0038-1635081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/07/2018] [Indexed: 10/17/2022] Open
Abstract
Objective To investigate the influence of patient demographic factors and hospital factors on cost and length of stay in patients undergoing pituitary surgery. Design/Setting A retrospective cross-sectional study of the 2008 to 2012 Nationwide/National Inpatient Sample. Participants Patient demographics and hospital characteristics for patients undergoing pituitary surgery were compared between white, black, and Hispanic patients. Main Outcome Measures Variables associated with increased cost and increased length of hospital stay were ascertained and compared against each racial and ethnic group via multiple linear regression analysis. Results Of 8,812 patients who underwent pituitary surgery, 5,924 (67.2%) patients were white, 1,590 (18.0%) were black, and 1,296 (14.7%) were Hispanic. Patient variables found to be significantly different between racial groups via univariate analysis were age, chronic conditions, gender, income, and primary payer. Hospital variables found to be significantly different were location/teaching status, region, and ownership. Hospitalization cost was significantly lower for whites (-$3,082, 95% confidence interval [CI] -$3,961 to -$2,202) and significantly higher for both blacks ($1,889, 95% CI $842-$2,937) and Hispanics ($2,997, 95% CI $1,842-$4,152). Length of hospital stay was also significantly lower in whites (-1.01, 95% CI -1.31 to -0.72) and significantly higher for both blacks (0.65, 95% CI 0.30 to 1.00) and Hispanics (0.96, 95% CI 0.57-1.35). Conclusions Racial and ethnic factors contribute to differences in hospital utilization and cost for patients undergoing pituitary surgery. Further investigations are necessary to uncover the sources of these disparities in an effort to provide safer and more affordable care to all patients.
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Affiliation(s)
- Arjun K Parasher
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Alan D Workman
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Sarah M Kidwai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Erden Goljo
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Anthony Del Signore
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Alfred M Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Raj Shrivastava
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Amol Navathe
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
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Morse E, Fujiwara RJT, Judson B, Mehra S. Treatment Times in Salivary Gland Cancer: National Patterns and Association with Survival. Otolaryngol Head Neck Surg 2018; 159:283-292. [PMID: 29460669 DOI: 10.1177/0194599818758020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective To characterize treatment times in salivary cancer; associate treatment times with patient, tumor, and treatment characteristics; and examine the association of treatment times and overall survival. Study Design Retrospective cohort. Setting Commission-on-Cancer Accredited Hospitals 2004-2013. Subjects and Methods In total, 5953 patients with salivary cancer included in the National Cancer Database were identified. For each treatment interval, patients in the fourth quartile ("prolonged") were compared to patients in the first and second quartiles ("not prolonged"). Patient, tumor, and treatment characteristics were associated with prolonged times via multivariable binary logistic regression. Prolongation of each interval was associated with overall survival via multivariable Cox proportional hazards regression, controlling for clinically relevant factors. Results Median durations for diagnosis-to-treatment initiation, surgery-to-radiation treatment (RT), RT duration, total treatment package, and diagnosis-to-treatment end were 31, 44, 47, 92, and 110 days, respectively. Race, insurance status, comorbidities, age, T and N stage, facility volume and location, and a facility care transition from diagnosis to initial treatment were associated with prolonged treatment time. Prolonged RT duration was associated with decreased overall survival (OS) (62% vs 75% 5-year OS, HR = 1.26 [95% confidence interval (CI), 1.09-1.47]; P = .002), but prolonged diagnosis-to-treatment initiation, surgery-to-RT, total treatment package, and diagnosis-to-treatment end intervals were not (70% vs 67% 5-year OS, HR = 1.11 [95% CI, 0.92-1.34], P = .284; 72% vs 68%, HR = 0.93 [95% CI, 0.79-1.09], P = .370; 70% vs 70%, HR = 1.00 [95% CI, 0.84-1.20], P = .974; 66% vs 71%, HR = 0.99 [95% CI, 0.84-1.18], P = .920, respectively). Conclusion The median durations identified here can serve as reference points. Radiation therapy duration is associated with overall survival in salivary cancer and could be considered a quality indicator.
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Affiliation(s)
- Elliot Morse
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rance J T Fujiwara
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin Judson
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
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Patient Choice of Nonsurgical Treatment Contributes to Disparities in Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2018; 158:1057-1064. [DOI: 10.1177/0194599818755353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives There are well-established outcome disparities among different demographic groups with head and neck squamous cell carcinoma (HNSCC). We aimed to investigate the potential contribution of patient choice of nonsurgical treatment to these disparities by estimating the rate of this phenomenon, identifying its predictors, and estimating the effect on cancer-specific survival. Study Design Retrospective nationwide analysis. Settings Surveillance, Epidemiology, and End Results Database (2004-2014). Subjects and Methods Patients with HNSCC, who were recommended for primary surgery, were included. Multivariable logistic regression was used to identify demographic and clinical factors associated with patient choice of nonsurgical treatment, and Kaplan Meier/Cox regression was used to analyze survival. Results Of 114,506 patients with HNSCC, 58,816 (51.4%) were recommended for primary surgery, and of those, 1550 (2.7%) chose nonsurgical treatment. Those who chose nonsurgical treatment were more likely to be older (67.1 ± 12.6 vs 63.6 ± 13.1, P < .01), were of Black (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.28-1.74) or Asian (OR = 1.79; 95% CI, 1.46-2.20) ethnicity, were unmarried (OR married, 0.50; 95% CI, 0.44-0.58), had an advanced tumor, and had a hypopharyngeal or laryngeal primary. Choice of nonsurgical treatment imparted a 2.16-fold (95% CI, 2.02-2.30) increased risk of cancer-specific death. Conclusion Of the patients, 2.7% chose nonsurgical treatment despite a provider recommendation that impairs survival. Choice of nonsurgical treatment is associated with older age, having Black or Asian ethnicity, being unmarried, having an advanced stage tumor, and having a primary site in the hypopharynx or larynx. Knowledge of these disparities may help providers counsel patients and help patients make informed decisions.
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Jabbour J, Robey T, Cunningham MJ. Healthcare disparities in pediatric otolaryngology: A systematic review. Laryngoscope 2017; 128:1699-1713. [DOI: 10.1002/lary.26995] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/28/2017] [Accepted: 10/10/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Jad Jabbour
- Department of Otolaryngology and Communication Sciences; Medical College of Wisconsin; Milwaukee Wisconsin U.S.A
| | - Thomas Robey
- Department of Otolaryngology and Communication Sciences; Medical College of Wisconsin; Milwaukee Wisconsin U.S.A
- Division of Pediatric Otolaryngology; Children's Hospital of Wisconsin; Milwaukee Wisconsin U.S.A
| | - Michael J. Cunningham
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts U.S.A
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Carey RM, Parasher AK, Workman AD, Yan CH, Glicksman JT, Chen J, Palmer JN, Adappa ND, Newman JG, Brant JA. Disparities in sinonasal squamous cell carcinoma short- and long-term outcomes: Analysis from the national cancer database. Laryngoscope 2017; 128:560-567. [DOI: 10.1002/lary.26804] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/05/2017] [Accepted: 06/26/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Ryan M. Carey
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
| | - Arjun K. Parasher
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
- Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
| | - Alan D. Workman
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
- Perelman School of Medicine; Philadelphia Pennsylvania U.S.A
| | - Carol H. Yan
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
| | - Jordan T. Glicksman
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
| | - Jinbo Chen
- University of Pennsylvania and the Department of Biostatistics and Epidemiology; Philadelphia Pennsylvania U.S.A
| | - James N. Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
| | - Nithin D. Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
| | - Jason G. Newman
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
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Taib BG, Rylands J, Povall S, Jones TM, Taylor-Robinson D. Protocol: systematic review of the association between socio-economic status and survival in adult head and neck cancer. Syst Rev 2017; 6:151. [PMID: 28768525 PMCID: PMC5541745 DOI: 10.1186/s13643-017-0545-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 07/18/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Head and neck cancer incidence is increasing worldwide. Despite overall improvements in survival, numerous studies suggest worse survival in more disadvantaged populations; however, this literature has not been systematically reviewed. The aim of this review is to investigate whether lower compared to higher socioeconomic status (SES) influences survival in head and neck squamous cell cancer (HNSCC) and explore possible explanations for any relationship found. METHOD A systematic strategy will be used to identify articles, appraise their quality and extract data. Online databases including MEDLINE, Web of Knowledge, ESBCO Host and Scopus will be used to locate observational studies of adults with a primary diagnosis of head and neck cancer in EU15+ countries (15 members of the EU, Australia, Canada, Norway, USA and New Zealand) where the outcomes report associations between SES and survival. This will be augmented by searching for grey literature and through reference lists. Data will be extracted using a standardised form. Study quality will be assessed using the Newcastle Ottawa scale and where possible meta-analysis of the pooled data will be conducted. DISCUSSION This review will quantify the association between SES and survival outcomes for adult head and neck cancer patients in developed countries. The results will help identify gaps in the literature and therefore direct further novel research in the field. Ultimately, this will inform public policy and strategies to reduce the inequalities in HNSCC survival. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016037019 .
