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Namavarian A, Gabinet-Equihua A, Deng Y, Khalid S, Ziai H, Deutsch K, Huang J, Gilbert RW, Goldstein DP, Yao CMKL, Irish JC, Enepekides DJ, Higgins KM, Rudzicz F, Eskander A, Xu W, de Almeida JR. Length of Stay Prediction Models for Oral Cancer Surgery: Machine Learning, Statistical and ACS-NSQIP. Laryngoscope 2024; 134:3664-3672. [PMID: 38651539 DOI: 10.1002/lary.31443] [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: 01/27/2024] [Revised: 03/17/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Accurate prediction of hospital length of stay (LOS) following surgical management of oral cavity cancer (OCC) may be associated with improved patient counseling, hospital resource utilization and cost. The objective of this study was to compare the performance of statistical models, a machine learning (ML) model, and The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) calculator in predicting LOS following surgery for OCC. MATERIALS AND METHODS A retrospective multicenter database study was performed at two major academic head and neck cancer centers. Patients with OCC who underwent major free flap reconstructive surgery between January 2008 and June 2019 surgery were selected. Data were pooled and split into training and validation datasets. Statistical and ML models were developed, and performance was evaluated by comparing predicted and actual LOS using correlation coefficient values and percent accuracy. RESULTS Totally 837 patients were selected with mean patient age being 62.5 ± 11.7 [SD] years and 67% being male. The ML model demonstrated the best accuracy (validation correlation 0.48, 4-day accuracy 70%), compared with the statistical models: multivariate analysis (0.45, 67%) and least absolute shrinkage and selection operator (0.42, 70%). All were superior to the ACS-NSQIP calculator's performance (0.23, 59%). CONCLUSION We developed statistical and ML models that predicted LOS following major free flap reconstructive surgery for OCC. Our models demonstrated superior predictive performance to the ACS-NSQIP calculator. The ML model identified several novel predictors of LOS. These models must be validated in other institutions before being used in clinical practice. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3664-3672, 2024.
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Affiliation(s)
- Amirpouyan Namavarian
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Yangqing Deng
- Department of Biostatistics, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - Shuja Khalid
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Konrado Deutsch
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jingyue Huang
- Department of Biostatistics, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - Danny J Enepekides
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Kevin M Higgins
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Frank Rudzicz
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Szabó É, Kopjár E, Rumi L, Boronkai Á, Bellyei S, Gyöngyi Z, Zemplényi A, Sütő B, Girán J, Kiss I, Pozsgai É, Szanyi I. Changes in Time to Initial Physician Contact and Cancer Stage Distribution during the COVID-19 Pandemic in Patients with Head and Neck Squamous Cell Carcinoma at a Large Hungarian Cancer Center. Cancers (Basel) 2024; 16:2570. [PMID: 39061209 PMCID: PMC11274479 DOI: 10.3390/cancers16142570] [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: 06/04/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of our study was to compare the characteristics and time to initial physician contact in patients with head and neck squamous cell carcinoma (HNSCC) before and during the COVID-19 pandemic at a large Hungarian cancer center. This was a retrospective study of patients 18 years or older presenting at the regional cancer center of Pécs Clinical Center with HNSCC between 1 January 2017, and 15 March 2020 (the pre-COVID-19 period) and between 16 March 2020, and 13 May 2021 (the COVID-19 period). Demographic and clinical data were collected, and the time between initial symptom onset and initial physician contact (TTP) was determined. Descriptive and exploratory statistical analyses were performed. On average, the number of patients diagnosed with HNSCC per month during the pandemic decreased by 12.4% compared with the pre-COVID-19 period. There was a significant increase in stage I and stage II cancers (from 15.9% to 20.3% and from 12.2% to 13.8%, respectively; p < 0.001); a decrease in stage III and IVa,c cancers; and a significant increase in stage IVb cancers (from 6% to 19.9%; p < 0.001) during the pandemic. The median TTP increased during the pandemic from 43 to 61 days (p = 0.032). To our knowledge, this is the first study investigating the effect of COVID-19 on patients with HNSCC in the Central-Eastern European region. We found a bidirectional shift in cancer stages and increased TTP during the pandemic. Our findings highlight the necessity for more nuanced analyses of the effects of COVID-19.
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Affiliation(s)
- Éva Szabó
- Department of Otorhinolaryngology, Clinical Center, University of Pécs, Munkácsy M. Street 2., 7621 Pécs, Hungary
| | - Eszter Kopjár
- Department of Otorhinolaryngology, Clinical Center, University of Pécs, Munkácsy M. Street 2., 7621 Pécs, Hungary
| | - László Rumi
- Urology Clinic, Clinical Center, University of Pécs, Munkácsy Mihaly Street 2, 7621 Pécs, Hungary
| | - Árpád Boronkai
- Department of Oncotherapy, Clinical Center, University of Pécs, Édesanyák Street 17, 7624 Pécs, Hungary
| | - Szabolcs Bellyei
- Department of Oncotherapy, Clinical Center, University of Pécs, Édesanyák Street 17, 7624 Pécs, Hungary
| | - Zoltán Gyöngyi
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti Street 12, 7624 Pécs, Hungary
| | - Antal Zemplényi
- Center for Health Technology Assessment and Pharmacoeconomics Research, Faculty of Pharmacy, University of Pécs, Rákóczi Street 2, 7623 Pécs, Hungary
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Balázs Sütő
- Department of Anesthesiology and Intensive Therapy, Clinical Center, University of Pécs, Ifjúság Street 13, 7624 Pécs, Hungary
| | - János Girán
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti Street 12, 7624 Pécs, Hungary
| | - István Kiss
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti Street 12, 7624 Pécs, Hungary
| | - Éva Pozsgai
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti Street 12, 7624 Pécs, Hungary
- Department of Primary Health Care, Medical School, University of Pécs, Rákóczi Street 2, 7623 Pécs, Hungary
| | - István Szanyi
- Department of Otorhinolaryngology, Clinical Center, University of Pécs, Munkácsy M. Street 2., 7621 Pécs, Hungary
