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Trakimas DR, Mydlarz W, Mady LJ, Koch W, Quon H, London NR, Fakhry C. Increasing radiation therapy and lower survival for human papillomavirus-related oropharynx cancer associated with a shift to community cancer center care. J Natl Cancer Inst 2024; 116:1051-1062. [PMID: 38167712 PMCID: PMC11223870 DOI: 10.1093/jnci/djad238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/20/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Studies have shown lower overall survival for patients with head and neck cancer treated at low-volume or community cancer centers. As the incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma steadily rises in the United States, we hypothesized that a greater proportion of patients with HPV-related oropharyngeal squamous cell carcinoma is being treated at community cancer centers, with a shift toward primary nonsurgical treatment. METHODS This cohort study included patients from the US National Cancer Database who received a diagnosis of HPV-related oropharyngeal squamous cell carcinoma from 2010 to 2019 and underwent treatment at a community cancer center or academic cancer center. The proportion of patients with HPV-related oropharyngeal squamous cell carcinoma treated at community cancer centers and receiving primary nonsurgical treatment was analyzed over time. Four-year overall survival was compared between community cancer centers and academic cancer centers. RESULTS The majority (67.4%) of 20 298 patients were treated at an academic cancer center, yet the proportion of patients treated at community cancer centers increased by 10% from 2010 to 2019 (P < .01 for trend). The proportion of patients undergoing primary nonsurgical treatment increased from 62.1% to 73.7% from 2010 to 2019 (P < .01 for trend), and patients were statistically significantly more likely to undergo nonsurgical treatment at community cancer centers than at academic cancer centers (adjusted odds ratio = 1.20, 95% confidence interval = 1.18 to 1.22). Treatment at community cancer centers was associated with worse survival overall (adjusted hazard ratio = 1.19, 95% confidence interval = 1.09 to 1.31), specifically for patients receiving primary nonsurgical treatment (adjusted hazard ratio = 1.22, 95% confidence interval = 1.11 to 1.34). CONCLUSIONS Treatment of HPV-related oropharyngeal squamous cell carcinoma has recently shifted to community cancer centers, with an increase in the proportion of nonsurgical treatment and worse overall survival at these centers compared with academic cancer centers. Concentration of care for HPV-related oropharyngeal squamous cell carcinoma at academic cancer centers and dedicated head and neck cancer centers may increase access to all available treatment modalities and improve survival.
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Affiliation(s)
- Danielle R Trakimas
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Wojtek Mydlarz
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Leila J Mady
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Wayne Koch
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Harry Quon
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
- Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nyall R London
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
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Lao IJ, Berry J, Li J, Balogun Z, Elgohari B, Skinner H, Johnson J, Nilsen ML. Prognostic Factors and Outcomes Associated With Neck Lymphedema in Head and Neck Cancer Survivors. Laryngoscope 2024. [PMID: 38501703 DOI: 10.1002/lary.31396] [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: 11/16/2023] [Revised: 02/06/2024] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVES The purpose of this study is to determine the predictors of neck lymphedema and to explore its association with symptoms and patient-reported outcomes (PROs) in Head and Neck Cancer (HNC) patients who underwent non-operative treatment. METHODS This study involved a cross-sectional secondary analysis of data from patients diagnosed with head and neck squamous cell carcinoma who underwent radiation therapy (±chemotherapy). Patients with visits <6 weeks or >2 years following completion of radiation and those with recurrent or metastatic cancer were excluded. Presence of post-treatment lymphedema, demographics, clinical characteristics, health-related behaviors, and symptoms were collected. PROs were obtained using validated questionnaires that assessed depression, anxiety, swallowing dysfunction, and quality of life (QOL). Multivariable regression models were used to examine the relationship between lymphedema with predictors and symptoms. RESULTS Of the 203 patients included, 88 (43.4%) developed post-treatment lymphedema. In multivariable analysis, pre-treatment Body Mass Index (BMI) (odds ratio [OR] = 1.07, 95% confidence interval [CI] [1.01, 1.14] p = 0.016) and N stage (OR = 1.96, 95% CI [1.06, 3.66], p = 0.032) were found to be independently associated with lymphedema. Regarding PROs, lymphedema was associated with greater swallowing dysfunction (3.48, 95% CI [0.20, 6.75], p = 0.038), decreased mouth opening (-3.70, 95% CI [-7.31, -0.10], p = 0.044), and increased fatigue (1.88, 95% CI [1.05, 3.38], p = 0.034). CONCLUSION Higher pre-treatment BMI and greater N stage are identified as independent predictors for lymphedema development in non-operative HNC patients. Additionally, patients experiencing lymphedema reported worsening swallowing dysfunction and increased symptoms related to trismus and fatigue. Recognizing patients at elevated risk for lymphedema allows for early intervention, alleviation of symptom burden, and optimization of health care resources. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Isabella J Lao
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Jacklyn Berry
- UPMC Rehabilitation Institute, Pittsburgh, Pennsylvania, U.S.A
| | - Jinhong Li
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, U.S.A
| | - Zainab Balogun
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Baher Elgohari
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Heath Skinner
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Jonas Johnson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Marci L Nilsen
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, U.S.A
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Semprini J, Reynolds J, Zahnd WE, Wehby G. Eliminating Medicaid dental benefits and early-stage oral cancer diagnoses. Cancer Med 2024; 13:e7061. [PMID: 38457253 PMCID: PMC10923030 DOI: 10.1002/cam4.7061] [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: 07/21/2023] [Revised: 11/25/2023] [Accepted: 02/20/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Despite the importance of regular dental visits for detecting oral cancer, millions of low-income adults lack access to dental services. In July 2009, California eliminated adult Medicaid dental benefits. We tested if this impacted oral cancer detection for Medicaid enrollees. METHODS We analyzed Surveillance, Epidemiology, and End Results-Medicaid data, which contains verified Medicaid enrollment status, to estimate a difference-in-differences model. Our design compares the change in early-stage (Stages 0-II) diagnoses before and after dropping dental benefits in California with the change in early-stage diagnoses among eight states that did not change Medicaid dental benefits. Patients were grouped by oropharyngeal cancer (OPC) and non-OPC (oral cavity cancer), type, and the length of Medicaid enrollment. We also assessed if the effect of dropping dental benefits varied by the number of dentists per capita. RESULTS Dropping Medicaid dental benefits was associated with a 6.5%-point decline in early-stage diagnoses of non-OPC (95% CI = -14.5, -3.2, p = 0.008). This represented a 20% relative reduction from baseline rates. The effect was highest among beneficiaries with 3 months of continuous Medicaid enrollment prior to diagnosis who resided in counties with more dentists per capita. Specifically, dropping dental coverage was associated with a 1.25%-point decline in the probability of early-stage non-OPC diagnoses for every additional dentist per 5000 population (p = 0.006). CONCLUSIONS Eliminating Medicaid dental benefits negatively impacted early detection of cancers of the oral cavity. Continued volatility of Medicaid dental coverage and provider shortages may be further delaying oral cancer diagnoses. Alternative approaches are needed to prevent advanced stage OPC.