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Affiliation(s)
- Bilal G. Taib
- Postgraduate Centre, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP UK
| | - Joseph Rylands
- Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL UK
| | - Sue Povall
- Institute of Psychology, Health and Society, University of Liverpool, Waterhouse building, Liverpool, L69 3BX UK
| | - Terry M. Jones
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA UK
| | - David Taylor-Robinson
- Institute of Psychology, Health and Society, University of Liverpool, Waterhouse building, Liverpool, L69 3BX UK
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Jalisi S, Rubin SJ, Wu KY, Kirke DN. Outcomes of head and neck cancer surgery in the geriatric population based on case volume at academic centers. Laryngoscope 2017; 127:2539-2544. [DOI: 10.1002/lary.26750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/06/2017] [Accepted: 05/30/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Scharukh Jalisi
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston Massachusetts U.S.A
| | - Samuel J. Rubin
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston Massachusetts U.S.A
| | - Kevin Y. Wu
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston Massachusetts U.S.A
| | - Diana N. Kirke
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston Massachusetts U.S.A
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Characteristics and predictors of oral cancer knowledge in a predominantly African American community. PLoS One 2017; 12:e0177787. [PMID: 28545057 PMCID: PMC5435300 DOI: 10.1371/journal.pone.0177787] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/03/2017] [Indexed: 12/16/2022] Open
Abstract
Purpose To characterize smoking and alcohol use, and to describe predictors of oral cancer knowledge among a predominantly African-American population. Methods A cross-sectional study was conducted between September, 2013 among drag racers and fans in East St. Louis. Oral cancer knowledge was derived from combining questionnaire items to form knowledge score. Covariates examined included age, sex, race, marital status, education status, income level, insurance status, tobacco and alcohol use. Adjusted linear regression analysis measured predictors of oral cancer knowledge. Results Three hundred and four participants completed questionnaire; 72.7% were African Americans. Smoking rate was 26.7%, alcohol use was 58.3%, and mean knowledge score was 4.60 ± 2.52 out of 17. In final adjusted regression model, oral cancer knowledge was associated with race and education status. Compared with Caucasians, African Americans were 29% less likely to have high oral cancer knowledge (β = -0.71; 95% CI: -1.35, -0.07); and participants with a high school diploma or less were 124% less likely to have high oral cancer knowledge compared with college graduates (β = -1.24; 95% CI: -2.44, -0.41). Conclusions There was lower oral cancer knowledge among African Americans and those with low education. The prevalence of smoking was also very high. Understanding predictors of oral cancer knowledge is important in future design of educational interventions specifically targeted towards high-risk group for oral cancer.
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Iwata AJ, Williams AM, Taylor AR, Chang SS. Socioeconomic disparities and comorbidities, not race, affect salivary gland malignancy survival outcomes. Laryngoscope 2017; 127:2545-2550. [PMID: 28498500 DOI: 10.1002/lary.26633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/28/2017] [Accepted: 03/23/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study sought to determine whether comorbidities, race, and socioeconomic factors affect 5- and 10-year survival outcomes for patients with salivary gland malignancies treated at a single large academic institution with a large African American population. STUDY DESIGN A retrospective cohort study was performed of all patients with salivary gland malignancies, from 1990 to 2015, at a large academic medical center. METHODS Standard statistical analysis was performed using Kaplan-Meier survival curve analysis and Cox proportional hazard models. RESULTS The overall 5- and 10-year survival rates decreased with age ≥ 60 years (P < .001), stage 3 or 4 (P < .001), clinical T stage 3 or 4 (P < .001), and clinical N stage 1, 2, or 3 (P < .001). Living in a ZIP code with an increasing proportion of residents with a high school degree or less (P < .05), being male (P < .05), increasing age at the time of diagnosis (P < .001), and increasing Charlson comorbidity index (P < .05) detrimentally impacted survival at 5 and 10 years. Race was associated with socioeconomic variables, but race was not a prognostic indicator of survival. CONCLUSIONS Socioeconomic factors and comorbidities, not race, were negative prognostic indicators of survival of patients with salivary gland malignancies. Using race as a marker for socioeconomic status should be used with caution. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2545-2550, 2017.
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Affiliation(s)
| | | | - Andrew R Taylor
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, U.S.A
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Dwojak S, Bhattacharyya N. Racial disparities in preventable risk factors for head and neck cancer. Laryngoscope 2017; 127:1068-1072. [PMID: 28215050 DOI: 10.1002/lary.26203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/18/2016] [Accepted: 06/27/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES/HYPOTHESIS To demonstrate racial differences in preventable risk behaviors/practices that contribute to head and neck cancer (HNCA). STUDY DESIGN Cross-sectional analysis of large national risk factor survey. METHODS The Behavioral Risk Factor Surveillance System for 2013 was analyzed. Demographic data were extracted, including age, sex, and race. Social habits considered risk factors for HNCA were also extracted, including alcohol consumption, smoking, and human papillomavirus (HPV) vaccination status. Statistical comparisons were conducted according to race for each risk factor, and additional comparisons were conducted within the American Indian population subgroup for risk factors according to sex. RESULTS A total of 238.6 million Americans were surveyed. American Indians reported higher rates of binge drinking (19.0%) than whites (17.3%), blacks (12.4%), and Asian Americans (13.1%; P < .001). This rate was significantly higher for American Indian males (23.5%) versus females (13.7%; P < .001). Mean total drinks per month was higher for whites and American Indians (13.5 and 13.5; P < .001). American Indians reported the highest rates of current smoking (28.1%), followed by blacks (20.1%), whites (18.3%), and Asians (10.2%; P < .001). American Indians also reported the highest rates of every day smoking (18.2%), versus whites (13.3%), blacks (13.1%), and Asians (6.1%; P < .001). Rates of HPV vaccination were lowest for American Indians (11.7%), compared to whites (14.6%), blacks (13.6%), and Asians (12%; P = 0.618). CONCLUSIONS There are striking racial disparities in the prevalence of preventable risk factors for HNCA. These data highlight the need for targeted education and prevention programs in particular racial groups. LEVEL OF EVIDENCE 4. Laryngoscope, 127:1068-1072, 2017.
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Affiliation(s)
- Sunshine Dwojak
- Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Neil Bhattacharyya
- Harvard University, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
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65
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Wong TH, Skanthakumar T, Nadkarni N, Nguyen HV, Iyer NG. Survival of patients with head and neck squamous cell carcinoma by housing subsidy in a tiered public housing system. Cancer 2017; 123:1998-2005. [PMID: 28135397 DOI: 10.1002/cncr.30557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Socioeconomic status affects survival in patients diagnosed with head and neck squamous cell carcinoma (HNSCC), even in health systems with universal health care. Singapore has a tiered subsidized housing system, in which income determines eligibility for subsidies by size of apartment. The objective of this study was to assess whether a patient's residential type (small/heavily subsidized, medium/moderate subsidy, large/minimal or no subsidy) influenced mortality. A secondary analysis examined whether patients in smaller subsidized apartments were more likely to present with advanced disease. METHODS An historical cohort study of patients in a tertiary referral center with HNSCC was identified in the multidisciplinary cancer database from 1992 to 2014. Clinicopathologic data were extracted for analysis. Patient residential postal codes were matched to type of housing. Logistic regression was performed to evaluate the relationship between all-cause mortality and the predictors of interest as well as the association between housing type and disease stage at presentation. RESULTS Of the 758 patients identified, most were men (73.4%), the median age was 64 years, 30.5% and 15.2% were smokers and former smokers, respectively. Over one-half (56.8%) of patients presented with advanced disease. Male gender, age, stage at presentation, survival time from diagnosis, and smoker status were significant predictors of mortality. Patients living in the smaller, higher subsidy apartments had poorer survival, although they were not more likely to present with advanced disease, suggesting that the survival difference was not because of delayed presentation. CONCLUSIONS Patients with HNSCC living in smaller, higher-subsidy apartments have poorer survival despite no apparent delays in presentation. Cancer 2017;123:1998-2005. © 2017 American Cancer Society.