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Garcia J, Yesantharao L, Frick KD, Fakhry C, Koch W, Mydlarz W, Eisele DW, Gourin CG. Concentration of High-Cost Head and Neck Cancer Surgical Patients. Laryngoscope 2024. [PMID: 38973626 DOI: 10.1002/lary.31618] [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: 03/24/2024] [Revised: 05/02/2024] [Accepted: 06/20/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE Health care costs are disproportionately concentrated among a small number of patients. We sought to identify variables associated with high-cost patients and high hospital concentration of high-cost patients and to examine associations with short-term outcomes in head and neck cancer (HNCA) surgery. STUDY DESIGN The Nationwide Inpatient Sample was used to identify 170,577 patients who underwent HNCA surgery in 2001-2011. High-cost patients were defined as patients whose costs of care were in the top decile, and high-concentration hospitals were defined as those whose percentage of high-cost patients was in the top decile. METHODS Multivariable regression was used to evaluate associations between cost and patient and hospital variables, postoperative complications, and in-hospital mortality. RESULTS Costs associated with high-cost patients were 4.47-fold greater than the remaining 90% of patients. High-concentration hospitals treated 36% of all high-cost patients. High-cost patients were more likely to be non-white (OR = 2.08 [1.45-2.97]), have oral cavity cancer (OR = 1.21 [1.05-1.39]), advanced comorbidity (OR = 1.53 [1.31-1.77]), Medicaid (OR = 1.93 [1.62-2.31]) or self-pay payor status (OR = 1.72 [1.38-2.14]), income>50th percentile (OR = 1.25 [1.05-1.51]), undergo major procedures (OR = 3.52 [3.07-4.05]) and have non-routine discharge (OR = 7.50 [6.01-9.35]). High-concentration hospitals were more likely to be teaching hospitals (OR = 3.14 [1.64-6.05]) and less likely to be urban (OR = 0.20 [0.04-0.93]). After controlling for all other variables, high-cost patients were associated with an increased odds of mortality (OR = 8.00 [5.89-10.85]) and postoperative complications (OR = 5.88 [5.18-6.68]). High-concentration hospitals were associated with an increased odds of postoperative complications (OR = 1.31 [1.08-1.61]) but were not associated with increased mortality (OR = 0.98 [0.67-1.44]). CONCLUSIONS High-cost HNCA surgical patients are associated with increased postoperative morbidity and mortality, and are disproportionately concentrated at teaching hospitals. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Jordan Garcia
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Lekha Yesantharao
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Kevin D Frick
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Wayne Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Wojtech Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
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Velasco KJS, Fullante PB, Calaquian CME. Patient Profiles and Cost of Otolaryngologic Surgeries in an LMIC Country. ACTA MEDICA PHILIPPINA 2024; 58:65-73. [PMID: 38939417 PMCID: PMC11199366 DOI: 10.47895/amp.vi0.7540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Objectives This study aims to analyze the cost of patient care among ORL-HNS patients admitted in a tertiary, teaching government hospital in a low- to middle-income country. Methods This is a prevalence-based, prospective, bottom-up, cost-of-illness analysis among patients of the Department of Otorhinolaryngology-Head and Neck Surgery in a tertiary training government hospital admitted from July 2021 to March 2022. The value assessment method used is the human capital approach. The societal perspective is used for analysis to estimate and reflect payer (insurance providers) and patient perspectives. Results A total of one hundred fifty seven (157) patients were admitted for elective surgery under the service of ORL-HNS consisting of 75 females and 82 males. The average total overall cost was $3,851.10 (Php 199, 870.50 ± 164, 725.60). The total direct health care cost for all patients within the study period amounted to $3,712.18 (Php 192, 662.22 ± 159, 548.60) while the direct non-health care cost was $58.60. The workforce cost (58.5%) and medication cost (18.8%) comprised the majority of in-patient expenses with a mean cost of $2,221.36 (Php 37,083.66) and $714.51 (Php 44,363.14), respectively. In this study, an average of $80.29 was lost due to illness and hospitalization (± $81.74). The total PHIC coverage pays a range from zero to 67.5% with an average coverage of only 17%. Conclusion Our analysis has shown that workforce and medication expenses are the main cost drivers for the direct healthcare costs among Otolaryngology patients admitted for elective procedures. Stakeholders, such as the otolaryngologists and hospitals should coordinate closely to create a more encompassing coverage of Philhealth to prevent patients from suffering from financial crises due to their illness.
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Affiliation(s)
- Karen Joyce S Velasco
- Department of Otolaryngology - Head and Neck Surgery, Philippine General Hospital, University of the Philippines Manila
| | - Philip B Fullante
- Department of Otolaryngology - Head and Neck Surgery, Philippine General Hospital, University of the Philippines Manila
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Gissi DB, Suàrez-Fernandez C, Rossi R, Vitali F, Marzi Manfroni A, Gabusi A, Morandi L, Balbi T, Montebugnoli L, Foschini MP, Tarsitano A. Direct healthcare costs of oral cancer: A retrospective study from a tertiary care center. J Craniomaxillofac Surg 2024; 52:630-635. [PMID: 38582671 DOI: 10.1016/j.jcms.2024.03.002] [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: 10/20/2023] [Revised: 12/19/2023] [Accepted: 03/05/2024] [Indexed: 04/08/2024] Open
Abstract
The aim of this study was to retrospectively evaluate the direct costs of OSCC treatment and postsurgical surveillance in a tertiary hospital in northeast Italy. Sixty-three consecutive patients surgically treated for primitive OSCC at S. Orsola Hospital in Bologna (Italy) between January 2018 and January 2020 were analyzed. Billing records of the Emilia Romagna healthcare system and institutional costs were used to derive specific costs for the following clinical categories: operating theatre costs, intensive and ordinary hospitalization, radiotherapy, chemotherapy, postsurgical complications, visits, and examinations during the follow-up period. The study population comprised 17 OSCC patients classified at stage I, 14 at stage II, eight at stage III, and 24 at stage IV. The estimated mean total direct cost for OSCC treatment and postsurgical surveillance was €26 338.48 per patient (stage I: €10 733, stage II: €19 642.9, stage III: €30 361.4, stage IV: €39 957.2). An advanced diagnosis (stages III and IV), complex surgical procedure, and loco-regional recurrences resulted in variables that were significantly associated with a higher cost of OSCC treatment and postsurgical surveillance. Redirection of funds used for OSCC treatment to screening measures may be an effective strategy to improve overall health outcomes and optimize national health resources.