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Affiliation(s)
- Jason Semprini
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Julie Reynolds
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Whitney E. Zahnd
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - George Wehby
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
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Armstrong AT, Velez-Velez LM, Simpson MC, Massa ST. Trends and Implications of Adjuvant Systemic Therapy for Head and Neck Cancer Without High-Risk Features. Otolaryngol Head Neck Surg 2023; 169:556-569. [PMID: 36939584 DOI: 10.1002/ohn.252] [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: 09/20/2022] [Revised: 12/03/2022] [Accepted: 12/19/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Determine trends and survival implications of adjuvant systemic therapy use for lower risk head and neck cancer. STUDY DESIGN Retrospective cohort study. SETTING US National Cancer Database, 2010 to 2019. METHODS Patients with mucosal head and neck squamous cell carcinoma treated with surgery and postoperative radiation therapy were identified. Adjuvant systemic therapy trends in those with and without extranodal extension or positive margins were assessed as annual percent change by JoinPoint analysis. Factors associated with adjuvant systemic therapy and overall survival were assessed with multivariable models and cox proportional hazard models, respectively. RESULTS From 2010 to 2019, approximately one-third of head and neck cancer patients without extranodal extension or positive margins received adjuvant systemic therapy. This rate decreased throughout the study period, with the highest annual percent change from 2016 to 2019 (12.21%; 95% confidence interval: 3.73%-19.95%). Younger age, male sex, Hispanic ethnicity, community program setting, advanced stage, and lymphovascular invasion increased the odds a patient would receive adjuvant systemic therapy. Adjuvant systemic therapy was associated with inferior overall survival when used in those without extranodal extension or positive margins after controlling for covariates. CONCLUSION Though decreasing, adjuvant systemic therapy use is still common in the absence of extranodal extension and positive margins, and a variety of patient, provider, and oncologic factors may influence its use. The inferior overall survival after adjuvant systemic therapy in the absence of high-risk features suggests any oncologic benefit may not outweigh the costs and morbidity of the therapy.
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Affiliation(s)
- Austin T Armstrong
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Lisa M Velez-Velez
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Matt C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, USA
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Chow JCH, Cheuk W, Cho WCS, Wong CF, Au DWY, Tam AHP, Wong RCW, Chan JCH, Law SCC, Ngan RKC, Wong KH, Cheung KM. Comparison of Clinical Outcomes, Pathologic Characteristics, and Immune-Related Features of Postradiation vs Sporadic Oral Cavity Squamous Cell Carcinoma. JAMA Netw Open 2023; 6:e2323890. [PMID: 37459093 PMCID: PMC10352864 DOI: 10.1001/jamanetworkopen.2023.23890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/02/2023] [Indexed: 07/20/2023] Open
Abstract
Importance Postradiation oral cavity squamous cell carcinoma (OCSCC) is a common secondary malignant neoplasm affecting survivors of head and neck cancer who underwent radiotherapy. The clinical, pathologic, and immune-related features of postradiation OCSCC are poorly characterized, and treatment options are limited because of surgical difficulty and high morbidity associated with reirradiation. Objective To determine whether postradiation OCSCC has distinctive clinical, pathologic, and immune-related features compared with demographic-matched sporadic OCSCC. Design, Setting, and Participants This retrospective matched cohort study was conducted at a single tertiary oncology center in Hong Kong. Participants included consecutive patients with OCSCC diagnosed between 2000 and 2020. Patients with postradiation OCSCC were matched with patients with sporadic OCSCC using age, year of diagnosis, sex, and anatomic subsites. Data analysis was performed from July to December 2022. Exposure Head and neck irradiation involving the oral cavity before the diagnosis of OCSCC. Main Outcomes and Measures The primary outcomes were relapse pattern, survival, and causes of death. Pathologic features; immunohistochemical staining for programmed death-ligand 1, PD-1, MSH6, PMS2, FOXP3, and Ki67; and mRNA expression of 31 immune-related genes were also analyzed. Results A total of 173 patients, 60 with postradiation OCSCC (median [IQR] age, 63.8 [53.0-71.7] years; 43 men [71.7%]) and 113 with sporadic OCSCC (median [IQR] age, 64.4 [52.8-70.6] years; 83 men [73.5%]), were included. Patients with postradiation OCSCC had a higher proportion of N0 disease than those with sporadic OCSCC (50 patients [83.3%] vs 56 patients [49.6%]). With a median (IQR) follow-up of 10.2 (1.2-20.5) years, the 10-year relapse-free survival rates were lower in patients with postradiation OCSCC than sporadic OCSCC (29.6% [95% CI, 17.1%-43.2%] vs 52.4% [95% CI, 41.8%-62.0%]; P = .04), and the same was true for overall survival (30.5% [95% CI, 17.6%-44.4%] vs 52.3% [95% CI, 41.4%-62.1%]; P = .03). All relapses in patients with postradiation OCSCC were locoregional, whereas 35.2% of relapses (12 of 34 patients) in patients with sporadic OCSCC were distant. Despite similar 10-year disease-specific survival rates between the 2 groups (68.8% [95% CI, 55.8%-81.0%] vs 67.1% [95% CI, 57.5%-76.5%]; P = .91), patients with postradiation OCSCC had excess mortality due to pneumonia and cerebrovascular events. Postradiation OCSCC exhibited more adverse pathologic features (perineural invasion, worse pattern of invasion, and tumor budding), higher PD-1 expression, and higher gene expression of CD4 and TGF-β compared with sporadic OCSCC. Conclusions and Relevance This retrospective matched cohort study found distinctive pathologic characteristics and relapse patterns of postradiation OCSCC compared with sporadic OCSCC, which may be attributable to the lack of adjuvant radiotherapy, aggressive biologic phenotype, and different host immune response. Further exploration of the role of immune checkpoint therapy may be justified.