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Affiliation(s)
- Ting Hway Wong
- Department of General Surgery, Singapore General Hospital, Singapore.,Duke-National University of Singapore Medical School, Singapore
| | | | | | - Hai Van Nguyen
- School of Pharmacy, Memorial University of Newfoundland, Canada
| | - N Gopalakrishna Iyer
- Duke-National University of Singapore Medical School, Singapore.,Division of Surgical Oncology, National Cancer Center Singapore, Singapore
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66
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Naghavi AO, Echevarria MI, Strom TJ, Abuodeh YA, Ahmed KA, Venkat PS, Trotti A, Harrison LB, Green BL, Yamoah K, Caudell JJ. Treatment delays, race, and outcomes in head and neck cancer. Cancer Epidemiol 2016; 45:18-25. [DOI: 10.1016/j.canep.2016.09.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/10/2016] [Accepted: 09/12/2016] [Indexed: 02/06/2023]
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67
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Fornadley J, Stern W, Nathan CAO. Head and neck cancer: a humanitarian effort in your own backyard. EAR, NOSE & THROAT JOURNAL 2016; 94:54, 56. [PMID: 25651345 DOI: 10.1177/014556131509400203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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68
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Cannon RB, Sowder JC, Buchmann LO, Hunt JP, Hitchcock YJ, Lloyd S, Grossman KF, Monroe MM. Increasing use of nonsurgical therapy in advanced-stage oral cavity cancer: A population-based study. Head Neck 2016; 39:82-91. [PMID: 27641220 DOI: 10.1002/hed.24542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/22/2016] [Accepted: 05/17/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND National guidelines support surgical-based treatment and offer nonsurgical therapy as an alternative for advanced-stage oral cavity squamous cell carcinoma (SCC). There are limited data evaluating current utilization of these therapies and their survival outcomes. METHODS A total of 5856 patients were found in the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2008 with resectable advanced-stage oral cavity SCC tumors. Outcomes were disease-specific survival (DSS) and overall survival (OS). RESULTS Surgical therapy had significantly improved mean DSS and OS (115 and 71 months, respectively) compared to nonsurgical therapy (63 and 35 months, respectively; p < .001). The use of nonsurgical therapy was significantly associated with the hard palate, and patients who were single, divorced, and black, with T3, T4, and N3 tumors, and the percent utilization has significantly increased from 12% to 20% (p < .05). CONCLUSION Utilization of nonsurgical therapy for advanced-stage oral cavity SCC is increasing and is independently associated with a reduction in survival, as well as patient factors traditionally associated with reduced access to medical care and advanced T and N classifications. © 2016 Wiley Periodicals, Inc. Head Neck 39: 82-91, 2017.
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Affiliation(s)
- Richard B Cannon
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Justin C Sowder
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Luke O Buchmann
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah.,Huntsman Cancer Hospital, Salt Lake City, Utah.,Department of Surgery, Division Otolaryngology, George E. Whalen VAMC, Salt Lake City, Utah
| | - Jason P Hunt
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah.,Huntsman Cancer Hospital, Salt Lake City, Utah
| | | | - Shane Lloyd
- Huntsman Cancer Hospital, Salt Lake City, Utah
| | | | - Marcus M Monroe
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah.,Huntsman Cancer Hospital, Salt Lake City, Utah.,Department of Surgery, Division Otolaryngology, George E. Whalen VAMC, Salt Lake City, Utah
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69
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Peterson CE, Khosla S, Chen LF, Joslin CE, Davis FG, Fitzgibbon ML, Freels S, Hoskins K. Racial differences in head and neck squamous cell carcinomas among non-Hispanic black and white males identified through the National Cancer Database (1998-2012). J Cancer Res Clin Oncol 2016; 142:1715-26. [PMID: 27251759 DOI: 10.1007/s00432-016-2182-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/19/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE Head and neck squamous cell carcinoma (HNSCC) incidence is increasing, and evidence suggests survival disparities between non-Hispanic (nH) black and white males. However, temporal changes in HNSCCs and factors contributing to survival differences have not been examined at the national level. METHODS National Cancer Database (NCDB) cases were used to evaluate temporal trends in HNSCC anatomical sites and site groupings (i.e., oral cavity, oropharyngeal, non-oropharyngeal), and to estimate incidence ratios (IRs) comparing nH black and white males in demographic and clinical characteristics. RESULTS Between 1998 and 2012, 18,443 (11 %) nH black males and 145,611 (89 %) nH white males were diagnosed with HNSCCs. Cases rose from 9094 diagnosed in 1998 to 13,838 in 2012, driven by increases in oropharyngeal tumors, particularly tumors of the tonsil and tongue. Annual percent changes in nH black males and nH white males were 1.93 and 3.17, respectively. Additionally, nH black males had higher incidence of the more aggressive non-oropharyngeal tumors (p < .0001) and distant-stage tumors (76 vs. 64 %, p < .0001). However, nH white males had higher incidence of high-risk HPV types (IRs range from 1.68, 95 % CI 1.50-1.88 in oropharyngeal tumors to 3.03, 95 % CI 1.11-8.25 in non-oropharyngeal tumors). CONCLUSIONS Incidence of oropharyngeal tumors has risen in both nH black and white males. However, nH white males have higher incidence of HPV, and nH black males have higher incidence of more aggressive and advanced HNSCCs. Racial differences in clinical characteristics associated with poorer survival exist, and future studies should determine factors associated with these differences.
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Affiliation(s)
- Caryn E Peterson
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Room 888, Chicago, IL, 60612, USA.
- Cancer Control and Population Science Research Program, University of Illinois at Chicago Cancer Center, Chicago, IL, USA.
- Institute for Health Research and Policy, Chicago, IL, USA.
| | - Shaveta Khosla
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Room 888, Chicago, IL, 60612, USA
| | - Lucy F Chen
- Department of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Charlotte E Joslin
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Room 888, Chicago, IL, 60612, USA
- Cancer Control and Population Science Research Program, University of Illinois at Chicago Cancer Center, Chicago, IL, USA
- Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Faith G Davis
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Room 888, Chicago, IL, 60612, USA
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Marian L Fitzgibbon
- Cancer Control and Population Science Research Program, University of Illinois at Chicago Cancer Center, Chicago, IL, USA
- Institute for Health Research and Policy, Chicago, IL, USA
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - Sally Freels
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Room 888, Chicago, IL, 60612, USA
| | - Kent Hoskins
- Cancer Control and Population Science Research Program, University of Illinois at Chicago Cancer Center, Chicago, IL, USA
- Institute for Health Research and Policy, Chicago, IL, USA
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
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Mandelbaum RS, Abemayor E, Mendelsohn AH. Laryngeal Preservation in Glottic Cancer. Otolaryngol Head Neck Surg 2016; 155:265-73. [DOI: 10.1177/0194599816639248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/25/2016] [Indexed: 12/27/2022]
Abstract
Objective When total laryngectomy is not required, organ preservation surgery or radiotherapy is considered the standard of care for primary glottic cancer. These accepted treatment options are available for early and advanced glottic cancers due to equivalent locoregional control and survival rates. However, in today’s climate of accountable care, the financial burden of treatment choices continues to increase in significance. We therefore compared hospital charges and treatment-related morbidity between organ-preserving surgery and radiation with or without chemotherapy—herein, (chemo)radiation—in the primary treatment of glottic cancer. Study Design Nationwide Inpatient Sample Database was analyzed to assess clinical and financial information. Setting Population-based analysis. Subjects Patients (N = 5499) with primary glottic cancer undergoing treatment with laryngeal preservation strategies. Methods Patients were subdivided by ICD-9 codes into 3 treatment groups: endoscopic resection, open partial laryngectomy, and (chemo)radiation. Treatment-related outcomes, charges, and length of hospitalization were analyzed among treatment groups. Results When adjusting for sex, age, race, comorbidity, and primary payer, (chemo)radiotherapy was associated with increased direct charges ( P < .001; coefficient, $23,658.99; 95% confidence interval [95% CI]: $10,227.15-$37,090.84) and length of hospitalization ( P < .001; hazard ratio, 0.593; 95% CI: 0.502-0.702) when compared with endoscopic surgery. As compared with open surgery, endoscopic surgery was associated with reduced hospital charges ( P = .012; coefficient, $11,967.01; 95% CI: $2,784.17-$21,249.85) and duration of hospitalization ( P < .001; hazard ratio, 0.749; 95% CI: 0.641-0.876). Conclusions This analysis suggests that increased utilization of endoscopic surgery in patients with primary glottic cancer not requiring total laryngectomy may lead to reduced financial burden and duration of hospitalization when compared with open surgery or (chemo)radiation therapy.
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Affiliation(s)
- Rachel S. Mandelbaum
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, California, USA
| | - Elliot Abemayor
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, California, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, California, USA
| | - Abie H. Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, California, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, California, USA
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Abstract
The study assessed participant awareness of oral cancer (OC), risk factors, signs and symptoms, and history of an OC screening exam and whether a relationship exists between these factors and the participant's age, level of education, socioeconomic status (SES), ethnicity, and gender. It was a descriptive survey research with a non-randomized sample. Participants were a convenience sample of seniors participating in a congregate dining program of the DuPage County Senior Citizens Council. Data was collected through a written, self-administered survey. Sixty-two surveys were completed, with an overall response rate of 66%. A statistically significant relationship was found between the level of education and awareness of OC risk factors (r = 0.26; P = 0.04). An inverse relationship was found between the level of education and the level of OC awareness questions, "have you ever heard about OC?" (r = -0.37; P = 0.004), and "how much do you know about OC?" (r = 0.35; P = 0.008). A trend toward significance was noted for the level of education and awareness of OC signs and symptoms (r = 0.24; P = 0.06). The levels of OC awareness in the seniors were lower than the general population. Seniors in the lower SES strata and who have low education levels are of particular concern, and it is important to conduct further studies tailored towards populations with these combined factors. Additional research is needed to determine how to best communicate OC awareness and implement programs specifically for this high-risk group.