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Affiliation(s)
- Davide Bartolomeo Gissi
- Department of Biomedical and Neuromotor Sciences, Section of Oral Sciences, University of Bologna, Bologna, Italy.
| | - Carlota Suàrez-Fernandez
- Department of Surgery and Medical-Surgical Specialities, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain
| | - Roberto Rossi
- Department of Biomedical and Neuromotor Sciences, Section of Oral Sciences, University of Bologna, Bologna, Italy
| | - Francesco Vitali
- Oral and Maxillofacial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, Section of Maxillofacial Surgery at Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Alice Marzi Manfroni
- Oral and Maxillofacial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, Section of Maxillofacial Surgery at Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Andrea Gabusi
- Department of Biomedical and Neuromotor Sciences, Section of Oral Sciences, University of Bologna, Bologna, Italy
| | - Luca Morandi
- Functional and Molecular Neuroimaging Unit, Bellaria Hospital, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Tiziana Balbi
- Unit of Anatomic Pathology, S. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Lucio Montebugnoli
- Department of Biomedical and Neuromotor Sciences, Section of Oral Sciences, University of Bologna, Bologna, Italy
| | - Maria Pia Foschini
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology at Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Achille Tarsitano
- Oral and Maxillofacial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, Section of Maxillofacial Surgery at Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
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Silfverschiöld M, Jarl J, Hafström A, Greiff L, Sjövall J. Cost of Illness of Head and Neck Cancer in Sweden. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:425-432. [PMID: 38307390 DOI: 10.1016/j.jval.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/25/2023] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES Head and neck cancer (HNC) is the sixth most common cancer worldwide. The condition and its treatment often lead to marked morbidities and, for some patients, premature death. Inferentially, HNC imposes a significant economic burden on society. This study aims to provide a comprehensive and detailed estimation of the cost of illness of HNC for Sweden in 2019. METHODS This is a prevalence-based cost of illness study. Resource utilization and related costs are quantified using national registry data. A societal perspective is applied, including (1) direct costs for healthcare utilization, (2) costs for informal care from family and friends, and (3) costs for productivity loss due to morbidity and premature death. The human capital approach is used when estimating productivity losses. RESULTS The societal cost of HNC for Sweden in 2019 was estimated at €92 million, of which the direct costs, costs for informal care, and costs for productivity loss represented 34%, 2%, and 64%, respectively. Oral cavity cancer was the costliest HNC, followed by oropharyngeal cancer, whereas nasopharyngeal cancer was the costliest per person. The cost of premature mortality comprised 60% of the total cost of productivity loss. Males accounted for 65% of direct costs and 67% of costs for productivity loss. CONCLUSIONS The societal cost of HNC is substantial and constitutes a considerable burden to Swedish society. The results of the present study may be used by policymakers for planning and allocation of resources. Furthermore, the information may be used for future cost-effectiveness analyses.
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Affiliation(s)
- Maria Silfverschiöld
- Department of ORL, Head and Neck Surgery, Skåne University Hospital, Lund, Skåne, Sweden; Department of Clinical Sciences, Lund University, Lund, Skåne, Sweden.
| | - Johan Jarl
- Department of Clinical Sciences, Malmö, Health Economics, Lund University, Malmö, Skåne, Sweden
| | - Anna Hafström
- Department of ORL, Head and Neck Surgery, Skåne University Hospital, Lund, Skåne, Sweden; Department of Clinical Sciences, Lund University, Lund, Skåne, Sweden
| | - Lennart Greiff
- Department of ORL, Head and Neck Surgery, Skåne University Hospital, Lund, Skåne, Sweden; Department of Clinical Sciences, Lund University, Lund, Skåne, Sweden
| | - Johanna Sjövall
- Department of ORL, Head and Neck Surgery, Skåne University Hospital, Lund, Skåne, Sweden; Department of Clinical Sciences, Lund University, Lund, Skåne, Sweden
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O’Meara CH, Nguyen TV, Jafri Z, Boyer M, Shonka DC, Khachigian LM. Personalised Medicine and the Potential Role of Electrospinning for Targeted Immunotherapeutics in Head and Neck Cancer. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 14:6. [PMID: 38202461 PMCID: PMC10780990 DOI: 10.3390/nano14010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/03/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
Advanced head and neck cancer (HNC) is functionally and aesthetically destructive, and despite significant advances in therapy, overall survival is poor, financial toxicity is high, and treatment commonly exacerbates tissue damage. Although response and durability concerns remain, antibody-based immunotherapies have heralded a paradigm shift in systemic treatment. To overcome limitations associated with antibody-based immunotherapies, exploration into de novo and repurposed small molecule immunotherapies is expanding at a rapid rate. Small molecule immunotherapies also have the capacity for chelation to biodegradable, bioadherent, electrospun scaffolds. This article focuses on the novel concept of targeted, sustained release immunotherapies and their potential to improve outcomes in poorly accessible and risk for positive margin HNC cases.
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Affiliation(s)
- Connor H. O’Meara
- Department of Otorhinolaryngology, Head & Neck Surgery, The Canberra Hospital, Garran, ACT 2605, Australia
- ANU School of Medicine, Australian National University, Canberra, ACT 0200, Australia
| | - Thanh Vinh Nguyen
- School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Zuhayr Jafri
- Vascular Biology and Translational Research, Department of Pathology, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (Z.J.)
| | - Michael Boyer
- Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia;
| | - David C. Shonka
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Levon M. Khachigian
- Vascular Biology and Translational Research, Department of Pathology, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (Z.J.)
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Li SP, Zhang ZM, Bao Y, Zhou LX, Zhao R, Li JM, Zhou YH, Chen X, Hu SZ, Liu WS. The Diagnostic and Prognostic Value of EBUS-TBNA for Intrathoracic Metastasis in Previously Treated Patients With Head and Neck Cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2661-2672. [PMID: 37449666 DOI: 10.1002/jum.16302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The present study assessed the diagnostic and prognostic significance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for suspected intrathoracic metastasis after HNC treatment. METHODS A retrospective analysis was conducted on 75 patients with a prior history of head and neck cancer treatment who underwent EBUS-TBNA for suspected intrathoracic metastases between March 2012 and December 2021. RESULTS A total of 126 targeted lesions, including 107 mediastinal/hilar lymph nodes and 19 intrapulmonary/mediastinal masses, were sampled. The metastatic head and neck cancer (HNC) cases detected by EBUS-TBNA consisted of nasopharyngeal carcinoma (n = 24), oropharyngeal carcinoma (n = 3), hypopharynx carcinoma (n = 6), laryngeal carcinoma (n = 6), and oral cavity carcinoma (n = 6). Cases with negative EBUS-TBNA results consisted of tuberculosis (n = 9), sarcoidosis (n = 3), anthracosis (n = 9), and reactive lymphadenitis (n = 9). Six false-negative cases were found among the 75 patients with suspected intrathoracic metastases. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the EBUS-TBNA procedure for metastatic HNC were 88.2, 100.0, 100.0, 80, and 92.0%, respectively. The diagnosis of HNC intrathoracic metastasis by EBUS-TBNA correlated with an adverse prognosis in terms of overall survival (OS) (P = .008). The log-rank univariate analysis and Cox regression multivariate analysis results indicated that the detection of metastatic HNC through EBUS-TBNA was a significant independent prognostic factor for patients with HNC who had received prior treatment. CONCLUSIONS Endobronchial ultrasound-guided transbronchial needle aspiration is a safe, effective, and minimally invasive procedure for assessing suspected intrathoracic metastasis in HNC patients after treatment. The intrathoracic metastasis detected by EBUS-TBNA has crucial prognostic significance in previously treated HNC patients.