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Affiliation(s)
- James C. H. Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Wah Cheuk
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - William C. S. Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Chi-Fai Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Dennis W. Y. Au
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Anthony H. P. Tam
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Rachel C. W. Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Jeffrey C. H. Chan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Simon C. C. Law
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Roger K. C. Ngan
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kam-Hung Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Ka-Man Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
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Hu SH, Huang MY, Chen CY, Hsieh HM. Treatment patterns of targeted and nontargeted therapies and survival effects in patients with locally advanced head and neck cancer in Taiwan. BMC Cancer 2023; 23:567. [PMID: 37340424 DOI: 10.1186/s12885-023-11061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/12/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Taiwan's National Health Insurance has covered targeted therapy, namely cetuximab, for locally advanced head and neck cancers (LAHNC) since July 2009. This study examines treatment trends and survival effects of locally advanced head and neck cancer patients before and after Taiwan's National Health Insurance covered cetuximab. METHODS We examined treatment trends and survival effects for patients with LAHNC using Taiwan's National Health Insurance Research Database. Patients who received treatment within 6 months were categorized as either nontargeted or targeted therapy groups. We analyzed treatment trends with the Cochran-Armitage trend test and explored factors associated with treatment selection and survival effects using multivariable logistic regression and Cox proportional hazards models. RESULTS Of the 20,900 LAHNC patients included in the study, 19,696 received nontargeted therapy, while 1,204 received targeted therapy. Older patients with more comorbid conditions, advanced stages and patients with hypopharynx and oropharynx cancers were more likely to receive targeted therapy with concomitant cetuximab treatment. Patients who received targeted therapy in addition to other treatment modalities had a greater risk of one-year and long-term all-cause mortality or cancer-specific mortality than those without receiving targeted therapy (P < 0.001). CONCLUSIONS Our study found an increasing trend in cetuximab utilization among LAHNC after reimbursement in Taiwan, but overall usage rates were low. LAHNC patients receiving cetuximab with other treatments had higher mortality risk than those receiving cisplatin, suggesting cisplatin may be preferred. Further research is needed to identify subgroups that could benefit from concomitant cetuximab treatment.
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Affiliation(s)
- Szu-Han Hu
- Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Yu Chen
- Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Public Health, Department of Medical Research, Department of Community Medicine, Research Center for Precision Environmental Medicine, Kaohsiung Medical University Hospital, 100 Shih-Chung 1st Road, San-Ming Dist, Kaohsiung, 807, Taiwan.
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Semprini J, Williams JC. Community socioeconomic status and rural/racial disparities in HPV-/+ head and neck cancer. Tech Innov Patient Support Radiat Oncol 2023; 26:100205. [PMID: 36974082 PMCID: PMC10038787 DOI: 10.1016/j.tipsro.2023.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Background Head and Neck Cancer (HNC) is a major cause of cancer morbidity and mortality in the United States, but the burden is not evenly distributed. Rural and racial disparities are obvious across the HNC continuum. Most HNC disparities research have emphasized individual factors perpetuating rural and racial disparities, ignoring the role of community-level factors. Methods We analyzed data from the Surveillance Epidemiology and End Results (SEER) program's "Specialized HNC-Human Papillomavirus (HPV) Census-Tract SES" datafile (2010-2016). In addition to cancer patient characteristics, this data includes a socioeconomic status (SES) quintile based on the patient's census-tract. Our outcome variables included whether the HNC patient 1) was diagnosed at a distant stage, 2) received initial treatment two or more months after diagnosis, 3) received radiation therapy, 4) survived two years after diagnosis. We tested for differences across SES quintiles, in the full sample and then within rural/racial categories. We then tested for differences between each rural/racial category conditional on SES quintile. Results For both HPV(-) and HPV + HNCs, patients in higher SES census-tracts have 8-10% lower rates of distant stage diagnoses and delayed treatment initiation, and 12.0-14.5% higher survival rates than patients in lower SES census-tracts. Radiation treatment only varied across SES quintiles in HPV + HNC patients. We find little evidence of rural-urban differences within each socioeconomic quintile. However, within lower SES quintiles, we found significant racial disparities in delayed detection and treatment. These differences were largest in the lowest SES quintile, as non-Hispanic Black patients reported 10-11% higher rates of delayed detection and treatment initiation than non-Hispanic White patients. Conclusions Our research illustrates the value and constraints in leveraging community-level factors in health disparities research that can ultimately assist in designing effective policies that address and achieve rural and racial cancer equity.