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72
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Choi SH, Terrell JE, Fowler KE, McLean SA, Ghanem T, Wolf GT, Bradford CR, Taylor J, Duffy SA. Socioeconomic and Other Demographic Disparities Predicting Survival among Head and Neck Cancer Patients. PLoS One 2016; 11:e0149886. [PMID: 26930647 PMCID: PMC4773190 DOI: 10.1371/journal.pone.0149886] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/06/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Institute of Medicine (IOM) report, "Unequal Treatment," which defines disparities as racially based, indicates that disparities in cancer diagnosis and treatment are less clear. While a number of studies have acknowledged cancer disparities, they have limitations of retrospective nature, small sample sizes, inability to control for covariates, and measurement errors. OBJECTIVE The purpose of this study was to examine disparities as predictors of survival among newly diagnosed head and neck cancer patients recruited from 3 hospitals in Michigan, USA, while controlling for a number of covariates (health behaviors, medical comorbidities, and treatment modality). METHODS Longitudinal data were collected from newly diagnosed head and neck cancer patients (N = 634). The independent variables were median household income, education, race, age, sex, and marital status. The outcome variables were overall, cancer-specific, and disease-free survival censored at 5 years. Kaplan-Meier curves and univariate and multivariate Cox proportional hazards models were performed to examine demographic disparities in relation to survival. RESULTS Five-year overall, cancer-specific, and disease-free survival were 65.4% (407/622), 76.4% (487/622), and 67.0% (427/622), respectively. Lower income (HR, 1.5; 95% CI, 1.1-2.0 for overall survival; HR, 1.4; 95% CI, 1.0-1.9 for cancer-specific survival), high school education or less (HR, 1.4; 95% CI, 1.1-1.9 for overall survival; HR, 1.4; 95% CI, 1.1-1.9 for cancer-specific survival), and older age in decades (HR, 1.4; 95% CI, 1.2-1.7 for overall survival; HR, 1.2; 95% CI, 1.1-1.4 for cancer-specific survival) decreased both overall and disease-free survival rates. A high school education or less (HR, 1.4; 95% CI, 1.0-2.1) and advanced age (HR, 1.3; 95% CI, 1.1-1.6) were significant independent predictors of poor cancer-specific survival. CONCLUSION Low income, low education, and advanced age predicted poor survival while controlling for a number of covariates (health behaviors, medical comorbidities, and treatment modality). Recommendations from the Institute of Medicine's Report to reduce disparities need to be implemented in treating head and neck cancer patients.
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Affiliation(s)
- Seung Hee Choi
- College of Nursing, Michigan State University, East Lansing, MI, United States of America
| | - Jeffrey E. Terrell
- University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Karen E. Fowler
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America
| | - Scott A. McLean
- University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Tamer Ghanem
- Henry Ford Hospital, Detroit, MI, United States of America
| | - Gregory T. Wolf
- University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Carol R. Bradford
- University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Jeremy Taylor
- Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, MI, United States of America
| | - Sonia A. Duffy
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America
- College of Nursing, Ohio State University, Columbus, OH, United States of America
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73
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Patel ZM, Li J, Chen AY, Ward KC. Determinants of racial differences in survival for sinonasal cancer. Laryngoscope 2016; 126:2022-8. [PMID: 26915596 DOI: 10.1002/lary.25897] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/24/2015] [Accepted: 01/04/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS Racial differences in survival are present across multiple cancer types, including sinonasal cancer. Thus far in the literature, reasons for this have been theorized but not proven. We aimed to examine proposed potential factors and understand the true determinants in racial differences for survival in sinonasal cancer. STUDY DESIGN Utilizing the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2000-2008), we analyzed multiple demographic, tumor-related, and treatment-related factors. Use of the Medicare subset allows much deeper examination of patient and treatment factors than the usual SEER database study. METHODS Univariate analysis and multivariate Cox proportional hazard regression models were used. RESULTS Eight hundred and forty-five patients remained after exclusion criteria. Five-year cause-specific survival (CSS) was 62%, with a racial difference confirmed because non-Hispanic whites (NHW) and blacks and Hispanic whites (B/HW) demonstrated 64% and 52% CSS, respectively. After multivariate analysis, factors significantly determining racial survival were age, stage, histology, grade, comorbidity status, and standard of care. CONCLUSION This study confirms the difference in racial survival in sinonasal cancer. In opposition to popular theories of access to care and education level- and poverty level-determining outcomes, those factors were not significant on multivariate analysis, whereas stage and receiving standard of care, determined by unimodality versus multimodality treatment appropriate to stage, were the two most important prognostic factors. LEVEL OF EVIDENCE 2c. Laryngoscope, 126:2022-2028, 2016.
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Affiliation(s)
- Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Juan Li
- Rollins School of Public Health, Department of Epidemiology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Amy Y Chen
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Kevin C Ward
- Rollins School of Public Health, Department of Epidemiology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
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74
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Osazuwa-Peters N, Christopher KM, Hussaini AS, Behera A, Walker RJ, Varvares MA. Predictors of stage at presentation and outcomes of head and neck cancers in a university hospital setting. Head Neck 2015; 38 Suppl 1:E1826-32. [PMID: 26695355 DOI: 10.1002/hed.24327] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND To increase early detection of head and neck cancers, it is important that disparities associated with access to care are addressed. METHODS A total of 351 patients aged 20 to 91 years (58.72 ± 11.70 years) diagnosed with head and neck cancers at a university hospital from 1997 to 2010 were analyzed. Logistic regression assessed the association between clinical stage at presentation and predictors. Cox proportional hazards model assessed the effect of stage at presentation on survival. RESULTS Being African American was associated with increased odds of late stage at presentation (adjusted odds ratio [OR] = 2.16; 95% confidence interval [CI] = 1.01-4.59), and those without health insurance were 10.97 times more likely to present at late stage (95% CI = 1.30-92.49). Unmarried patients were 1.6 times at an increased hazard of death (95% CI = 1.12-2.24). CONCLUSION Disparities, such as race and health insurance status, are important predictors of stage at presentation of patients with head and neck cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1826-E1832, 2016.
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Affiliation(s)
- Nosayaba Osazuwa-Peters
- Saint Louis University Cancer Center, Saint Louis, Missouri.,Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, School of Medicine, Saint Louis, Missouri.,Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - Kara M Christopher
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, School of Medicine, Saint Louis, Missouri
| | - Adnan S Hussaini
- Saint Louis University, School of Medicine, Saint Louis, Missouri
| | - Anit Behera
- Saint Louis University, School of Medicine, Saint Louis, Missouri.,Saint Louis University Center for Outcomes Research, Saint Louis, Missouri
| | - Ronald J Walker
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, School of Medicine, Saint Louis, Missouri
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, School of Medicine, Saint Louis, Missouri.,Harvard Medical School, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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Ramakodi MP, Kulathinal RJ, Chung Y, Serebriiskii I, Liu JC, Ragin CC. Ancestral-derived effects on the mutational landscape of laryngeal cancer. Genomics 2015; 107:76-82. [PMID: 26721311 DOI: 10.1016/j.ygeno.2015.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/26/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Abstract
Laryngeal cancer disproportionately affects more African-Americans than European-Americans. Here, we analyze the genome-wide somatic point mutations from the tumors of 13 African-Americans and 57 European-Americans from TCGA to differentiate between environmental and ancestrally-inherited factors. The mean number of mutations was different between African-Americans (151.31) and European-Americans (277.63). Other differences in the overall mutational landscape between African-American and European-American were also found. The frequency of C>A, and C>G were significantly different between the two populations (p-value<0.05). Context nucleotide signatures for some mutation types significantly differ between these two populations. Thus, the context nucleotide signatures along with other factors could be related to the observed mutational landscape differences between two races. Finally, we show that mutated genes associated with these mutational differences differ between the two populations. Thus, at the molecular level, race appears to be a factor in the progression of laryngeal cancer with ancestral genomic signatures best explaining these differences.
