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Agarwal P, Bloom J, Zhou Y, Zhao R, Huang S, Yajima M, Devaiah AK. Socioeconomic disparities in treatment and survival in patients with hypopharyngeal malignancy. Head Neck 2023; 45:2670-2679. [PMID: 37638612 DOI: 10.1002/hed.27492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND This retrospective study utilizes The Surveillance, Epidemiology, and End Results database to investigate socioeconomic factors leading to treatment disparities in hypopharyngeal malignancy. METHODS Treatment was compared to National Cancer Care Network guidelines. Novel analyses, including logistic modeling, allowed survival analysis and identification of socioeconomic variables not previously considered in staging and management guidelines. RESULTS Black and older patients, and residence in low-income areas predict lower likelihood of standard therapy (p < 0.05). Early-stage disease and standard therapy correlate with improved survival (p < 0.001). Medicaid, advanced age, advanced disease, and treatment outside of consensus guidelines correlated with lower survival (p < 0.0001). CONCLUSIONS There are clear socioeconomic factors impacting treatment and survival in hypopharyngeal malignancies. Standard therapy affords superior survival rate. Black, low socioeconomic status, and older patients are less likely to receive standard therapy. Education and language isolation do not predict treatment or survival. Understanding these discrepancies is paramount to palliating disparities in healthcare.
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Affiliation(s)
- Pratima Agarwal
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jacob Bloom
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Runqi Zhao
- Boston University, Boston, Massachusetts, USA
| | - Simu Huang
- Boston University, Boston, Massachusetts, USA
| | | | - Anand K Devaiah
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
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Cortese S, Muratori E, Mastronicola R, Roch M, Beulque E, Rauch P, Dekerle L, Deganello A, Dolivet G. Partial pharyngolaryngectomy with infrahyoid flap: Our experience. Am J Otolaryngol 2019; 40:102271. [PMID: 31445929 DOI: 10.1016/j.amjoto.2019.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/27/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
AIM We evaluated a cohort of advanced hypopharyngeal squamous cell carcinoma, treated with conservative surgery, reconstruction with infrahyoid flap and radio-chemotherapy. METHODS We used partial pharyngo-laryngectomy and radio-chemotherapy to treat fifty-seven patients with stage III-IV hypopharyngeal SCC from November 1994 to December 2011. Clinical examination and speech therapy evaluation were used for estimation of laryngeal function. RESULTS All patients received a partial pharyngo-laryngectomy. All patients underwent neck dissection; 56 patients received bilateral neck dissection. Reconstruction was achieved by infra-hyoid flap. Five-year overall and disease-specific survival rates were 54.4% and 61.4%, respectively. Successful laryngeal function preservation with complete five-year remission was achieved in 44% of the patients. CONCLUSION Selected even if advanced carcinomas of the hypopharynx maybe treated with partial pharyngo-laryngectomy with reconstruction with pedicled flap. Both oncological and functional results showed a good outcome.
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Park YM, Kim SH. ASO Author Reflections: Transoral Robotic Surgery Combined with Neoadjuvant Chemotherapy for Management of Advanced Laryngohypopharyngeal Cancer. Ann Surg Oncol 2018; 25:894-895. [PMID: 30288650 DOI: 10.1245/s10434-018-6850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Young Min Park
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
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Lien CF, Wang CC, Hwang TZ, Liu CF, Lin BS, Weng HH, Liu CY. Comparison between open partial laryngectomy with tube-free tracheostomy and total laryngectomy for hypopharyngeal cancer with cartilage invasion. Oncol Lett 2018; 16:4961-4969. [PMID: 30250561 PMCID: PMC6144867 DOI: 10.3892/ol.2018.9298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 11/03/2017] [Indexed: 12/01/2022] Open
Abstract
The present study aimed to identify a feasible treatment strategy for hypopharyngeal cancer (HPC) with non-extensive invasion of the thyroid and/or cricoid cartilage. Between June 2008 and December 2014, patients with previously untreated HPC invading cartilage who had received either open partial laryngectomy (OPL) with tube-free tracheostomy or total laryngectomy (TL) with permanent tracheostomy and an artificial larynx (pneumatic tube) were retrospectively reviewed. The patients with extensive cartilage invasion and those with inoperable or T4b disease were excluded for OPL. Outcomes and quality of life were compared between the two treatment modalities. A total of 44 patients were included. The survival rates, complications, and Dysphagia Score were compared between the two treatment modalities. The outcome of the Voice Handicap Index (P=0.032), understandability of speech (P<0.001), normalcy of diet (P=0.041), senses (P=0.006), speech (P<0.001) and social contact (P=0.004) were significantly improved in the group receiving OPL compared with the group receiving TL. Therefore, OPL with tube-free tracheostomy may be a feasible option to treat patients with HPC with non-extensive invasion of the thyroid and/or cricoid cartilage.