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Affiliation(s)
- Jason Semprini
- University of Iowa College of Public Health, United States
- Corresponding author at: 145 N. Riverside Dr. N277, Iowa City, IA 52240, United States.
| | - Jessica C. Williams
- University of Boston School Henry M. Goldman School of Dental Medicine, United States
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Murray MC, Kane A. Perioperative Assessment/Prehabilitation in Larynx Cancer. Otolaryngol Clin North Am 2023; 56:205-214. [PMID: 37030935 DOI: 10.1016/j.otc.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Head and neck cancer (HNC) survivorship is increasing, and with it, a shift in treatment practices has occurred. Radical surgical resections for the treatment of HNC have decreased, and organ preservation treatments have increased. Although effective in treating HNC, chemoradiation therapy toxicities can be detrimental to a patient's overall health, nutrition status, and quality of life (QOL). Considering that dysphagia is typically a driving element of dysfunction, speech-language pathologists are vital to the prehabilitation phase. Prehabilitation programs include a variety of components, with the primary goal being to improve functional and QOL outcomes posttreatment.
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Affiliation(s)
- Mary Caroline Murray
- University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
| | - Anne Kane
- University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
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Mell LK, Wong SJ. Good Radiosensitizer Hunting. J Clin Oncol 2023; 41:2313-2318. [PMID: 36724418 DOI: 10.1200/jco.22.02350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Stuart J Wong
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Mazul AL, Chidambaram S, Zevallos JP, Massa ST. Disparities in head and neck cancer incidence and trends by race/ethnicity and sex. Head Neck 2023; 45:75-84. [PMID: 36200577 PMCID: PMC9742317 DOI: 10.1002/hed.27209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The epidemiology of head and neck cancer (HNC) sites differ substantially. This study compares HNC incidence trends by site and demographic subgroups. METHODS We used the U.S. Cancer Statistics Public Use Database to calculate HNC incidence rates per 100 000. We assessed trends with annual percent change (APC) longitudinally from 2001 to 2017. RESULTS The oropharyngeal cancer incidence APC decreased from 4.38% (95% CI: 3.6, 5.1) to 2.93% (2.5, 3.3) in 2008 among White males. Oral cavity cancer incidence rose in Other race males (APC 2.5% [1.6, 3.36]) and White females (APC: 0.96% [0.7, 1.2]). Although decreasing (APC: -1.15% [-1.48, -0.83]), laryngeal cancer incidence remained disproportionately high among Black males. CONCLUSIONS Notable incidence trends occurred in non-White groups at non-oropharyngeal sites. With parity of smoking rates by race, differing sexual behaviors, and shifting demographics by race and sex, future studies of HNC trends should consider stratifying analyses to understand health disparities.
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Affiliation(s)
- Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Smrithi Chidambaram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jose P Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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Dillard LK, Lopez-Perez L, Martinez RX, Fullerton AM, Chadha S, McMahon CM. Global burden of ototoxic hearing loss associated with platinum-based cancer treatment: A systematic review and meta-analysis. Cancer Epidemiol 2022; 79:102203. [PMID: 35724557 PMCID: PMC9339659 DOI: 10.1016/j.canep.2022.102203] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 11/06/2022]
Abstract
Platinum-based chemotherapeutic agents cisplatin and carboplatin are widely used in cancer treatment worldwide and may result in ototoxic hearing loss. The high incidence of cancer and salient ototoxic effects of platinum-based compounds pose a global public health threat. The purpose of this study was twofold. First, to estimate the prevalence of ototoxic hearing loss associated with treatment with cisplatin and/or carboplatin via a systematic review and meta-analysis. Second, to estimate the annual global burden of ototoxic hearing loss associated with exposure to cisplatin and/or carboplatin. For the systematic review, three databases were searched (Ovid Medline, Ovid Embase, and Web of Science Core Collection) and studies that reported prevalence of objectively measured ototoxic hearing loss in cancer patients were included. A random effects meta-analysis determined pooled prevalence (95% confidence intervals [CI]) of ototoxic hearing loss overall, and estimates were stratified by treatment and patient attributes. Estimates of ototoxic hearing loss burden were created with published global estimates of incident cancers often treated with platinum-based compounds and cancer-specific treatment rates. Eighty-seven records (n = 5077 individuals) were included in the meta-analysis. Pooled prevalence of ototoxic hearing loss associated with cisplatin and/or carboplatin exposure was 43.17% [CI 37.93–48.56%]. Prevalence estimates were higher for regimens involving cisplatin (cisplatin only: 49.21% [CI 42.62–55.82%]; cisplatin & carboplatin: 56.05% [CI 45.12–66.43%]) versus carboplatin only (13.47% [CI 8.68–20.32%]). Our crude estimates of burden indicated approximately one million individuals worldwide are likely exposed to cisplatin and/or carboplatin, which would result in almost half a million cases of hearing loss per year, globally. There is an urgent need to reduce impacts of ototoxicity in cancer patients. This can be partially achieved by implementing existing strategies focused on primary, secondary, and tertiary hearing loss prevention. Primary ototoxicity prevention via otoprotectants should be a research and policy priority. An estimated one million people are exposed to chemotherapeutic drugs per year. An estimated half a million cases of hearing loss per year are from chemotherapy. Hearing loss prevalence after exposure to cisplatin and/or carboplatin is 43%. Primary, secondary and tertiary prevention of hearing loss should be prioritized. Ototoxic hearing loss prevention is a global public health priority.