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Affiliation(s)
- Sheng-Ping Li
- Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Zhen-Ming Zhang
- Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Bao
- Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Ling-Xiao Zhou
- Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Rui Zhao
- Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Ji-Man Li
- Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Ye-Han Zhou
- Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xi Chen
- Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Shang-Zhi Hu
- Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Wu-Song Liu
- Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
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9
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Shah R, Tyagi S, Liu C, Judson B. Extra imaging beyond NCCN surveillance guidelines is cost effective for HPV- but not HPV+ oropharyngeal cancer. Oral Oncol 2023; 146:106564. [PMID: 37672950 DOI: 10.1016/j.oraloncology.2023.106564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Rema Shah
- Yale University School of Medicine, New Haven, CT, USA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
| | - Sidharth Tyagi
- Yale University School of Medicine, New Haven, CT, USA; Medical Scientist Training Program, Yale University School of Medicine, New Haven, CT, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Christina Liu
- Yale University School of Medicine, New Haven, CT, USA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin Judson
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Bouland C, Vanden Eynden X, Lalmand M, Buset T, Yanni A, Javadian R, Rodriguez A, Loeb I, Lechien JR, Journe F, Saussez S, Dequanter D. Preventive and Therapeutic Effect of Metformin in Head and Neck Cancer: A Concise Review. J Clin Med 2023; 12:6195. [PMID: 37834839 PMCID: PMC10573641 DOI: 10.3390/jcm12196195] [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: 08/07/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Head and neck cancer (HNC) is a complex affection. Nowadays, conventional treatments are associated with many side effects, reducing the patient's quality of life. Recent studies suggest that metformin, a first-line treatment for diabetes, could decrease cancer incidence and improve cancer-related survival rates. METHODS This systematic review summarizes important data from studies evaluating metformin's contribution to preventing and treating HNC. RESULTS The results suggest a protective effect of metformin in HNC. However, no consensus has been found on its therapeutic effects. Metformin seems to confer an improved cancer-related survival rate in a diabetic population, but compared to a non-diabetic population, the review could not identify any advantages. Nevertheless, no studies presented a negative impact. CONCLUSION In conclusion, the results of this systematic review suggest that HNC patients may benefit from metformin. Indeed, it would reduce the HNC incidence. However, more studies are required to evaluate the effect on cancer-related survival rates.
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Affiliation(s)
- Cyril Bouland
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Xavier Vanden Eynden
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Martin Lalmand
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Thibaut Buset
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Antoine Yanni
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Rokneddine Javadian
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Alexandra Rodriguez
- Department of Otorhinolaryngology—Head and Neck Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (S.S.)
| | - Isabelle Loeb
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
| | - Jérôme R. Lechien
- Department of Otorhinolaryngology—Head and Neck Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (S.S.)
- Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons (UMONS), 7000 Mons, Belgium
| | - Fabrice Journe
- Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons (UMONS), 7000 Mons, Belgium
- Laboratory of Oncology and Experimental Surgery, Jules Bordet Institute, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Sven Saussez
- Department of Otorhinolaryngology—Head and Neck Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (S.S.)
- Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons (UMONS), 7000 Mons, Belgium
| | - Didier Dequanter
- Department of Stomatology—Maxillofacial Surgery, CHU-Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium (M.L.)
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11
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Porta-Vázquez M, López-Cedrún JL, Fernández-Sanromán J, García-Mato E, Diz-Dios P, Diniz-Freitas M. Estimating the direct costs of oral cancer in Spain: a retrospective hospital data analysis. Med Oral Patol Oral Cir Bucal 2023; 28:e425-e432. [PMID: 37330962 PMCID: PMC10499339 DOI: 10.4317/medoral.25847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/08/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Studies on the costs incurred from cancer in Spain are scarce and have focused on the most prevalent types such as colorectal, breast, and lung cancer. The aim of this study was to calculate the direct costs associated with the diagnostic, treatment and follow-up procedures for oral cancer in Spain. MATERIAL AND METHODS Applying a bottom-up approach, we retrospectively analyzed the medical records of a cohort of 200 patients with oral cancer (C00-C10), diagnosed and treated in Spain between 2015 and 2017. For each patient, we collected their age, sex, degree of medical impairment (American Society of Anesthesiologists [ASA] classification), tumor extent (TNM classification), relapses and survival during the first 2 years of follow-up. The final calculation of the costs is expressed in absolute values in euros as the percentage of the gross domestic product per capita and in international dollars (I$). RESULTS The total cost per patient rose to €16,620 (IQR, €13,726; I$11,634), and the total direct cost at the national level was €136,084,560 (I$95,259,192). The mean cost for oral cancer represented 65.1% of the gross domestic product per capita. The costs for the diagnostic and therapeutic procedures were determined by the ASA grade, tumor size, lymph node infiltration and presence of metastases. CONCLUSIONS The direct costs for oral cancer are considerable compared with other types of cancer. In terms of gross domestic product, the costs were similar to those of countries neighboring Spain, such as Italy and Greece. The main determinants of this economic burden were the patient's degree of medical impairment and tumor extent.
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Affiliation(s)
- M Porta-Vázquez
- Department of Surgery and Medical-Surgical Specialties Faculty of Medicine and Odontology, University of Santiago de Compostela c/Entrerríos s/n, 15782-Santiago de Compostela, Spain
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12
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Baliga MS, Lasrado S, Krishna A, George T, Madathil LP, D’souza RF, Palatty PL. Social, Ethical and Treatment Related Problems Faced by Healthcare Workers in the Care of Head and Neck Cancer Patients: A Narrative Review from the Bioethics Consortium from India. Indian J Otolaryngol Head Neck Surg 2023:1-11. [PMID: 37362104 PMCID: PMC10206566 DOI: 10.1007/s12070-023-03738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/26/2023] [Indexed: 06/28/2023] Open
Abstract
Head and neck cancer (HNC) presents a variety of ethical difficulties for an oncologist involved in screening, diagnosis, treatment, and rehabilitation that are challenging to address, especially for those professionals/people who are not trained in medical ethics. The bioethics department has spent the last ten years compiling information and rating the seriousness of numerous niche ethical concerns and their effects on healthcare professionals practising in India. Based on these findings, the current analysis makes an effort to outline the different challenges faced by oncologists when screening, diagnosing, treating, and rehabilitating people affected with HNC, particularly in a traditional nation like India. According to the authors, this is the first overview to address these issues from an Indian viewpoint, and it represents a small effort to document a crucial but unaddressed component of cancer treatment. It is hoped that these endeavours would aid in educating upcoming healthcare professionals on how to effectively handle the difficulties.