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Affiliation(s)
- Meganathan P Ramakodi
- Cancer Prevention and Control Program, Fox Chase Cancer Center-Temple Health, Philadelphia, PA 19111, USA; Department of Biology, Temple University, Philadelphia, PA 19122, USA; African-Caribbean Cancer Consortium; Center for Computational Genetics and Genomics, Temple University, Philadelphia, PA 19122, USA
| | - Rob J Kulathinal
- Department of Biology, Temple University, Philadelphia, PA 19122, USA; African-Caribbean Cancer Consortium; Center for Computational Genetics and Genomics, Temple University, Philadelphia, PA 19122, USA
| | - Yujin Chung
- Department of Biology, Temple University, Philadelphia, PA 19122, USA; Center for Computational Genetics and Genomics, Temple University, Philadelphia, PA 19122, USA
| | - Ilya Serebriiskii
- Developmental Therapeutics, Fox Chase Cancer Center- Temple Health, Philadelphia, PA 19111, USA; Kazan Federal University, Kazan, Russia
| | - Jeffrey C Liu
- Cancer Prevention and Control Program, Fox Chase Cancer Center-Temple Health, Philadelphia, PA 19111, USA; Department of Otolaryngology - Head and Neck Surgery, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Camille C Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center-Temple Health, Philadelphia, PA 19111, USA; African-Caribbean Cancer Consortium; Department of Otolaryngology - Head and Neck Surgery, Temple University School of Medicine, Philadelphia, PA 19140, USA; College of Public Health, Temple University, Philadelphia, PA 19122, USA.
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76
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Gillison ML, Restighini C. Anticipation of the Impact of Human Papillomavirus on Clinical Decision Making for the Head and Neck Cancer Patient. Hematol Oncol Clin North Am 2015; 29:1045-60. [DOI: 10.1016/j.hoc.2015.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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77
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Rereddy SK, Jordan DR, Moore CE. Dying to be Screened: Exploring the Unequal Burden of Head and Neck Cancer in Health Provider Shortage Areas. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:490-496. [PMID: 25420766 DOI: 10.1007/s13187-014-0755-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Multiple factors contribute to disparities in head and neck cancer prevalence across the sociodemographic spectrum, including a lack of screening efforts in mostly underserved minority communities. African Americans and other ethnic minorities are at greater risk for late-stage diagnoses due to the lack of routine screenings and examinations. Advanced stage diagnosis profoundly limits treatment options, disease recovery, and survivorship. Differential access to care is frequently cited as contributing to delayed diagnosis in minority patients. Access to care is a complex concept that includes not only insurance status but also the equitable spatial distribution of health-care services. Recognizing this complexity, we explored the distribution of head and neck cancer cases seen at Grady Health System from 2010 to 2012 in order to identify geographic trends in disease prevalence compared to the distribution of oral health-care providers at the zip code level. We identified 53 cases of head and neck cancer spread across 36 zip codes primarily in the metropolitan Atlanta region. Geographic information systems analysis showed a spatial mismatch: increased disease prevalence and provider shortage in the mostly minority zip codes, and decreased disease prevalence and greater provider presence in the majority zip codes.
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Affiliation(s)
- Shruthi K Rereddy
- Department of Otolaryngology, Head and Neck Surgery, Grady Memorial Hospital, Emory University School of Medicine, 80 Jesse Hill Jr. Drive - Suite 3J, Atlanta, GA, 30303, USA
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78
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Daraei P, Moore CE. Racial Disparity Among the Head and Neck Cancer Population. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:546-551. [PMID: 25398667 DOI: 10.1007/s13187-014-0753-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Head and neck cancer is the ninth most common cancer in the USA, accounting for 3.3 % of all cancers. The incidence of head and neck cancer has plateaued recently; however, morbidity and mortality continue to remain high. Moreover, racial disparity between African-American and White patients has been studied in the head and neck community, and a vast difference still remains in mortality rate and late stage at presentation. A review of the English literature was performed using PubMed/MEDLINE for demographics, epidemiology, and studies that focused on the disparity in head and neck cancer between African-American and White patients. Age-adjusted incidence of head and neck cancer is increased in African-Americans, while the 5-year survival is decreased compared to Whites. African-American patients present with more advanced disease. When receiving similar multidisciplinary care, the overall survival was not significantly different, but racial disparity often persists in treatment regimens. Socioeconomic determinants such as insurance status play a critical role in racial disparity, along with low levels of public awareness, a lack of knowledge of specific risk factors, and a sense of mistrust that is seen in the African-American population. Disparity in the head and neck cancer community is worrisome, and although efforts have been taken to decrease the disparity, a significant difference exists. Fortunately, the disparity is reversible and can be eliminated. To do so, it is critical to extend to underserved community programs that provide appropriate screening and diagnosis, with subsequent follow-up and treatment following the standards of care.
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Affiliation(s)
- Pedram Daraei
- Department of Otolaryngology - Head and Neck Surgery, Emory University, 550 Peachtree Street NE, Medical Office Tower, 11th Floor, Atlanta, GA, 30308, USA,
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79
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Smith SP, Russell JL, Chen NW, Kuo YF, Resto VA. Sinonasal Carcinoma: Racial and Ethnic Disparities in Survival--A Review of 4714 Patients. Otolaryngol Head Neck Surg 2015; 153:551-60. [PMID: 26163451 DOI: 10.1177/0194599815593277] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/05/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether or not patient race and ethnicity affect sinonasal cancer survival. STUDY DESIGN Retrospective database analysis. SETTING National Cancer Institute's Surveillance, Epidemiology, and End Results Database, 1988-2010. SUBJECTS AND METHODS Sinonasal carcinoma cases were extracted according to site codes and histology recode-broad groupings. The cohort was used to calculate disease-specific survival in regard to race and ethnicity. Extracted data were further analyzed through direct comparisons and multivariable Cox regression models controlling for patient, tumor, and treatment characteristics. RESULTS Unadjusted survival curves for all sinonasal carcinomas showed poorer disease-specific survival for black versus white patients (P = .02), which was eliminated after controlling for tumor characteristics (hazard ratio: 1.02, P = .86). Specifically for sinonasal squamous cell carcinoma, significantly poorer disease-specific survival was found for both black (P = .01) and Hispanic (P = .01) patients as compared with white patients. Similarly, when controlling for tumor characteristics, the disease-specific survival disparity was eliminated for black (hazard ratio: 0.93, P = .59) and Hispanic patients (hazard ratio: 1.01, P = .94). CONCLUSION Black race is a risk factor for poorer disease-specific survival when all sinonasal histologic subtypes are examined together. Specifically for sinonasal squamous cell carcinoma, both black race and Hispanic ethnicity are risk factors for poorer disease-specific survival. When tumor characteristics are controlled for in this cohort, the survival disparity is eliminated, demonstrating that the disparity can be accounted for exclusively by more advanced disease at presentation, opposed to the more complex effect seen in other subsites of the head and neck.
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Affiliation(s)
- Steven P Smith
- Department of Otolaryngology-Head and Neck Surgery, UTMB Health, Galveston, Texas, USA
| | - Joseph L Russell
- Department of Otolaryngology-Head and Neck Surgery, UTMB Health, Galveston, Texas, USA
| | - Nai-Wei Chen
- Biostatistics Core, Department of Preventive Medicine and Community Health, UTMB Health, Galveston, Texas, USA
| | - Yong-Fang Kuo
- Biostatistics Core, Department of Preventive Medicine and Community Health, UTMB Health, Galveston, Texas, USA
| | - Vicente A Resto
- Department of Otolaryngology-Head and Neck Surgery, UTMB Health, Galveston, Texas, USA
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Zandberg DP, Liu S, Goloubeva O, Ord R, Strome SE, Suntharalingam M, Taylor R, Morales RE, Wolf JS, Zimrin A, Lubek JE, Schumaker LM, Cullen KJ. Oropharyngeal cancer as a driver of racial outcome disparities in squamous cell carcinoma of the head and neck: 10-year experience at the University of Maryland Greenebaum Cancer Center. Head Neck 2015; 38:564-72. [PMID: 25488341 DOI: 10.1002/hed.23933] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Racial outcome disparities have been observed in head and neck squamous cell carcinoma (HNSCC) with diminished survival for black patients compared with white patients. METHODS We retrospectively analyzed 1318 patients with primary HNSCC treated at the University of Maryland Greenebaum Cancer Center (UMGCC) from 2000 to 2010. RESULTS Of all the patients, 65.9% were white, 30.7% were black, and 3.3% were of other races. Black patients were less likely to present with oral cavity cancer, and more likely to present with laryngeal or hypopharyngeal cancers. White patients were more likely to have early stage disease, especially in the oral cavity. Black race was independently associated with worse overall survival (OS) in the entire cohort. Black patients had a significantly worse OS among oral cavity and oropharyngeal cancers, with the largest disparity in oropharyngeal cancer. However, in multivariate analysis, race was only still significant in oropharyngeal cancer. CONCLUSION We observed differences by race in distribution of disease site, stage, and OS. Survival disparity in the entire cohort was driven mostly by differences among oropharyngeal cancer.