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Affiliation(s)
- Lauren K Dillard
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States.
| | - Lucero Lopez-Perez
- Cluster of Healthier Populations, World Health Organization, Geneva, Switzerland
| | - Ricardo X Martinez
- Cluster of Healthier Populations, World Health Organization, Geneva, Switzerland
| | - Amanda M Fullerton
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
| | - Shelly Chadha
- Department on Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Catherine M McMahon
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
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12
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Tan SE, Abdul Satar NF, Majid HA. Effects of Immunonutrition in Head and Neck Cancer Patients Undergoing Cancer Treatment – A Systematic Review. Front Nutr 2022; 9:821924. [PMID: 35360685 PMCID: PMC8961436 DOI: 10.3389/fnut.2022.821924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aims Malnutrition is prevalent among head and neck cancer (HNC) patients and leads to undesirable outcomes such as reduced treatment response and increased treatment-related side effects. This systematic review summarizes the recent evidence regarding the effect of immunonutrition in HNC patients undergoing radiotherapy and chemotherapy. Methods A literature search was conducted of the CENTRAL, ProQuest, MEDLINE, EBSCOhost, Web of Science and CINAHL databases; and further supplemented with internet and manual searches. Studies published between January 2011 and May 2021 were identified, screened, retrieved, and data extraction was performed. Results Twenty studies involving 1535 patients were included, 15 were randomized controlled trials (RCTs), three were retrospective study and two were comparative cohort studies. Five out of seven studies reported improvement or maintenance of nutrition status with continuous supplementation using immunonutrient-enriched formula. Three studies reported functional status as an outcome, with one study reporting significant improvement, one study reporting maintenance, and another study reporting no difference in the functional status of patients supplemented with immunonutrient-enriched formulas. Supplementation with glutamine did not reduce the overall incidence of mucositis but delayed the onset of oral mucositis and had significantly less incidence of severe oral mucositis. Conclusion Supplementation with immunonutrient-enriched formulas in HNC patients during radiotherapy and chemotherapy may improve or maintain nutrition status. Supplementation with glutamine during HNC radiotherapy and chemotherapy may delay the onset of oral mucositis and reduce incidences of severe oral mucositis. Further investigations are required, focusing on the timing, dosage, and duration of immunonutrition. Systematic Review Registration: PROSPERO, identifier CRD42021241817.
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Affiliation(s)
- Sing Ean Tan
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Ministry of Health, Putrajaya, Malaysia
| | | | - Hazreen Abdul Majid
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Nutrition, Faculty of Public Health, Airlangga University, Surabaya, Indonesia
- *Correspondence: Hazreen Abdul Majid
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13
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Ranta P, Kytö E, Nissi L, Kinnunen I, Vahlberg T, Minn H, Haapio E, Nelimarkka L, Irjala H. Dysphagia, hypothyroidism, and osteoradionecrosis after radiation therapy for head and neck cancer. Laryngoscope Investig Otolaryngol 2022; 7:108-116. [PMID: 35155788 PMCID: PMC8823172 DOI: 10.1002/lio2.711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/26/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To analyze the long-term side effects of radiation therapy (RT) for head and neck cancer (HNC). METHODS Retrospective chart analysis of all 688 HNC patients treated during 2010-2015 at Turku University Hospital, Finland. All patients who survived for more than a year after RT/chemoRT were included (n = 233). Intensity modulated RT (IMRT) with standard fractionation was applied in each case. RESULTS One hundred and six patients (45%) reported persisting dysphagia, for which neck RT increased risk. Definitive neck RT to high-risk volume did not increase late toxicity risks compared to elective neck RT. Radiation-induced hypothyroidism (29%, n = 67) was more common among younger patients and females. Osteoradionecrosis (12%, n = 29) was more common in the oral cavity cancer group (20.7%, n = 92) compared to all other subsites. CONCLUSIONS Late toxicities of RT for HNC are common. Age, gender, tumor subsite, and neck RT affect susceptibility to long-term side effects. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Pihla Ranta
- Department of Otorhinolaryngology - Head and Neck Surgery Turku University and Turku University Hospital Turku Finland
| | - Eero Kytö
- Department of Otorhinolaryngology - Head and Neck Surgery Turku University and Turku University Hospital Turku Finland
| | - Linda Nissi
- Department of Oncology and Radiotherapy Turku University and Turku University Hospital Turku Finland
| | - Ilpo Kinnunen
- Department of Otorhinolaryngology - Head and Neck Surgery Turku University and Turku University Hospital Turku Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics Turku University and Turku University Hospital Turku Finland
| | - Heikki Minn
- Department of Oncology and Radiotherapy Turku University and Turku University Hospital Turku Finland
| | - Eeva Haapio
- Department of Otorhinolaryngology - Head and Neck Surgery Turku University and Turku University Hospital Turku Finland
| | - Lassi Nelimarkka
- Department of Endocrinology, Division of Medicine Turku University and Turku University Hospital Turku Finland
| | - Heikki Irjala
- Department of Otorhinolaryngology - Head and Neck Surgery Turku University and Turku University Hospital Turku Finland
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14
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Hermanns I, Ziadat R, Schlattmann P, Guntinas-Lichius O. Trends in Treatment of Head and Neck Cancer in Germany: A Diagnosis-Related-Groups-Based Nationwide Analysis, 2005-2018. Cancers (Basel) 2021; 13:6060. [PMID: 34885170 PMCID: PMC8656765 DOI: 10.3390/cancers13236060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
Advances in head and neck cancer (HNC) treatment might have changed treatment strategies. This study determined, with focus on gender disparity, whether treatment rates have changed for inpatients in Germany between 2005 and 2018. Nation-wide population-based diagnosis-related groups (DRG) data of virtually all HNC cases (1,226,856 procedures; 78% men) were evaluated. Poisson regression analyses were used to study changes of annual treatment rates per German population. For surgery, the highest increase was seen for women with cancer of the oral cavity (relative risk (RR) 1.14, 95% confidence interval (CI) 1.11-1.18, p < 0.0001) and the highest decrease for men with laryngeal cancer (RR 0.90, CI 0.87-0.93). In women with oropharyngeal cancer, the highest increase of radiotherapy rates was seen (RR 1.18, CI 1.10-1.27, p < 0.0001). A decrease was seen in men for hypopharyngeal cancer (RR 0.93, CI 0.87-0.98, p = 0.0093). The highest increase for chemotherapy/immunotherapy was seen for women with oropharyngeal cancer (RR 1.16, CI 1.08-1.24, p < 0.0001), and a decrease in men with hypopharyngeal cancer (RR 0.93, CI 0.88-0.97, p = 0.0014). Treatment patterns had changed for nearly all subsites and therapy types. There were relevant gender disparities, which cannot be explained by the DRG data.