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Affiliation(s)
- Ching-Feng Lien
- Department of Otolaryngology, Head and Neck Surgery, E-DA Hospital of I-Shou University, Kaohsiung 82445, Taiwan, R.O.C.,Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 71150, Taiwan, R.O.C
| | - Chih-Chun Wang
- Department of Otolaryngology, Head and Neck Surgery, E-DA Hospital of I-Shou University, Kaohsiung 82445, Taiwan, R.O.C
| | - Tzer-Zen Hwang
- Department of Otolaryngology, Head and Neck Surgery, E-DA Hospital of I-Shou University, Kaohsiung 82445, Taiwan, R.O.C
| | - Ching-Feng Liu
- Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan 71101, Taiwan, R.O.C
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 71150, Taiwan, R.O.C
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan, R.O.C.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan, R.O.C
| | - Chih-Yi Liu
- Department of Nursing, E-DA Hospital of I-Shou University, Kaohsiung 82445, Taiwan, R.O.C
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Hung LT, Huang HI, Wang LW, Yang MH, Chu PY. Oncologic results and quality of life in patients with squamous cell carcinoma of hypopharynx after transoral laser microsurgery. Lasers Surg Med 2017; 50:117-124. [DOI: 10.1002/lsm.22742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Li-Ting Hung
- Department of Otolaryngology; Taipei Veterans General Hospital and National Yang-Ming University; Taipei Taiwan
| | - Hsin-I Huang
- Department of Otolaryngology; Taipei Veterans General Hospital and National Yang-Ming University; Taipei Taiwan
| | - Ling-Wei Wang
- Department of Oncology Medicine; Taipei Veterans General Hospital and National Yang-Ming University; Taipei Taiwan
| | - Muh-Hwa Yang
- Department of Oncology Medicine; Taipei Veterans General Hospital and National Yang-Ming University; Taipei Taiwan
| | - Pen-Yuan Chu
- Department of Otolaryngology; Taipei Veterans General Hospital and National Yang-Ming University; Taipei Taiwan
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Niska JR, Halyard MY, Tan AD, Atherton PJ, Patel SH, Sloan JA. Electronic patient-reported outcomes and toxicities during radiotherapy for head-and-neck cancer. Qual Life Res 2017; 26:1721-1731. [PMID: 28247313 PMCID: PMC6301021 DOI: 10.1007/s11136-017-1528-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE To characterize quality of life (QOL) using real-time, electronic patient-reported outcomes (ePROs) and to evaluate adverse events (AEs) and supportive care during head-and-neck radiotherapy (RT) and concurrent chemoradiotherapy (CCRT). METHODS Sixty-five patients undergoing head-and-neck RT completed electronic, real-time, 12-item linear analog self-assessments (LASA) at baseline, before biweekly appointments, and at the last week of RT. Changes in QOL domains between time points were calculated. Clinical data were collected from the institutional medical record. AEs were recorded at the same time points as the LASA and graded. RESULTS During head-and-neck RT, most patients had clinically meaningful decreases in all QOL domains except level of support, financial concerns, and legal concerns. QOL domains with the most prevalent, clinically meaningful decreases were fatigue (75.4% of patients; 95% CI, 62.9-84.9%), social activity (70.8%; 95% CI, 58.0-81.1%), and overall QOL (70.8%; 95% CI, 58.0-81.1%). All patients had grade 2 AEs; 35.4% had grade 3 (50.0%, CCRT; 12.0%, RT; P = .002). Weight loss averaged 5.5 kg (6.9 kg, CCRT; 2.8 kg, RT; P < .001). Intravenous hydration was needed in 52.3% (77.5%, CCRT; 12.0%, RT; P < .001); feeding tube placement 40.0% (57.5%, CCRT; 12.0%, RT; P = .001); emergency department visits without hospitalization, 10.8%; and emergent hospitalization, 27.7% (37.5%, CCRT; 12.0%, RT; P = .04). CONCLUSIONS Head-and-neck RT, particularly CCRT, negatively impacts patients' overall QOL, social activity, and fatigue, with frequent grade 3 AEs, weight loss, intravenous hydration, feeding tube placement, ED visits, and hospitalization. Real-time ePROs allow providers to monitor QOL at multiple time points during RT, potentially allowing early intervention to improve QOL and mitigate AEs.