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Affiliation(s)
- Manjeshwar Shrinath Baliga
- Bioethics Education and Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka 575002 India
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala 682041 India
- Member, International Chair in Bioethics, University of Porto Portugal (Formerly UNESCO Chair in Bioethics, University of Haifa) Directorate of The Asia Pacific Division and Education Department, Cleeland Street, Melbourne, Australia
| | - Savita Lasrado
- Department of Otorhinolaryngology, Father Muller Medical College, Kankanady, Mangalore, 575002 India
| | - Abhishek Krishna
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, Karnataka 570001 India
| | - Thomas George
- Internal Medicine, Coney Island Hospital, 2601 Ocean Pkwy, Brooklyn, NY 11235 USA
| | - Lal P. Madathil
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala 682041 India
| | - Russell Franco D’souza
- Member, International Chair in Bioethics, University of Porto Portugal (Formerly UNESCO Chair in Bioethics, University of Haifa) Directorate of The Asia Pacific Division and Education Department, Cleeland Street, Melbourne, Australia
- Chair Department of Education, International Chair in Bioethics, University of Porto Portugal (Formerly UNESCO Chair in Bioethics, University of Haifa); Directorate of The Asia Pacific Division and Education Department, Cleeland Street, Melbourne, Australia
| | - Princy Louis Palatty
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala 682041 India
- Department of Pharmacology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala 682041 India
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13
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Nguyen OT, Donato U, McCormick R, Reblin M, Kim L, Hume E, Otto AK, Alishahi Tabriz A, Islam JY, Hong Y, Turner K, Patel KB. Financial toxicity among head and neck cancer patients and their caregivers: A cross‐sectional pilot study. Laryngoscope Investig Otolaryngol 2023; 8:450-457. [PMID: 37090884 PMCID: PMC10116977 DOI: 10.1002/lio2.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/25/2023] [Accepted: 02/19/2023] [Indexed: 03/11/2023] Open
Abstract
Objectives Head and neck cancer (HNC) patients experience greater financial toxicity than other cancer patients. Research on financial toxicity has concentrated on patients despite many informal caregivers sharing finances and reducing work hours to provide patient care. Thus, our pilot study: (1) assessed the feasibility of financial toxicity screening of HNC patients and their caregivers, and (2) described financial toxicity levels of HNC patients and their caregivers. Methods We surveyed English-speaking adult HNC patients initiating treatment at a National Cancer Institute-designated Comprehensive Cancer Center and their informal caregivers. This survey assessed demographics and financial toxicity through the Comprehensive Score for Financial Toxicity (COST) measure (0-44 range; lower score indicates higher financial toxicity). Screening feasibility was defined as ≥50% consent rate and ≥60% data completion rate. Results Our sample included 27 HNC patients and 9 caregivers. They both had slightly lower consent and completion rates than our goals. Patients reported a median COST score of 27 while caregivers reported a median COST score of 16. Approximately 25.9% of patients and 44.4% of caregivers reported high financial toxicity (COST < 17.5). Caregivers reported high concerns about their future financial health and their ability to control the amount of their financial contributions to the patient's care. Conclusions Patients and caregivers may require additional outreach approaches beyond emailed questionnaires to screen for their financial toxicity systematically. Future research is needed to replicate our results to determine whether differences in financial toxicity occur between patients and caregivers and identify areas of focus for interventions. Level of evidence IV.
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Affiliation(s)
- Oliver T. Nguyen
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Umberto Donato
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- College of Medicine, University of South Florida Tampa Florida USA
| | | | - Maija Reblin
- Department of Family Medicine University of Vermont Burlington Vermont USA
- Cancer Control and Population Health Sciences Program University of Vermont Cancer Center Burlington Vermont USA
| | - Lindsay Kim
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- College of Medicine, University of South Florida Tampa Florida USA
| | - Emma Hume
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Amy K. Otto
- Department of Public Health Sciences University of Miami Miller School of Medicine Miami Florida USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Department of Oncologic Sciences University of South Florida Tampa Florida USA
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Jessica Y. Islam
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Department of Cancer Epidemiology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Young‐Rock Hong
- Department of Health Services, Research, and Management University of Florida Gainesville Florida USA
| | - Kea Turner
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Department of Oncologic Sciences University of South Florida Tampa Florida USA
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Krupal B. Patel
- Department of Head and Neck Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
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McDermott JD, Amini A, Molina E, Stokes WA, Karam SD. Treatment outcomes and cost comparisons for older adults with T4 laryngeal squamous cell cancer. Head Neck 2023; 45:664-674. [PMID: 36563300 PMCID: PMC10626713 DOI: 10.1002/hed.27284] [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: 05/12/2021] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To evaluate treatment modalities of T4 larynx cancer in older adults using SEER-Medicare. METHODS The database was queried for patients aged 66 and older with nonmetastatic T4 laryngeal squamous cell cancer from 2006 to 2015. Treatment modalities compared were surgery plus chemoradiation (SCR), surgery plus radiation (SR), chemoradiation (CR), surgery (S), and radiation (R). Multivariate analysis and Kaplan-Meier methods were used to explore the relationship of treatment modality and survival. Total cancer-related costs were calculated. RESULTS A total of 438 patients met inclusion criteria. Patients receiving CR or SR had similar CSS to SCR (HR 1.36 and HR 1.24, respectively). Those receiving S (HR 2.00) or R (HR 2.41) had significantly worse CSS. Similar findings were observed for OS. Cancer care-related costs were not significantly different but highest in SCR ($162215) and lowest in R ($121421). CONCLUSION Older patients with T4 larynx cancer had similar survival rates when treated with CR, SR, and SCR. Average total health care costs were not significantly different between modalities. Patients not eligible for triple-modality could consider these other treatment options.