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Affiliation(s)
- Isabel Hermanns
- Department of Otorhinolaryngology, Jena University Hospital, D-07747 Jena, Germany; (I.H.); (R.Z.)
| | - Rafat Ziadat
- Department of Otorhinolaryngology, Jena University Hospital, D-07747 Jena, Germany; (I.H.); (R.Z.)
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Data Sciences, Jena University Hospital, D-07743 Jena, Germany;
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, D-07747 Jena, Germany; (I.H.); (R.Z.)
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15
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Automated health chats for symptom management of head and neck cancer patients undergoing radiation therapy. Oral Oncol 2021; 122:105551. [PMID: 34700280 DOI: 10.1016/j.oraloncology.2021.105551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report the early experience using an automated chatbot (Chats)for patient-reported outcomes (PRO) and symptom self-managementinhead and neck cancer (HNC) patients undergoing radiation treatment (RT). METHODS Patients aged ≥ 18 yearsdiagnosed with HNC who were scheduled to begin RT were given the option to use Chats from June 2018 to June 2019. Enrolled patients received chat notifications two days before weekly on-treatment visitsand every 1-4 weeks after RT for an additional 4 months. After the first in-person follow-up visit, participants completed an electronic usability and satisfaction questionnaire. RESULTS Of 95 patients who agreed to participate, 84 were eligible for analysis.Participantswere significantly younger than patients who declined participation (mean age 61.3 vs 68.3 years;p-value < 0.001). Patient engagement with Chats was highest at 67% during the first month and declined over time (p-value = 0.004). Concordance between PRO and clinician-reported outcomes (CRO) was fair, ranging from 0.10 to 0.43 (Cohen κ statistics). The most commonly under-reported symptoms were salivary duct inflammation (53%), xerostomia (41%), and mucositis (37%). 89% (39 of 44) of patients who completed surveys found Chats easy to use, and 61% reported that Chats helped with symptom self-management and reduced the need to call the care team. CONCLUSIONS These early results suggest that an interactive chatbot is feasible and provides support for HNC patients during and after RT. Chats identified discordance between PRO and CRO. Further study is required to measure benefits of Chats in a larger population.
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16
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Pigott A, Brown B, Trevethan M, Porceddu S, McCann A, Pitt R, Nixon J. Head and neck lymphoedema-research challenges during the COVID-19 pandemic. Br J Community Nurs 2021; 26:S6-S15. [PMID: 34542313 DOI: 10.12968/bjcn.2021.26.sup10.s6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Management of secondary head and neck lymphoedema has undergone little research investigation. Its treatment is time and labour intensive and involves multiple therapeutic modalities without a clear understanding of which is most effective. This study aimed to determine the feasibility of a randomised controlled trial comparing two therapeutic modalities to manage head and neck lymphoedema. The secondary objective was to evaluate the clinical effects of these treatments. Participants were randomised to receive treatment with manual lymphatic drainage or compression over 6 weeks, with the primary outcome-percentage tissue water-measured 12 weeks after treatment. Six participants were recruited until the study was ceased due to restrictions imposed by the COVID-19 pandemic. Some 86% of required attendances were completed. Percentage tissue water increased in all participants at 12 weeks. No consistent trends were identified between internal and external lymphoedema. The small number of people recruited to this study informs its feasibility outcomes but limits any conclusions about clinical implications.
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Affiliation(s)
- Amanda Pigott
- Clinical Specialist, Occupational Therapy, Princess Alexandra Hospital; Honorary Research Fellow, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Bena Brown
- Senior Research Fellow, Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Australia
| | - Megan Trevethan
- Senior Occupational Therapist, Occupational Therapy, Princess Alexandra Hospital, Australia
| | - Sandra Porceddu
- Senior Radiation Oncologist & Director of Radiation Oncology Research, Radiation Oncology, Princess Alexandra Hospital, Australia
| | - Andrew McCann
- Director, Vascular Medicine, Princess Alexandra Hospital, Australia
| | - Rachael Pitt
- Acting Advanced Clinician, Speech Pathology, Princess Alexandra Hospital, Australia
| | - Jodie Nixon
- Advanced Team Leader, Occupational Therapy, Princess Alexandra Hospital, Australia
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17
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Weeks KS, Lynch CF, Pagedar N. Trends in Cancer Treatment for Oral Cavity, Oropharynx, and Larynx in 2016 Versus 2009: SEER Patterns of Care Studies. Ann Otol Rhinol Laryngol 2021; 131:629-639. [PMID: 34365844 DOI: 10.1177/00034894211037194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine if there was a higher percentage of patients treated surgically and with advanced radiotherapy in 2016 (N = 897) versus 2009 (N = 1136), the patient and tumor characteristics associated with surgical care and advanced radiotherapy, and if chemotherapy or targeted agent use varied over time for squamous cell carcinoma of the head and neck. METHODS We utilized Surveillance Epidemiology and End Results Patterns of Care datasets. Rao-Scott Chi-square tests and logistic regressions were applied to determine differences in surgery, advanced radiotherapy (RT), and chemotherapy by year. RESULTS There was a lower prevalence of surgery only treatment in 2016 versus 2009 with exception of oral cavity stages IVB/IVC and unknown, and larynx stage unknown. Advanced RT was more common in 2016 for patients receiving definitive RT among all sites, excluding stages I/II glottic larynx. Among each site (oral cavity, oropharynx, and larynx) lower stage was associated with increased odds of surgery. Among each site, advanced RT was more common in patients receiving definitive versus postoperative RT. For the larynx site, 2016 versus 2009 was associated with greater odds of advanced RT. Systemic treatment with fluorouracil, taxanes, or cetuximab was less prevalent in 2016. CONCLUSION In 2016 versus 2009, there was largely not a higher percentage of patients treated surgically. There was a higher prevalence of advanced RT for definitive care. Further investigations of these patterns are needed, including trend analysis.