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Affiliation(s)
- Joshua R Niska
- Department of Radiation Oncology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Michele Y Halyard
- Department of Radiation Oncology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Angelina D Tan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Pamela J Atherton
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Jeff A Sloan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Hall SF, Griffiths R. Did the addition of concomitant chemotherapy to radiotherapy improve outcomes in hypopharyngeal cancer? A population-based study. ACTA ACUST UNITED AC 2016; 23:266-72. [PMID: 27536177 DOI: 10.3747/co.23.3085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND For oncologists and for patients, no site-specific clinical trial evidence has emerged for the use of concurrent chemotherapy with radiotherapy (ccrt) over radiotherapy (rt) alone for cancer of the hypopharynx (hpc) or for other human papilloma virus-negative head-and-neck cancers. METHODS This retrospective population-based cohort study using administrative data compared treatments over time (1990-2000 vs. 2000-2010), treatment outcomes, and outcomes over time in 1333 cases of hpc diagnosed in Ontario between January 1990 and December 2010. RESULTS The incidence of hpc is declining; the use of ccrt that began in 2001 is increasing; and the 3-year overall survival for all patients remains poor at 34.6%. No difference in overall survival was observed in a comparison of patients treated in the decade before ccrt and of patients treated in the decade during the uptake of ccrt. CONCLUSIONS The addition of ccrt to the armamentarium of treatment options for oncologists treating head-and-neck patients did not improve outcomes for hpc at the population level.
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Affiliation(s)
- S F Hall
- Department of Otolaryngology/Head and Neck Surgery, Kingston, ON
| | - R Griffiths
- ices Queen's, Queen's University, Kingston, ON
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Santos CGD, Bergmann A, Coça KL, Garcia AA, Valente TCDO. Acuidade olfatória e qualidade de vida após a laringectomia total. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201517611415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: identificar a prevalência e os fatores associados às alterações do olfato e descrever a qualidade de vida após a laringectomia total. Métodos: estudo transversal para avaliar a acuidade olfatória e a qualidade de vida de laringectomizados totais no Instituto Nacional de Câncer por meio da aplicação do Teste de Identificação do Olfato da Universidade da Pensilvânia, do Questionário de Qualidade de Vida da Universidade de Washington e do Questionário sobre a Acuidade Olfatória Pré-Reabilitação do Olfato. Resultados: foram avaliados 48 laringectomizados totais, sendo 39 do sexo masculino e 9 do sexo feminino, com idade média de 62 anos e tempo médio de 5,6 anos desde a laringectomia total. No Teste de Identificação do Olfato a pontuação média foi de 17,9. De acordo com a classificação do olfato no teste, a maioria dos participantes apresentou algum grau de alteração, sendo que apenas 2 indivíduos tiveram o olfato considerado dentro da normalidade. No Questionário de Qualidade de vida da Universidade de Washington, o escore composto foi 80,47. Os domínios que apresentaram as médias de pontos mais baixas foram paladar, saliva e fala. No questionário sobre a acuidade olfatória pré-reabilitação do olfato, a maioria dos participantes consideraram seu olfato de ruim a razoável. 21 indivíduos relataram apresentar algum grau de dificuldade em suas atividades de vida diária em decorrência de alterações do olfato. Conclusão: os laringectomizados totais apresentaram alta prevalência de alterações do olfato, com comprometimentos relacionados às suas atividades de vida diária.
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Affiliation(s)
| | - Anke Bergmann
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Brazil
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Vilaseca I, Ballesteros F, Martínez-Vidal BM, Lehrer E, Bernal-Sprekelsen M, Blanch JL. Quality of life after transoral laser microresection of laryngeal cancer: A longitudinal study. J Surg Oncol 2013; 108:52-6. [PMID: 23609524 DOI: 10.1002/jso.23348] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 03/28/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Isabel Vilaseca
- Department of Otolaryngology; Hospital Clínic; Barcelona Spain
- ENT Surgical Oncology Section; Hospital Clínic; Barcelona Spain
- Faculty of Medicine; University of Barcelona; Barcelona Spain
| | - Ferran Ballesteros
- Department of Otolaryngology; Hospital Clínic; Barcelona Spain
- Department of Otolaryngology; Hospital de Terrassa; Terrassa Spain
| | | | - Eduardo Lehrer
- Department of Otolaryngology; Hospital Clínic; Barcelona Spain
| | - Manuel Bernal-Sprekelsen
- Department of Otolaryngology; Hospital Clínic; Barcelona Spain
- Faculty of Medicine; University of Barcelona; Barcelona Spain
| | - José Luis Blanch
- Department of Otolaryngology; Hospital Clínic; Barcelona Spain
- ENT Surgical Oncology Section; Hospital Clínic; Barcelona Spain
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