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Affiliation(s)
- Dan P Zandberg
- Department of Medicine, Division of Medical Oncology, University of Maryland School of Medicine, Baltimore, Maryland.,University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, Maryland
| | - Sandy Liu
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Olga Goloubeva
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, Maryland
| | - Robert Ord
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, Maryland.,Department of Oral and Maxillofacial Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Scott E Strome
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mohan Suntharalingam
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rodney Taylor
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert E Morales
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jeffrey S Wolf
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ann Zimrin
- Department of Medicine, Division of Medical Oncology, University of Maryland School of Medicine, Baltimore, Maryland.,University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, Maryland
| | - Joshua E Lubek
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, Maryland.,Department of Oral and Maxillofacial Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lisa M Schumaker
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, Maryland
| | - Kevin J Cullen
- Department of Medicine, Division of Medical Oncology, University of Maryland School of Medicine, Baltimore, Maryland.,University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, Maryland
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Misono S, Marmor S, Yueh B, Virnig BA. T1 glottic carcinoma: do comorbidities, facility characteristics, and sociodemographics explain survival differences across treatment? Otolaryngol Head Neck Surg 2015; 152:856-62. [PMID: 25715348 PMCID: PMC5560894 DOI: 10.1177/0194599815572112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/20/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Recent large-scale studies have observed differences in survival following treatment for early laryngeal carcinoma depending on treatment type but were not able to take sociodemographic, comorbidity, and facility data into account. The objective of this study was to determine whether survival differences across treatment types persist when these factors are included in the analysis. STUDY DESIGN Retrospective cohort analysis. SETTING Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data files. SUBJECTS AND METHODS Medicare beneficiaries who were identified through the SEER registries (1991-2009) as having T1 glottic squamous cell carcinoma (scca) and a known treatment type were included. RESULTS A total of 2338 patients with incident T1 glottic scca were identified. Most were white and male. Treatment type was radiation only in 47%, local surgery and radiation in 39%, and local surgery only in 14%. Black race and increased comorbidities were associated with worse survival. When sociodemographics, comorbidities, and facility characteristics were taken into account, survival differences were observed across treatment types, with those receiving local surgery demonstrating better overall and cancer-specific survival. CONCLUSION These results suggest that following treatment of T1 glottic scca, there may be survival differences across treatment types beyond those explained by sociodemographic, comorbidity, and facility characteristics.
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Affiliation(s)
- Stephanie Misono
- Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Schelomo Marmor
- Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bevan Yueh
- Department of Otolaryngology/Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Beth A Virnig
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Shin JY, Truong MT. Racial disparities in laryngeal cancer treatment and outcome: A population-based analysis of 24,069 patients. Laryngoscope 2015; 125:1667-74. [PMID: 25694265 DOI: 10.1002/lary.25212] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/15/2015] [Accepted: 01/23/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine the impact of race on laryngeal preservation strategies and overall survival (OS) for laryngeal squamous cell carcinoma (SCC). STUDY DESIGN Retrospective, national cancer database analysis. METHODS Data were extracted from the Surveillance, Epidemiology, and End Results database. Chi-square test, Kaplan-Meier method, and Cox regression models were employed in SPSS 20.0 (Armonk, NY: IBM Corp.) for data analyses. RESULTS A total of 24,069 patients with laryngeal SCC were identified. Of these, 18,166 (75.5%) patients were white, 3,475 (14.4%) were black, 1,608 (6.7%) were Hispanic, and 820 (3.4%) were Asian. Compared with other races, black patients were more likely to be diagnosed at a younger age (P < 0.001), undergo lymph node dissection (P < 0.001), have nodal metastasis (P < 0.001), be with advanced stage disease (P < 0.001), and be unmarried (P < 0.001). Black patients with T1 to T2 and T3 disease were more likely to undergo total laryngectomy as compared with white patients (T1-2: 8.2% vs. 4.3%; P < 0.001; T3: 28.4% vs. 24.3%; P = 0.023). For patients with T4 disease, however, rates of primary radiotherapy among black patients were higher (40.5% vs. 35.7%; P = 0.015). The 5-year OS for white, black, Hispanic, and Asian patients were 60.6%, 52.7%, 59.5% and 65.7% (P < 0.001). This significant 5-year OS difference by race persisted regardless of age, gender, year of diagnosis, primary treatment, nodal status, or tumor grade. On multivariate analysis, race remained an independent prognostic factor for OS. CONCLUSIONS Race is an independent prognostic factor for OS. Further studies are warranted to evaluate causes for racial disparities and discrepancies in OS and laryngeal preservation strategies.
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Affiliation(s)
- Jacob Y Shin
- Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Minh T Truong
- Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, U.S.A.,Department of Radiology, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, U.S.A
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83
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Chen MM, Roman SA, Sosa JA, Judson BL. Predictors of Survival in Sinonasal Adenocarcinoma. J Neurol Surg B Skull Base 2015. [PMID: 26225303 DOI: 10.1055/s-0034-1543995] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objectives To identify factors associated with disease-specific survival (DSS) in intestinal and nonintestinal sinonasal adenocarcinoma. Design Retrospective review. Setting Surveillance Epidemiology and End Results database. Participants Adult patients with sinonasal adenocarcinoma. Main Outcome Measures DSS. Results We identified 325 patients; of these, 300 had the nonintestinal type and 25 had intestinal type histologies. The 5-year DSS rates for patients who had no treatment, radiation (RT), surgery, and surgery and postoperative RT were 42.5, 46.1, 85.6, and 72.6%, respectively (log-rank test; p < 0.001). Black race, age ≥ 75 years, paranasal sinus involvement, and high grade were independently associated with decreased DSS. Compared with RT, surgery (hazard ratio [HR]: 0.34; 95% confidence interval [CI]: 0.15-0.77), and adjuvant RT (HR: 0.47; 95% CI, 0.26-0.86) were associated with improved DSS. Conclusions There is no difference in prognosis between intestinal and nonintestinal subtypes of sinonasal adenocarcinoma. Treatment with surgery alone or adjuvant RT is associated with a more favorable prognosis.
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Affiliation(s)
- Michelle M Chen
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States
| | - Sanziana A Roman
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States
| | - Julie A Sosa
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States ; Endocrine Neoplasia Diseases Group, Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States
| | - Benjamin L Judson
- Section of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
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84
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Mahal BA, Inverso G, Aizer AA, Bruce Donoff R, Chuang SK. Impact of African-American race on presentation, treatment, and survival of head and neck cancer. Oral Oncol 2014; 50:1177-81. [PMID: 25261298 DOI: 10.1016/j.oraloncology.2014.09.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 07/18/2014] [Accepted: 09/06/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the associations between African American race and stage at diagnosis, receipt of definitive therapy, and cancer-specific mortality among patients with head and neck cancer. MATERIALS AND METHODS The Surveillance, Epidemiology and End Results (SEER) database was used to conduct a retrospective study on 34,437 patients diagnosed with head and neck cancer from 2007 to 2010. Multivariable logistic regression analyses were applied to determine the impact of race on cancer stage at presentation (metastatic vs. non-metastatic) and receipt of definitive treatment. Fine and Gray competing-risks regression modeled the association between race and head and neck cancer-specific mortality. RESULTS African Americans were more likely to present with metastatic cancer compared to non-African Americans (Adjusted Odds Ratio [AOR] 1.76; CI 1.50-2.07; P<0.001). Among patients with non-metastatic disease, African Americans were less likely to receive definitive treatment (AOR 0.63; CI 0.55-0.72; P<0.001). After a median follow-up of 19months, African Americans with non-metastatic disease were found to have a higher risk of head and neck cancer specific mortality (AHR 1.19; 95% CI 1.09-1.29; P<0.001). CONCLUSION African Americans with head and neck cancer are more likely to present with metastatic disease, less likely to be treated definitively, and are more likely to die from head and neck cancer. The unacceptably high rates of disparity found in this study should serve as immediate targets for urgent healthcare policy intervention.