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Affiliation(s)
- Kristin S Weeks
- Medical Scientist Training Program, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Nitin Pagedar
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, USA
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18
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Discussion: Variation in Payment per Work Relative Value Unit for Breast Reconstruction and Nonbreast Microsurgical Reconstruction: An All-Payer Claims Database Analysis. Plast Reconstr Surg 2021; 147:514-515. [PMID: 33620948 DOI: 10.1097/prs.0000000000007680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study. Cancer 2021; 127:2476-2488. [PMID: 33345297 DOI: 10.1002/cncr.33320] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/26/2020] [Accepted: 10/08/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. METHODS This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19-positive patients and infections in the surgical team were determined by univariate analysis. RESULTS Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. CONCLUSIONS Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. LAY SUMMARY Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment.
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20
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Aragón N, Ordoñez D, Urrea MF, Holguín J, Collazos P, García LS, Osorio MC, Barreto JM, Bravo LE. Head and neck cancer in Cali, Colombia: Population-based study. Community Dent Oral Epidemiol 2021; 50:292-299. [PMID: 34105170 PMCID: PMC8651828 DOI: 10.1111/cdoe.12671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Head and neck cancer (HNC) is the seventh most common type of cancer in the world. In Latin America, data on HCN are limited by the scarcity of population-based cancer registries. OBJECTIVE To describe survival and changes in the time trends of incidence and mortality rates of HCN with data from the Cali Cancer Population Registry (Colombia) during 1962-2018. METHOD Males and females of any age residing in Cali were included. The trends in incidence rates (1962-2016) and mortality (1984-2018) were analysed by calculating the mean annual percentage change (APC). Five-year net survival was estimated for the four 5-year periods of 1996-2015 using the Pohar-Perme method. RESULTS During 1962-2015, 5,110 new cases of HNC were recorded: 1,506 in the larynx, 1,377 in the oral cavity, 487 in the nose and paranasal sinuses, 643 in the oropharynx, 603 in the salivary glands and 360 in Naso-Hypopharynx region. The incidence rates of HNC decreased significantly at all subsites, except in those associated with the human papillomavirus. Between 1984 and 2018, there were 1,941 deaths attributed to HNC, and the mortality rate decreased significantly. The 5-year age-standardized net survival was 43.2% in 1996-2000, remained stable during the following decade, and for 2011-2015 it was 50.9%. CONCLUSION The incidence and mortality of HNC in Cali decreased significantly during the study period in both sexes.
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Affiliation(s)
- Natalia Aragón
- School of Dentistry, Universidad del Valle, Cali, Colombia
| | - Dora Ordoñez
- School of Dentistry, Universidad del Valle, Cali, Colombia
| | | | - Jorge Holguín
- Department of Otorhinolaryngology, Universidad del Valle, Cali, Colombia
| | - Paola Collazos
- Department of Pathology, Universidad del Valle, Cali, Colombia
| | | | - María C Osorio
- Department of Otorhinolaryngology, Universidad del Valle, Cali, Colombia
| | - José M Barreto
- Department of Otorhinolaryngology, Universidad del Valle, Cali, Colombia
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21
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The Research Progression and Clinical Significance of Circular RNAs in Head and Neck Cancers. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2712310. [PMID: 33150169 PMCID: PMC7603539 DOI: 10.1155/2020/2712310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022]
Abstract
With rapid development of science technique and molecular research, a large number of circular RNAs (circRNAs) were discovered. CircRNAs that are a heterogeneous endogenous group of non-coding RNA not only are abundantly and diffusely expressed in mammals but also participate in many biological processes, such as in tumor ingenuity and progress. CircRNAs have rarely open reports in the head and neck cancers (HNC), which are an aggressive malignant tumor with unsatisfactory overall survival rates. The diagnostics and treatments continue to improve while the survival rate of HNC patients has no more obvious improvement. Recent studies that are aimed at exploring the molecular mechanisms of occurrence and progression of circRNAs in HNC provide a valuable insight into potential novel diagnostic and therapeutic approaches. In this review, we summarize the increasing number of published researches on the research progression of circRNAs in HNC, as well as their possible clinical implications on HNC.
