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Smith CDL, McMahon AD, Lyall DM, Goulart M, Inman GJ, Ross A, Gormley M, Dudding T, Macfarlane GJ, Robinson M, Richiardi L, Serraino D, Polesel J, Canova C, Ahrens W, Healy CM, Lagiou P, Holcatova I, Alemany L, Znoar A, Waterboer T, Brennan P, Virani S, Conway DI. Development and external validation of a head and neck cancer risk prediction model. Head Neck 2024; 46:2261-2273. [PMID: 38850089 DOI: 10.1002/hed.27834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/24/2024] [Accepted: 05/26/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Head and neck cancer (HNC) incidence is on the rise, often diagnosed at late stage and associated with poor prognoses. Risk prediction tools have a potential role in prevention and early detection. METHODS The IARC-ARCAGE European case-control study was used as the model development dataset. A clinical HNC risk prediction model using behavioral and demographic predictors was developed via multivariable logistic regression analyses. The model was then externally validated in the UK Biobank cohort. Model performance was tested using discrimination and calibration metrics. RESULTS 1926 HNC cases and 2043 controls were used for the development of the model. The development dataset model including sociodemographic, smoking, and alcohol variables had moderate discrimination, with an area under curve (AUC) value of 0.75 (95% CI, 0.74-0.77); the calibration slope (0.75) and tests were suggestive of good calibration. 384 616 UK Biobank participants (with 1177 HNC cases) were available for external validation of the model. Upon external validation, the model had an AUC of 0.62 (95% CI, 0.61-0.64). CONCLUSION We developed and externally validated a HNC risk prediction model using the ARCAGE and UK Biobank studies, respectively. This model had moderate performance in the development population and acceptable performance in the validation dataset. Demographics and risk behaviors are strong predictors of HNC, and this model may be a helpful tool in primary dental care settings to promote prevention and determine recall intervals for dental examination. Future addition of HPV serology or genetic factors could further enhance individual risk prediction.
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Affiliation(s)
- Craig D L Smith
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, United Kingdom
| | - Alex D McMahon
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Donald M Lyall
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Mariel Goulart
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Gareth J Inman
- School of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, United Kingdom
- Cancer Research UK Scotland Institute, Glasgow, United Kingdom
| | - Al Ross
- School of Health, Science and Wellbeing, Staffordshire University, Staffordshire, United Kingdom
| | - Mark Gormley
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Tom Dudding
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin, Italy
| | - Diego Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Claire M Healy
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | - Pagona Lagiou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ivana Holcatova
- Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Laia Alemany
- Catalan Institute of Oncology/IDIBELL, Barcelona, Spain
| | - Ariana Znoar
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Tim Waterboer
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Paul Brennan
- Genomic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Shama Virani
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
- Genomic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - David I Conway
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, United Kingdom
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Deane J, Norris R, O’Hara J, Patterson J, Sharp L. Who Presents Where? A Population-Based Analysis of Socio-Demographic Inequalities in Head and Neck Cancer Patients' Referral Routes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16723. [PMID: 36554605 PMCID: PMC9779534 DOI: 10.3390/ijerph192416723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Head and neck cancers (HNC) are often late stage at diagnosis; stage is a major determinant of prognosis. The urgent cancer referral pathway (two week wait; 2WW) within England's National Health Service aims to reduce time to diagnosis. We investigated factors associated with HNC route to diagnosis. Data were obtained from the English population-based cancer registry on 66,411 primary invasive HNCs (ICD C01-14 and C31-32) diagnosed 2006-2014. Multivariable logistic regression determined the likelihood of different diagnosis routes by patients' demographic and clinical characteristics. Significant socio-demographic inequalities were observed. Emergency presentations declined over time and 2WW increased. Significant socio-demographic inequalities were observed. Non-white patients, aged over 65, residing in urban areas with advanced disease, were more likely to have emergency presentations. White males aged 55 and older with an oropharynx cancer were more likely to be diagnosed via 2WW. Higher levels of deprivation were associated with both emergency and 2WW routes. Dental referral was more likely in women, with oral cancers and lower stage disease. Despite the decline over time in emergency presentation and the increased use of 2WW, socio-demographic variation is evident in routes to diagnosis. Further work exploring the reasons for these inequalities, and the consequences for patients' care and outcomes, is urgently required.