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Affiliation(s)
- Brandon A Mahal
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Gino Inverso
- Harvard School of Dental Medicine, 188 Longwood Ave., Boston, MA 02115, USA
| | - Ayal A Aizer
- Harvard Radiation Oncology Program, Massachusetts General Hospital, 55 FruitStreet, Boston, MA 02114, USA
| | - R Bruce Donoff
- Harvard School of Dental Medicine, 188 Longwood Ave., Boston, MA 02115, USA; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sung-Kiang Chuang
- Harvard School of Dental Medicine, 188 Longwood Ave., Boston, MA 02115, USA; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Hayes DN, Peng G, Pennella E, Hossain A, Carter GC, Muehlenbein C, Obasaju C. An exploratory subgroup analysis of race and gender in squamous cancer of the head and neck: inferior outcomes for African American males in the LORHAN database. Oral Oncol 2014; 50:605-10. [PMID: 24637172 DOI: 10.1016/j.oraloncology.2014.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 12/13/2013] [Accepted: 02/20/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Previous retrospective analyses show poor outcomes for African American (AA) patients with head and neck carcinoma (HNC). Such racial disparities are not well understood, and generally studies have been too small to investigate subgroups and interactions related to race. MATERIALS AND METHODS The longitudinal oncology registry of head and neck carcinoma registry was used to identify patients ⩾18 years of age with squamous cell carcinoma of the head and neck, with no baseline metastases, and with an adequate record of survival time. Patient demographic and treatment characteristics were evaluated as a function of race and other known potential confounders of outcome. Associations between patient characteristics, including smoking, stage, performance status, and overall survival (OS) and progression-free survival (PFS) outcomes were also examined. RESULTS Analysis of OS and PFS confirmed prior reports of inferior outcomes in AA patients vs. Whites with median OS/3-yr rate 41.7 mo/52% in AAs vs. 56.6 mo/70% in Whites (hazard ratio: 1.69 [95% confidence interval: 1.42, 2.01]). The elevated risk for worse OS and PFS in AAs remained, after multivariate adjustment. African American males incurred most of the excess risk compared to AA females. CONCLUSION This exploratory study confirmed a worse OS and PFS prognosis for AA patients, and it documents that most of the excess risk occurs in AA males. Future studies should confirm these findings and should investigate biological and other factors that account for such profound differences in outcomes.
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Affiliation(s)
- D Neil Hayes
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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86
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Racial disparities in Human Papillomavirus (HPV) associated head and neck cancer. Am J Otolaryngol 2014; 35:147-53. [PMID: 24209992 DOI: 10.1016/j.amjoto.2013.09.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/20/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE Poorer survival from head and neck squamous cell carcinoma (HNSCC) in African Americans (AA) may be due to disparity in the prevalence of Human Papillomavirus (HPV) but earlier studies often failed to control other etiological factors. We aimed to elucidate whether racial disparities in HPV prevalence and overall survival were due to confounding from smoking or alcohol use. MATERIALS AND METHODS 385 patients with SCC of the mouth, pharynx, nose, or larynx who had surgical resection at Wayne State University affiliated hospitals were identified through a population-based cancer registry. Formalin fixed paraffin embedded tissue blocks were used to determine the presence of HPV DNA and its genotype using a sensitive broad-spectrum PCR technique. Patients' demographics, tumor characteristics and vital status were obtained through record linkage with the registry data and smoking and alcohol information was abstracted from medical record. Cox's proportional hazard model and unconditional logistic regression models were employed to analyze the overall survival and tumor HPV-positivity, respectively. RESULTS HPV positivity in oropharyngeal cancer was substantially lower in AA than in other racial groups (odds ratio 0.14, 95% confidence interval (CI) 0.05-0.37) and adjustment for smoking or alcohol did not change this association. However, a significantly increased hazard ratio of death in AA oropharyngeal cancer patients (univariable hazard ratio (HR) 2.55, 95% CI 1.42-4.59) decreased to almost unity (HR 1.49, 95% CI 0.75-2.93) after adjustment for HPV and smoking. CONCLUSIONS Lower HPV prevalence in AA largely accounts for their poorer survival from oropharyngeal cancer, but not other HNSSC.
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Iyengar NM, Kochhar A, Morris PG, Morris LG, Zhou XK, Ghossein RA, Pino A, Fury MG, Pfister DG, Patel SG, Boyle JO, Hudis CA, Dannenberg AJ. Impact of obesity on the survival of patients with early-stage squamous cell carcinoma of the oral tongue. Cancer 2014; 120:983-91. [PMID: 24449483 DOI: 10.1002/cncr.28532] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/11/2013] [Accepted: 09/16/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although obesity increases risk and negatively affects survival for many malignancies, the prognostic implications in squamous cell carcinoma (SCC) of the oral tongue, a disease often associated with prediagnosis weight loss, are unknown. METHODS Patients with T1-T2 oral tongue SCC underwent curative-intent resection in this single-institution study. All patients underwent nutritional assessment prior to surgery. Body mass index (BMI) was calculated from measured height and weight and categorized as obese (≥ 30 kg/m(2) ), overweight (25-29.9 kg/m(2) ), or normal (18.5-24.9 kg/m(2) ). Clinical outcomes, including disease-specific survival, recurrence-free survival, and overall survival, were compared by BMI group using Cox regression. RESULTS From 2000 to 2009, 155 patients (90 men, 65 women) of median age 57 years (range, 18-86 years) were included. Baseline characteristics were similar by BMI group. Obesity was significantly associated with adverse disease-specific survival compared with normal weight in univariable (hazard ratio [HR] = 2.65, 95% confidence interval [CI] = 1.07-6.59; P = .04) and multivariable analyses (HR = 5.01; 95% CI = 1.69-14.81; P = .004). A consistent association was seen between obesity and worse recurrence-free survival (HR = 1.87; 95% CI = 0.90-3.88) and between obesity and worse overall survival (HR = 2.03; 95% CI = 0.88-4.65) though without reaching statistical significance (P = .09 and P = .10, respectively) in multivariable analyses. CONCLUSIONS In this retrospective study, obesity was an adverse independent prognostic variable. This association may not have been previously appreciated due to confounding by multiple factors including prediagnosis weight loss.
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Affiliation(s)
- Neil M Iyengar
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
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88
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Race and competing mortality in advanced head and neck cancer. Oral Oncol 2014; 50:40-4. [DOI: 10.1016/j.oraloncology.2013.09.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/16/2013] [Accepted: 09/23/2013] [Indexed: 11/18/2022]
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89
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Isayeva T, Xu J, Dai Q, Whitley AC, Bonner J, Nabell L, Spencer S, Carroll W, Jones G, Ragin C, Brandwein-Gensler M. African Americans with oropharyngeal carcinoma have significantly poorer outcomes despite similar rates of human papillomavirus-mediated carcinogenesis. Hum Pathol 2013; 45:310-9. [PMID: 24355195 DOI: 10.1016/j.humpath.2013.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/10/2013] [Accepted: 09/13/2013] [Indexed: 01/11/2023]
Abstract
We examined racial disparities among 102 oropharyngeal carcinoma (OPC) patients (30 African Americans and 72 whites) comparing rates of transcriptionally active human papillomavirus (HPV)16/18 and p16(INK4a) overexpression, with times to disease progression and disease-specific survival (DSS). Expression of HPV16/18 transcripts was assessed by reverse transcription and polymerase chain reaction using type-specific E6/E7 primers; p16(INK4a) was evaluated by immunohistochemistry. African Americans were significantly more likely to present with high T stage disease and receive nonsurgical treatment. HPV16/18 was present in 63% of patients; no racial differences were observed. Silenced p16(INK4a) in OPC was significantly more common in African Americans (15/24) than in whites (20/69) (P = .004) and in HPV16+ African Americans (6/24) than in HPV+ whites (2/42) (P = .023). Kaplan-Meier analysis for DSS revealed a protective effect for p16(INK4a) overexpression (P = .0028; hazard ratio [HR], 0.23), HPV16+ (P = .036; HR, 0.38), and whites (P = .0039; HR, 0.27). Shorter DSS was associated with primary definitive chemoradiation (P = .019; HR, 3.49) and T3/T4 disease (P = .0001; HR, 7.75). A protective effect with respect to disease progression was observed for HPV16+ (P = .007; HR, 0.27), whites (P = .0006; HR, 0.197), and p16(INK4a) overexpression (P = .0001; HR, 0.116). African Americans with OPC experience poorer outcomes likely due to p16(INK4a) silencing, higher T stage, and nonsurgical treatment but not lower rates of transcriptionally active HPV16/18.
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Affiliation(s)
- Tatyana Isayeva
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331
| | - Jie Xu
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331
| | - Qian Dai
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331
| | - Alex C Whitley
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331
| | - James Bonner
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331
| | - Lisle Nabell
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331
| | - Sharon Spencer
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331
| | - William Carroll
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331
| | - Giera Jones
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Heath, Philadelphia, PA, 19111-2497
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Heath, Philadelphia, PA, 19111-2497
| | - Margaret Brandwein-Gensler
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331.