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22
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Nachalon Y, Nativ-Zeltzer N, Evangelista LM, Dhar SI, Lin SJ, Shen SC, Belafsky PC. Cervical Fibrosis as a Predictor of Dysphagia. Laryngoscope 2020; 131:548-552. [PMID: 32628787 DOI: 10.1002/lary.28880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Radiotherapy of head and neck cancer (HNCA) causes dysfunction through radiation-induced fibrosis (RIF). We hypothesize that the degree of cervical fibrosis is associated with swallowing dysfunction. This study evaluated the association between cervical fibrosis and swallowing dysfunction in patients after radiation therapy for HNCA. STUDY DESIGN Cross sectional study. METHODOLOGY A convenience sample of patients with dysphagia who were at least 1 year post radiation therapy for HNCA underwent simultaneous cervical ultrasound (US) and video-fluroscopic swallow study (VFSS). US determinants of fibrosis were measurements of sternocleidomastoid fascia (SCMF) thickness bilaterally at the level of the cricoid. Primary and secondary outcome variables on VFSS were pharyngeal constriction ratio, a validated measure of pharyngeal contractility, and penetration aspiration scale (PAS). A qualitative assessment of lateral neck rotation was performed as a functional measure of neck fibrosis. RESULTS Simultaneous cervical US and VFSS examinations were performed on 18 patients with a history of radiotherapy for HNCA and on eight controls. The mean (±SD) age of the entire cohort (N = 26) was 66 (±10) years. Individuals with a history of radiation had significantly thinner mean SCMF (0.26 [±0.04 mm]) compared to controls (0.48 [±0.06 mm]; P < .05). Individuals with thinner SCMF were more likely to have moderate to severe restriction in lateral neck rotation, a higher PCR, and a higher PAS (P < .05). CONCLUSION Thinner sternocleidomastoid fascia on ultrasound in patients having undergone radiotherapy for head and neck cancer was associated with reduced lateral neck movement, poorer pharyngeal constriction and greater penetration/aspiration scale. The data suggest that cervical fibrosis is associated with swallowing dysfunction in head and neck cancer survivors and support the notion that, "As the neck goes, so does the swallow." LEVEL OF EVIDENCE 3. Laryngoscope, 131:548-552, 2021.
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Affiliation(s)
- Yuval Nachalon
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A
| | - Nogah Nativ-Zeltzer
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A
| | - Lisa M Evangelista
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A
| | - Shumon I Dhar
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A
| | - Sharon J Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A
| | - Shih C Shen
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A
| | - Peter C Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A
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23
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Song JS, Vallance P, Biron V, Jeffery CC. Epidemiological trends of head and neck Cancer survivors in Alberta: towards improved understanding of the burden of disease. J Otolaryngol Head Neck Surg 2020; 49:46. [PMID: 32631452 PMCID: PMC7339434 DOI: 10.1186/s40463-020-00443-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND With an increase in the incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) and more favourable survival outcomes, there is now a population of head and neck cancer survivors that are different from preceding decades. In addition, their long-term survivorship issues have become increasing research interests. This study was undertaken to determine the changing epidemiological trends of head and neck cancer survivors in Alberta to better anticipate future demands on healthcare services. METHODS The Alberta Cancer Registry was queried for adult (aged > 18 years), head and neck cancer (HNC) patients who were at least 1-year post-treatment completion between 1997 to 2016. Cutaneous head and neck and thyroid cancer patients were excluded. Extracted data was then used to calculate the incidence and prevalence of early (< 5 years from treatment), intermediate (5 to < 10 years from treatment), and late (> 10 years from treatment) survivors of head and neck cancer. Point prevalence of HNC survivors in 2005, 2010, and 2015 were then further stratified by gender, sub-site and age. RESULTS Over this time period, head and neck cancer survivors tended to be younger (64.0 vs. 62.1, p = 0.046) and male (M:F 2.45:1 vs 2.54:1). In 1997, the predominant subsites were the oral cavity and larynx at 45.8% and 30.9%, respectively. In 2015 the predominant subsites were the oral cavity and oropharynx at 33.0% and 29.4%, respectively. Within the cohort, the prevalence of late HNC survivors increased to 13.3 per 100,000 people in 2015. CONCLUSIONS There is a significant population of head and neck survivors who are younger, male, and more than 10 years post-treatment. While oral cavity cancers have shown stable disease prevalence in recent decades, the number of OPSCC survivors have increased. With an improved understanding of the distribution and characteristics of HNC survivors, a more guided healthcare support network can be fostered for these patients.
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Affiliation(s)
- Jin Soo Song
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of Alberta, 1E4 Walter Mackenzie Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Patrick Vallance
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Vincent Biron
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of Alberta, 1E4 Walter Mackenzie Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Caroline C Jeffery
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. .,Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of Alberta, 1E4 Walter Mackenzie Centre, 8440-112 Street NW, Edmonton, Alberta, T6G 2B7, Canada.
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24
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Fischlechner R, Kofler B, Schartinger VH, Dudas J, Riechelmann H. Does low-level laser therapy affect the survival of patients with head and neck cancer? Lasers Med Sci 2020; 36:599-604. [PMID: 32583188 DOI: 10.1007/s10103-020-03073-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/16/2020] [Indexed: 01/28/2023]
Abstract
Low-level laser therapy (LLLT) is used in patients with head and neck cancer (HNC) for treatment-related mucositis. There is conflicting evidence as to whether LLLT leads to the proliferation of tumor cells and whether it interferes with the tumoricidal effect of radiotherapy or chemoradiotherapy, if the tumor lies within the LLLT field. Using fuzzy matching, 126 HNC patients who had received LLLT including the tumor region and 126 matching HNC patients without LLLT (controls) treated at the Department of Otorhinolaryngology, Head & Neck Surgery, Medical University of Innsbruck, were identified. The overall survival was compared using the Kaplan-Meier analysis. Fuzzy matching yielded 2 patient samples well comparable in terms of risk of death. The survival did not significantly differ between patients with and without LLLT (p = 0.18). An increased risk of death in HNC patients who received LLLT covering the tumor region was not observed in our study.
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Affiliation(s)
- Rene Fischlechner
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Barbara Kofler
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
| | - Volker Hans Schartinger
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Jozsef Dudas
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology - Head & Neck Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
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