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Affiliation(s)
- Jennifer Deane
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
| | - Ruth Norris
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
| | - James O’Hara
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
- Freeman Hospital, Newcastle upon Tyne Hospitals, Newcastle-upon-Tyne NE7 7DN, UK
| | - Joanne Patterson
- School of Health Sciences, Institute of Population Health, University of Liverpool, Liverpool L69 7ZX, UK
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE1 4LP, UK
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Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors. Br Dent J 2022; 233:780-786. [PMID: 36369568 PMCID: PMC9652141 DOI: 10.1038/s41415-022-5166-x] [Citation(s) in RCA: 152] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022]
Abstract
Introduction Head and neck cancer appears to be increasing in incidence, with potential changes in aetiology proposed. This paper aims to provide a narrative overview of the epidemiological literature to describe the disease burden and trends in terms of incidence and mortality both in the UK and globally and to review the evidence on current risk factors. Methods A search was performed on multiple databases (PubMed and Epistemonikos), applying filters to identify systematic reviews and meta-analyses which investigated head and neck cancer incidence, mortality and risk factors. International and UK cancer registries and sources were searched for incidence and mortality data. Results Multiple definitions of head and neck cancer are employed in epidemiology. Globally, incidence rates have increased in recent decades, largely driven by oropharyngeal cancer. Mortality rates over the last decade have also started to rise, reflecting the disease incidence and static survival rates. Major risk factors include tobacco smoking alone and in combination with alcohol consumption, betel chewing (particularly in Southeast Asian populations) and the human papillomavirus in oropharyngeal cancer. Conclusions These epidemiological data can inform clinical and preventive service planning for head and neck cancer. Head and neck cancer incidence is increasing and is projected to continue to rise, largely driven by increases in oropharyngeal cancer. Mortality rates have started to increase within the last decade, reflecting a rising incidence and static survival rates. Major risk factors that are associated with the risk of head and neck cancer are tobacco smoking and tobacco used in combination with alcohol consumption. Human papillomavirus is an additional major risk factor for oropharyngeal cancer. Cancers of the head and neck are clearly socioeconomically patterned but this socioeconomic risk is not entirely explained by smoking and alcohol behaviours.
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Wang J, Zhou CC, Sun HC, Li Q, Hu JD, Jiang T, Zhou S. Identification of several senescence-associated genes signature in head and neck squamous cell carcinoma. J Clin Lab Anal 2022; 36:e24555. [PMID: 35692082 PMCID: PMC9279997 DOI: 10.1002/jcla.24555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background As one of the core aging processes, cellular senescence is associated with tumorigenesis, growth, and immune modulation in cancers. Nevertheless, the prognosis of senescence‐associated genes (SAGs) signature in head and neck squamous cell carcinoma (HNSCC) remains to be further evaluated. Methods The transcriptome and corresponding clinical datasets of SAGs in patients with HNSCC were downloaded from public databases. A new prognostic SAGs signature was established with least absolute shrinkage and selection operator discussion. Patients with HNSCC were fallen into two risk groups based on each sample's risk mark and the cutoff point. The survival analysis was extended to determine the predictive accuracy of the SAGs signature. Furthermore, the evaluation of SAGs signature was made according to clinicopathological characteristics, survival state, the infiltration of inflammatory cells, and efficacy of immunotherapy. Results 41 SAGs were recognized and adopted to establish the forecast signature. The survival analysis indicated that patients with HNSCC in the high‐senescent score group had significantly reduced overall survival compared with those in the low‐senescent score group. It was certified that the risk score of SAGs signature was a separate predicting agent for HNSCC applying Cox regression analysis. According to functional analysis, some immune‐associated pathways were increased in the low‐senescent score group significantly. High‐senescent score group was correlated with poor clinicopathological characteristics, given less the infiltration of inflammatory cells state and worse immunotherapeutic effect. Conclusion A new SAG signature predicting result and response to immunotherapy of HNSCC was identified. Cellular senescence may be a hidden target for HNSCC.
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Affiliation(s)
- Jian Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated People's Hospital of Ningbo University, Ningbo, China
| | - Chong-Chang Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Hong-Cun Sun
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated People's Hospital of Ningbo University, Ningbo, China
| | - Qun Li
- Department of Otorhinolaryngology Head and Neck Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Jian-Dao Hu
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated People's Hospital of Ningbo University, Ningbo, China
| | - Tao Jiang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated People's Hospital of Ningbo University, Ningbo, China
| | - Shao Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated People's Hospital of Ningbo University, Ningbo, China
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Lorenc A, Wells M, Fulton-Lieuw T, Nankivell P, Mehanna H, Jepson M. Clinicians' Views of Patient-initiated Follow-up in Head and Neck Cancer: a Qualitative Study to Inform the PETNECK2 Trial. Clin Oncol (R Coll Radiol) 2022; 34:230-240. [PMID: 34862101 PMCID: PMC8950325 DOI: 10.1016/j.clon.2021.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/13/2021] [Accepted: 11/12/2021] [Indexed: 12/23/2022]
Abstract
AIMS Current follow-up for head and neck cancer (HNC) is ineffective, expensive and fails to address patients' needs. The PETNECK2 trial will compare a new model of patient-initiated follow-up (PIFU) with routine scheduled follow-up. This article reports UK clinicians' views about HNC follow-up and PIFU, to inform the trial design. MATERIALS AND METHODS Online focus groups with surgeons (ear, nose and throat/maxillofacial), oncologists, clinical nurse specialists and allied health professionals. Clinicians were recruited from professional bodies, mailing lists and personal contacts. Focus groups explored views on current follow-up and acceptability of the proposed PIFU intervention and randomised controlled trial design (presented by the study co-chief investigator), preferences, margins of equipoise, potential organisational barriers and thoughts about the content and format of PIFU. Data were interpreted using inductive thematic analysis. RESULTS Eight focus groups with 34 clinicians were conducted. Clinicians highlighted already known limitations with HNC follow-up - lack of flexibility to address the wide-ranging needs of HNC patients, expense and lack of evidence - and agreed that follow-up needs to change. They were enthusiastic about the PETNECK2 trial to develop and evaluate PIFU but had concerns that PIFU may not suit disengaged patients and may aggravate patient anxiety/fear of recurrence and delay detection of recurrence. Anticipated issues with implementation included ensuring a reliable route back to clinic and workload burden on nurses and allied health professionals. CONCLUSIONS Clinicians supported the evaluation of PIFU but voiced concerns about barriers to help-seeking. An emphasis on patient engagement, psychosocial issues, symptom reporting and reliable, quick routes back to clinic will be important. Certain patient groups may be less suited to PIFU, which will be evaluated in the trial. Early, meaningful, ongoing engagement with clinical teams and managers around the trial rationale and recruitment process will be important to discourage selective recruitment and address risk-averse behaviour and potential workload burden.