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Alpha-2 Heremans Schmid Glycoprotein (AHSG) modulates signaling pathways in head and neck squamous cell carcinoma cell line SQ20B. Exp Cell Res 2013; 321:123-32. [PMID: 24332981 DOI: 10.1016/j.yexcr.2013.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 11/26/2013] [Accepted: 12/03/2013] [Indexed: 01/06/2023]
Abstract
This study was performed to identify the potential role of Alpha-2 Heremans Schmid Glycoprotein (AHSG) in Head and Neck Squamous Cell Carcinoma (HNSCC) tumorigenesis using an HNSCC cell line model. HNSCC cell lines are unique among cancer cell lines, in that they produce endogenous AHSG and do not rely, solely, on AHSG derived from serum. To produce our model, we performed a stable transfection to down-regulate AHSG in the HNSCC cell line SQ20B, resulting in three SQ20B sublines, AH50 with 50% AHSG production, AH20 with 20% AHSG production and EV which is the empty vector control expressing wild-type levels of AHSG. Utilizing these sublines, we examined the effect of AHSG depletion on cellular adhesion, proliferation, migration and invasion in a serum-free environment. We demonstrated that sublines EV and AH50 adhered to plastic and laminin significantly faster than the AH20 cell line, supporting the previously reported role of exogenous AHSG in cell adhesion. As for proliferative potential, EV had the greatest amount of proliferation with AH50 proliferation significantly diminished. AH20 cells did not proliferate at all. Depletion of AHSG also diminished cellular migration and invasion. TGF-β was examined to determine whether levels of the TGF-β binding AHSG influenced the effect of TGF-β on cell signaling and proliferation. Whereas higher levels of AHSG blunted TGF-β influenced SMAD and ERK signaling, it did not clearly affect proliferation, suggesting that AHSG influences on adhesion, proliferation, invasion and migration are primarily due to its role in adhesion and cell spreading. The previously reported role of AHSG in potentiating metastasis via protecting MMP-9 from autolysis was also supported in this cell line based model system of endogenous AHSG production in HNSCC. Together, these data show that endogenously produced AHSG in an HNSCC cell line, promotes in vitro cellular properties identified as having a role in tumorigenesis.
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91
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Sanghvi S, Khan MN, Patel NR, Yeldandi S, Baredes S, Eloy JA. Epidemiology of sinonasal squamous cell carcinoma: A comprehensive analysis of 4994 patients. Laryngoscope 2013; 124:76-83. [DOI: 10.1002/lary.24264] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 05/17/2013] [Accepted: 05/30/2013] [Indexed: 01/11/2023]
Affiliation(s)
- Saurin Sanghvi
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Mohemmed N. Khan
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Neal R. Patel
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Swetha Yeldandi
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Soly Baredes
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New JerseyUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
- Department of Neurological SurgeryUniversity of Medicine and Dentistry of New Jersey–New Jersey Medical SchoolNewark New Jersey U.S.A
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92
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Montero-Miranda PH, Ganly I. Survivorship--competing mortalities, morbidities, and second malignancies. Otolaryngol Clin North Am 2013; 46:681-710. [PMID: 23910478 DOI: 10.1016/j.otc.2013.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mortality of head and neck cancer has declined in the United States over the past 20 years. This improvement has been linked to use of multimodality treatment of advanced disease. Despite this improvement, disease-specific survival remains low. Patients who survive head and neck cancer are exposed to morbidity and mortality secondary to the same factors as the general population. Factors related to cancer and cancer treatment predispose them to increased risk of mortality. Improvements in head and neck cancer treatment have led to a scenario where an increasing proportion of patients die from causes other than the primary cancer, called competing mortalities.
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Affiliation(s)
- Pablo H Montero-Miranda
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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93
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Emerick KS, Leavitt ER, Michaelson JS, Diephuis B, Clark JR, Deschler DG. Initial Clinical Findings of a Mathematical Model to Predict Survival of Head and Neck Cancer. Otolaryngol Head Neck Surg 2013; 149:572-8. [DOI: 10.1177/0194599813495178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives (1) Identify clinical features that impact survival for head and neck cancer. (2) Determine the individual contribution to mortality of significant clinical features. (3) Develop a web-based calculator to integrate clinical features and predict survival outcome for individual patients. Study Design Analysis of a national cancer database. We fit patient data to the binary-biological model of cancer lethality, a mathematical model designed to predict cancer outcome. The model predicts the risk of cancer death, using information on tumor size, nodal status, and other prognostic factors. Subjects and Methods Analysis was carried out on a cohort of ~50,000 patients with head and neck cancer from the Survey, Epidemiology and End-Results (SEER) 2009 data set and validated with a cohort of ~1300 patients from an institutional Massachusetts General Hospital/Massachusetts Eye and Ear Infirmary database. We developed a web-based calculator written in JavaScript, PHP, and HTML. Results The risk of death due to head and neck cancer increases monotonically with tumor size. Each positive lymph node is associated with ~14% extra risk of death. Anatomical site, age, race, tumor extension, N stage, and extracapsular spread contribute to mortality. The lethal impact of these prognostics factors can be accurately estimated by the Size + Nodes + PrognosticMarkers (SNAP) method. Conclusions This predictive cancer model and web-based calculator provide a basis for estimating the risk of death for head and neck cancer patients by assigning values to the lethal contributions of tumor size, number of positive nodes, anatomical site, tumor extension, N stage, extracapsular spread, age at diagnosis, and race.
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Affiliation(s)
- Kevin S. Emerick
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Erica R. Leavitt
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Massachusetts General Hospital Department of Surgery, Boston, Massachusetts, USA
| | - James S. Michaelson
- Massachusetts General Hospital Department of Surgery, Boston, Massachusetts, USA
| | - Bradford Diephuis
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Massachusetts General Hospital Department of Surgery, Boston, Massachusetts, USA
| | - John R. Clark
- Massachusetts General Hospital Department of Medicine Hematology/Oncology, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Daniel G. Deschler
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Cambridge, Massachusetts, USA
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Disentangling the effects of race/ethnicity and socioeconomic status of neighborhood in cancer stage distribution in New York City. Cancer Causes Control 2013; 24:1069-78. [DOI: 10.1007/s10552-013-0184-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
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Zhao Z, Ge J, Sun Y, Tian L, Lu J, Liu M, Zhao Y. Is E-cadherin immunoexpression a prognostic factor for head and neck squamous cell carcinoma (HNSCC)? A systematic review and meta-analysis. Oral Oncol 2012; 48:761-7. [PMID: 22455948 DOI: 10.1016/j.oraloncology.2012.02.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 02/28/2012] [Accepted: 02/29/2012] [Indexed: 11/16/2022]
Abstract
We summarized existing evidence about whether the aberrant E-cadherin expression is a prognostic factor for patients with HNSCC. Identifying relevant articles, filtrating studies and extracting data were independently conducted by two reviewers. The quality of eligible studies was assessed according to systematic score criteria. Associations between aberrant E-cadherin expression and overall survival (OS) or disease-free survival (DFS) were summarized by hazard ratio (HR) estimates. Random or fixed effects models were used to investigate the effect of E-cadherin across the studies. According to the multivariate and univariate analyses, the meta-analysis of the included studies gave a statistically significant pooled HR for OS in HNSCC [the pooled HR=2.533; 95% confidence interval (CI)=1.971-3.254]. In addition, the subgroup analyses showed that the pooled HR of each subgroup also exhibited statistical significance according to the subpopulations (Asian and other subpopulations), treatments (surgery and other treatments), locations of primary tumors (oral cavity and other subsites), and data sources of HR (reported and estimated HR). Similar to the results of OS, the analysis of four included trials showed that the aberrant E-cadherin expression could predict low DFS. Meanwhile, a cumulative meta-analysis showed that the pooled HR became statistically significant. However, a meta-regression analysis showed that the OS was not statistically significant with the cutoff values of the included studies. Our study gives an important piece of evidence that aberrant E-cadherin expression was associated with a poor prognosis in patients with HNSCC.
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Affiliation(s)
- ZhiGang Zhao
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin 150081, Heilongjiang Province, People's Republic of China
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Sharma A, Méndez E, Yueh B, Lohavanichbutr P, Houck J, Doody DR, Futran ND, Upton MP, Schwartz SM, Chen C. Human papillomavirus-positive oral cavity and oropharyngeal cancer patients do not have better quality-of-life trajectories. Otolaryngol Head Neck Surg 2012; 146:739-45. [PMID: 22275190 DOI: 10.1177/0194599811434707] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine the role of human papillomavirus (HPV) status on quality of life (QOL) in patients with oral cavity and oropharyngeal squamous cell carcinoma (OSCC). Since OSCC that are associated with high-risk HPV have an improved response to treatment and survival, we hypothesized that patients with these tumors would have better QOL trajectories. STUDY DESIGN Prospective cohort study. SETTING Tertiary care academic medical center and 2 affiliated hospitals. SUBJECTS AND METHODS Head and neck-specific QOL was determined using the University of Washington Quality of Life scale version 4 in patients with newly diagnosed invasive OSSC (N = 228). RESULTS Pretreatment QOL was higher in patients with high-risk HPV-associated tumors compared with patients with HPV-negative or low-risk HPV-associated tumors (P = .015). Patients with high-risk HPV-associated tumors had larger decreases in QOL from pretreatment to immediate posttreatment compared with patients with HPV-negative or low-risk HPV-associated tumors (P = .041). There was no association between HPV status and 1-year posttreatment QOL. CONCLUSION Among OSCC patients, high-risk HPV-associated tumors were associated with higher pretreatment QOL and a larger decrease in QOL from pretreatment to immediate posttreatment, suggesting that treatment intensity in this unique population may adversely affect QOL.
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Affiliation(s)
- Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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