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Affiliation(s)
- Jessica D McDermott
- Department of Medical Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, California, USA
| | - Elizabeth Molina
- Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William A Stokes
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
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15
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Pytel A, Zielińska A, Staś J, Chabowski M. Quality of Life, Psychological Distress, and Nutritional Status of Polish Patients with Head and Neck Cancer Treated with Radiotherapy. J Clin Med 2023; 12:jcm12020659. [PMID: 36675586 PMCID: PMC9862327 DOI: 10.3390/jcm12020659] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Head and neck cancer (HNC) is a global epidemiological and clinical problem. In 2020, it was the seventh most common type of cancer worldwide. In 2019, HNC was the fourth most common cause of cancer death among men in Poland. Radiotherapy plays an important role in the treatment of patients with HNC at all clinical stages. However, it is associated with a significant rate of early and late adverse effects. As head and neck cancers are located close to vital anatomical structures, both the local progression of the disease and the treatments used can cause serious problems for patients with HNC, reducing their health-related quality of life (HRQoL) as well as increasing the risk of depressive disorders. Despite this, the current literature lacks research on these aspects of the therapeutic process in the Polish population. The aim of this study was to assess the early impact of radiotherapy on HRQoL outcomes, psychological distress, nutritional status, and overall performance of patients with HNC. METHODS The study was carried out among 85 patients with HNC treated in the Inpatient Radiotherapy Unit of the Radiotherapy Department of the Lower Silesian Oncology Center in Wrocław. The patients were asked to complete a set of questionnaires, including the EORTC QLQ-H&N35, the BDI, the NRS-2002, and the ECOG scale, at two time points: before the initiation of radiotherapy treatment and after a course of radiotherapy. The period between the assessments was 7 to 8 weeks. RESULTS Our findings demonstrated a negative impact of radiotherapy on scores in all the cancer-specific symptom and functioning scales used in the study. As regards functioning scales, the largest differences were observed for senses and swallowing, whereas with symptoms scales, the largest differences were noted for "sticky saliva" and "dry mouth". Over half of the patients included in the study required nutritional support after radiotherapy treatment. We found statistically significant differences in the levels of depressive symptom severity before and after radiotherapy treatment. CONCLUSION The present study showed significant changes in the physical and psychological functioning and nutritional status of the patients with HNC studied after radiotherapy treatment, which may have an impact on the effectiveness of cancer treatment.
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Affiliation(s)
- Aleksandra Pytel
- Department of Nursing and Obstetrics, Division of Internal Medicine Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618 Wroclaw, Poland
| | - Anna Zielińska
- Lower Silesian Oncology Center, 12 Hirszfeld Square, 53-413 Wroclaw, Poland
| | - Jakub Staś
- Student Research Club No 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Mariusz Chabowski
- Department of Nursing and Obstetrics, Division of Anaesthesiological and Surgical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618 Wroclaw, Poland
- Department of Surgery, 4th Military Teaching Hospital, 50-981 Wroclaw, Poland
- Correspondence: ; Tel.: +48-261-660-247; Fax: +48-261-660-245
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16
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Massa ST, Chidambaram S, Luong P, Graboyes EM, Mazul AL. Quantifying Total and Out-of-Pocket Costs Associated With Head and Neck Cancer Survivorship. JAMA Otolaryngol Head Neck Surg 2022; 148:1111-1119. [PMID: 36264567 PMCID: PMC9585466 DOI: 10.1001/jamaoto.2022.3269] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/28/2022] [Indexed: 01/10/2023]
Abstract
Importance Oncologic treatment is costly to the health care system and to individuals, but patients with head and neck cancer (HNC) also have long-term care needs after treatment. Survivors of HNC require specific consideration given their rapidly growing numbers. This subpopulation of cancer survivors often experiences long-term treatment-associated morbidity. Objective To describe the total and out-of-pocket (OOP) costs associated with HNC survivorship and the risk factors for financial toxicity among this population. Design, Setting, and Participants This was a retrospective review and economic evaluation of a cohort of US adults with a diagnosis of HNC from 2006 to 2018. The study used data the from IBM MarketScan Commercial Claims Database. Data were analyzed from November 2020 to June 2022. Exposures Treatment for HNC. Main Outcomes and Measures Total and OOP medical costs were assessed monthly and reported relative to the date of HNC diagnosis. The primary outcome was the difference between a patient's mean monthly survivorship costs (13-60 months after diagnosis) and mean monthly baseline costs (7-12 months before diagnosis). Univariate and multivariable linear regression models were created for total and OOP costs to generate coefficient estimates with 95% CIs. Results The study cohort of this economic evaluation included 19 098 patients with HNC (median [range] age, 56 [18-64] years; 14 144 [74.1%] men and 4954 [25.9%] women; race and ethnicity were not considered). Throughout the survivorship period, median total and OOP costs were $372 per month and $31 per month higher than baseline costs, respectively, with variation in expenses by demographic information, health plan type, and oncologic variables. In the multivariable model, greater total and OOP excess survivorship costs were associated with female sex ($343/mo; 95% CI, $126 to $560 and $9/mo; 95% CI, $4 to $14). Highest and lowest total excess survivorship costs associated with cancer site were seen for hypopharyngeal ($1908/mo; 95% CI, $1102 to $2714) and oropharyngeal cancers (-$703/mo; 95% CI, -$967 to -$439) vs oral cavity cancers. Compared with surgery or radiation therapy alone, multimodal treatment was generally associated with excess OOP survivorship costs. Conclusions and Relevance The findings of this retrospective economic evaluation review suggest that the costs of HNC survivorship remain persistently elevated above baseline costs for at least 5 years after diagnosis. High survivorship costs were associated with female sex, hypopharyngeal tumors, and treatment with multimodal therapy. Practitioners should seek to minimize costs for these patients at higher-risk of financial toxicity after treatment and work to provide directed supportive services.