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Affiliation(s)
- A Lorenc
- QuinteT Research Group, Bristol Medical School, University of Bristol, Bristol, UK.
| | - M Wells
- Nursing Directorate, Imperial College Healthcare, NHS Trust / Department of Surgery and Oncology, Imperial College, London, London, UK
| | - T Fulton-Lieuw
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - P Nankivell
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; University Hospitals, Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; University Hospitals, Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Jepson
- QuinteT Research Group, Bristol Medical School, University of Bristol, Bristol, UK
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Ravikumar S, Casellas NJ, Shah S, Rieth K. Geographic disparities in head and neck cancer survival in Upstate New York 2011-2019. Head Neck 2021; 44:472-482. [PMID: 34845771 DOI: 10.1002/hed.26945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/18/2021] [Accepted: 11/18/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To examine the association between distance to care-center and urban-rural residence on 5-year overall survival (OS) from head and neck cancer (HNC). MATERIALS AND METHODS Five-year OS was retrospectively measured from date of initial diagnosis for patients with HNC treated at a single tertiary care center. Distances were calculated based on ZIP code of patient's residence and care center. Multilevel Weibull regression was used to adjust for confounders and identify disparities in 5-year all-cause mortality. RESULTS A total of 670 patients included in study. Multivariable analysis revealed older age or late-stage cancer at diagnosis, and HPV negative status were associated with poorer OS. Patients residing in isolated small rural town (HR = 2.20, p = 0.015) or small rural town (HR = 2.07, p = 0.015) had lower OS. Distance to care center was not associated with OS (HR = 0.996, p = 0.11). CONCLUSIONS Greater rurality was associated with poorer OS among HNC patients in Upstate New York.
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Affiliation(s)
- Saiganesh Ravikumar
- Department of Otolaryngology - Head & Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA.,School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Nicolas J Casellas
- Department of Otolaryngology - Head & Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Shalini Shah
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Katherine Rieth
- Department of Otolaryngology - Head & Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
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Searl J, Kearney A, Genoa K, Doyle PC. Clinical Experiences of People With a Laryngectomy During the SARS COVID-19 Pandemic. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2430-2445. [PMID: 34665653 DOI: 10.1044/2021_ajslp-21-00117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose This study described the clinical experiences of patients with a total laryngectomy (TL) during the COVID-19 pandemic and identified changes in communication, tracheostoma care, and heat-moisture exchange (HME) use that were recommended or self-implemented. Method An online survey addressing the study aims was completed by 173 people with a TL who live in the United States. The survey was open from July 5 to August 10, 2020. Results In-person clinic visits, appointment cancellations, and contact from their speech-language pathologists (SLPs) were reported by 42%, 19%, and 54% of the TL respondents, respectively. At clinic visits, 78% were required to wear a mask over their nose/mouth, and 73% were required to wear a mask over their tracheostoma. Masks, gloves, and face shields worn by the SLP at these visits were reported by 84%, 82%, and 70% of the TL patients, respectively. Alaryngeal communication changes were recommended by the SLP for 7%-18% of TL patients, depending on their method of communication, whereas 43%-45% implemented changes on their own. Changes in tracheostoma care and HME use were recommended by the SLP for 27% and 21% of the TL respondents, respectively, whereas 54% and 47% made changes on their own. Conclusions Individuals with a TL will require in-person care even during a pandemic, as reflected in this study. Many had not been contacted by their SLP or otolaryngologist about TL guidelines that were becoming available. Notably, larger percentages of TL patients reported self-initiated changes to their communication, tracheostoma care, and HME use because of the pandemic than their SLP had advised. The types of communication changes varied in part, depending on the method of alaryngeal speech a respondent used. Supplemental Material https://doi.org/10.23641/asha.16807270.
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Affiliation(s)
- Jeff Searl
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Ann Kearney
- Department of Otolaryngology - Head & Neck Surgery, Division of Laryngology, Stanford University School of Medicine, CA
| | - Kathryn Genoa
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Philip C Doyle
- Department of Otolaryngology - Head & Neck Surgery, Division of Laryngology, Stanford University School of Medicine, CA
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