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Affiliation(s)
- Sean T. Massa
- Department of Otolaryngology−Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
| | - Smrithi Chidambaram
- Department of Otolaryngology−Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
- Department of Otolaryngology−Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Peter Luong
- Department of Otolaryngology−Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
| | - Evan M. Graboyes
- Department of Otolaryngology−Head and Neck Surgery, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Angela L. Mazul
- Department of Otolaryngology−Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
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17
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Diao K, Lei X, Smith GL, Jagsi R, Peterson SE, Sumer BD, Smith BD, Sher DJ. Patient-Reported Financial Toxicity in a Population-Based Cohort of Oropharynx Cancer Survivors. Int J Radiat Oncol Biol Phys 2022; 116:142-153. [PMID: 36812043 DOI: 10.1016/j.ijrobp.2022.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Patients with oropharyngeal squamous cell carcinoma (OPSCC) are at high risk for financial toxicity (FT), but the nature, extent, and predictors of FT experienced after primary radiation therapy (RT) or surgery are poorly understood. METHODS AND MATERIALS We used a population-based sample of patients from the Texas Cancer Registry with stage I to III OPSCC diagnosed from 2006 to 2016 and treated with primary RT or surgery. Of 1668 eligible patients, 1600 were sampled, 400 responded, and 396 confirmed OPSCC. Measures included the MD Anderson Symptom Inventory Head and Neck, Neck Dissection Impairment Index, and a financial toxicity instrument adapted from the Individualized Cancer Care (iCanCare) study. Multivariable logistic regression evaluated associations of exposures with outcomes. RESULTS Of 396 analyzable respondents, 269 (68%) received primary RT and 127 (32%) surgery. The median time from diagnosis to survey was 7 years. Due to OPSCC, 54% of patients experienced material sacrifice (including 28% who reduced food spending and 6% who lost their housing), 45% worried about financial problems, and 29% experienced long-term FT. Independent factors associated with more long-term FT included female sex (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.23-2.40), Black non-Hispanic race (OR, 2.98; 95% CI, 1.26-7.09), unmarried status (OR, 1.50; 95% CI, 1.11-2.03), feeding tube use (OR, 3.98; 95% CI, 2.29-6.90), and worst versus best quartile on the MD Anderson Symptom Inventory Head and Neck (OR, 1.89; 95% CI, 1.23-2.90) and Neck Dissection Impairment Index (OR, 5.62; 95% CI, 3.79-8.34). Factors associated with less long-term FT included age >57 years (OR, 0.54; 95% CI, 0.41-0.71; P < .001) and household income ≥$80,000 (OR, 0.60; 95% CI, 0.44-0.82; P = .001). Primary RT versus surgery was not associated with long-term FT (OR, 0.92; 95% CI, 0.68-1.24). CONCLUSIONS Oropharynx cancer survivors experience high rates of material sacrifice and long-term FT, and we identified important risk factors. Chronic symptom burden was associated with significantly worse long-term financial status, supporting the hypothesis that toxicity mitigation strategies may reduce long-term FT.
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Affiliation(s)
| | - Xiudong Lei
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace L Smith
- Departments of Radiation Oncology; Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Susan E Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Benjamin D Smith
- Departments of Radiation Oncology; Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David J Sher
- Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas.
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18
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Nguyen OT, McCormick R, Patel K, Reblin M, Kim L, Hume E, Powers B, Otto A, Alishahi Tabriz A, Islam J, Hong Y, Kirchhoff AC, Turner K. Health insurance literacy among head and neck cancer patients and their caregivers: A cross-sectional pilot study. Laryngoscope Investig Otolaryngol 2022; 7:1820-1829. [PMID: 36544972 PMCID: PMC9764792 DOI: 10.1002/lio2.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Health insurance literacy interventions may reduce financial burden and its effects on cancer patients and their caregivers. However, little is known about the health insurance literacy levels of head and neck cancer (HNC) patients and their caregivers. We assessed the feasibility of screening for health insurance literacy in a pilot study and described the health insurance literacy levels of HNC patients and their caregivers. Methods We administered a survey that assessed demographics and subjective and objective health insurance literacy to HNC patients and their caregivers. Subjective health insurance literacy was measured through the Health Insurance Literacy Measure (score range: 0-84). Objective health insurance literacy was measured through correct answers to a previously developed 10-question knowledge test. Due to a small sample size, inferential statistics were not used; we instead descriptively reported findings. Results The pilot included 48 HNC patients and 13 caregivers. About 44.4% of patients and 30.8% of caregivers demonstrated low health insurance literacy (HILM ≤60). On the 10-item knowledge test, patients had an average of 6.8 (SD: 2.3) correct responses and caregivers had 7.8 (SD: 1.1) correct responses. Calculating out-of-pocket costs for out-of-network services was challenging; only 9.5% of patients and 0% of caregivers answered correctly. Conclusion Additional outreach strategies may be needed to supplement screening for health insurance literacy. Areas of focus for interventions include improving understanding of how to calculate financial responsibility for health care services and filing an appeal for health insurance claim denial. Level of Evidence IV.
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Affiliation(s)
- Oliver T. Nguyen
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | | | - Krupal Patel
- Department of Head and Neck OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Maija Reblin
- Department of Family MedicineUniversity of VermontBurlingtonVermontUSA,Cancer Control & Population Health Sciences ProgramUniversity of Vermont Cancer CenterBurlingtonVermontUSA
| | - Lindsay Kim
- College of Medicine, University of South FloridaTampaFloridaUSA
| | - Emma Hume
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Benjamin Powers
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Amy Otto
- Department of Public Health SciencesUniversity of MiamiCoral GablesFloridaUSA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Oncological SciencesUniversity of South FloridaTampaFloridaUSA
| | - Jessica Islam
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Young‐Rock Hong
- Department of Health Services Research and ManagementUniversity of Florida College of Public Health and Health ProfessionsGainesvilleFloridaUSA
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences Research Program Huntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA,Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Kea Turner
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Oncological SciencesUniversity of South FloridaTampaFloridaUSA
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Ben-Arie E, Lottering B, Inprasit C, Yip HT, Ho WC, Ton G, Lee YC, Kao PY. Traditional Chinese medicine use in patients with oral cancer: A retrospective longitudinal cohort study in Taiwan. Medicine (Baltimore) 2022; 101:e30716. [PMID: 36197175 PMCID: PMC9509120 DOI: 10.1097/md.0000000000030716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Oral cancer is frequently associated with smoking, alcohol consumption, and betel quid chewing, which are common harmful behaviors observed in certain cohorts of the Taiwanese population. Some reports have explored the potential therapeutic effect of certain herbal remedies on cancer treatments and the outcomes thereof. However, supportive evidence regarding the specific use of traditional Chinese medicine (TCM) in oral cancer treatment is lacking and deserves further investigation. This study measured the use of TCM therapies for oral cancer in a Taiwanese population-based retrospective longitudinal cohort study. The Taiwan National Health Insurance Research Database was utilized to conduct this study. The study population was limited to oral cancer patients diagnosed between 2000 and 2009, which were followed up for at least 5 years. Therapeutic strategies investigated included acupuncture and the Chinese herbs and formula used. Additionally, the frequency of TCM treatment visits, total medical costs, and all-cause mortality were also analyzed. Between 2000 and 2009, a total of 951 patients were diagnosed with various oral cancers. 13.7% of the diagnosed patients utilized TCM treatment measures. The majority of the patients were males. The top 3 common single herbs used were Xuán shēn (Radix Scrophulariae), Shí hú (Herba Dendrobii), and Mài mén dōng (Ophiopogon Japonicus). Then, Gān lù yǐn, Zhī bǎi dì huáng wán, and Sàn zhǒng kuì jiān tāng were the most frequently used herbal formulas. The survival probability was higher in TCM users when compared to non-TCM users in 5- and 12-year all-cause mortality (P < .05). This study explored the use of TCM therapies in oral cancer patients and identified essential information regarding the specifics of conventional herbal medicine used, affiliated medical costs, survival probability, and common symptoms observed in Taiwanese oral cancer patients.
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Affiliation(s)
- Eyal Ben-Arie
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - Bernice Lottering
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - Chanya Inprasit
- Suphanburi Campus Establishment Project, Kasetsart University, Suphan Buri, Thailand
| | - Hei-Tung Yip
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Gil Ton
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - Yu-Chen Lee
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
- Department of Acupuncture, China Medical University Hospital, Taichung, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
- *Correspondence: Yu-Chen Lee, Graduate Institute of Acupuncture Science, China Medical University, 2 Yuh-Der Road, Taichung City 40402, Taiwan (e-mail: ) and Pei-Yu Kao, Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, 2 Yuh-Der Road, Taichung City 40402, Taiwan (e-mail: )
| | - Pei-Yu Kao
- Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Surgical Intensive Care Unit, China Medical University Hospital, Taichung, Taiwan
- *Correspondence: Yu-Chen Lee, Graduate Institute of Acupuncture Science, China Medical University, 2 Yuh-Der Road, Taichung City 40402, Taiwan (e-mail: ) and Pei-Yu Kao, Division of Thoracic Surgery, Department of Surgery, China Medical University Hospital, 2 Yuh-Der Road, Taichung City 40402, Taiwan (e-mail: )
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20
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Faiq S, Solis RN, Sekhon HK, Morisada MV, Wilson M, Abouyared M, Bewley AF, Birkeland AC. Predictors of Health Care Utilization Following Major Head and Neck Oncologic Surgery in Older Patients. Otolaryngol Head Neck Surg 2022:1945998221124828. [PMID: 36125882 DOI: 10.1177/01945998221124828] [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
OBJECTIVE To identify patient factors in older patients associated with making posttreatment visits in the first year after major head and neck oncologic surgery. STUDY DESIGN Retrospective cohort study. SETTING Academic institution. METHODS Patients aged ≥60 years who underwent a neck dissection with or without a free flap reconstruction were retrospectively analyzed. Data collected included patient demographics, comorbidities, social variables, perioperative course, and clinical visits. RESULTS Within a 1-year postoperative period, the 181 patients in our cohort had a mean ± SD 6.37 ± 3.6 postoperative clinic visits; 70% attended at least 4 visits. Multivariable regression analysis showed a significant association with distance closer to the hospital (P = .013): for every 10-mile increase in distance, the number of visits decreased by 0.15 (SE = 0.06). Additionally, receiving adjuvant radiation therapy (P = .0096) demonstrated significant associations: when compared with no adjuvant therapy, radiation therapy had on average 1.5 (SE = 0.56) more visits, and chemoradiation had 0.04 (SE = 0.73) more visits. CONCLUSION Older patients who undergo major head and neck oncology surgery are more likely to attend posttreatment visits in the 1 year following surgery if they are discharged home rather than to a skilled nursing facility, live closer to the hospital, and undergo adjuvant radiation therapy.
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Affiliation(s)
- Samya Faiq
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Roberto N Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Harveen K Sekhon
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Megan V Morisada
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Machelle Wilson
- Department of Biostatistics, Epidemiology, and Research Design, Clinical and Translational Science Center, University of California-Davis, Sacramento, California, USA
| | - Marianne Abouyared
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Arnaud F Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
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21
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Carazo-Casas C, Gil-Prieto R, Hernández-Barrera V, Gil de Miguel Á. Trends in hospitalization and death rates among patients with head and neck cancer in Spain, 2009 to 2019. Hum Vaccin Immunother 2022; 18:2082192. [PMID: 35930449 DOI: 10.1080/21645515.2022.2082192] [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: 11/04/2022] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide, and prevalence is still substantially higher in men than in women. Causative factors include smoking and alcohol use, while human papillomavirus (HPV) infection is causally related to a subset of oropharyngeal cancers. In this retrospective study, we aimed to provide estimates on the clinical and economic burden of HNSCC in Spain. METHODS We used the discharge reports from the Spanish Minimum Basic Data Set (MBDS), to retrospectively analyze hospital discharge data in individuals with a diagnosis of HNSCC in any diagnostic position, based on the ICD coding system (ICD-9-CM and ICD10 CM), from 2009 to 2019. RESULTS A total of 175,340 admissions and 14,498 deaths due to laryngeal, pharyngeal and oral cavity cancer were recorded in Spain, of which 85% occurred in men. The most prevalent diagnoses were laryngeal cancer in men (50.9%) and oral cavity cancer in women (49.1%). In general, the hospitalization and death rates for all major head and neck cancer sites decreased in men and increased or remained stable in women during the study period. However, the corresponding rates for tonsil cancer, strongly associated with HPV infection, increased significantly in men. Overall, the economic burden of HNSCC during the study period was estimated at 100 million euros per year on average. CONCLUSION HNSCC still places an important clinical and economic burden on the health system in Spain. Prevention strategies should be prioritized, and vaccination programs against HPV in both sexes should be reinforced.
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Affiliation(s)
- Carlos Carazo-Casas
- Department of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Ruth Gil-Prieto
- Department of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | | | - Ángel Gil de Miguel
- Department of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
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22
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Torres E, Richman A, Wright W, Wu Q. Assessing Dental Students' HPV Health Literacy and Intention to Engage in HPV-Related Oropharyngeal Cancer Prevention. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:950-956. [PMID: 33085019 DOI: 10.1007/s13187-020-01905-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
Oropharyngeal cancer has become the new face of HPV-related cancers, and this alarming growth highlights the pivotal role dentists can play in prevention. This study aims to identify current HPV-related curricula taught across US dental schools and evaluate HPV health literacy and intention to engage in HPV prevention among US dental students. The dental school curricula included responses from 40 Academic Deans (61% response rate). The 4-item survey focused on understanding HPV-related content in dental school curricula and was administered via Qualtrics. A 31-item paper survey was administered to dental students (N = 109) at a southeastern dental school assessing HPV health literacy, scope of practice, willingness to administer HPV vaccine, self-efficacy in HPV prevention, and basic demographics. Data were collected between February and May 2018. Over 40 courses were identified and included HPV-related content in multiple disciplines including oral and general pathology, immunology, oral medicine, microbiology, infectious diseases, public health, and oral health management among others. Among dental students, over half were female (61%), non-Hispanic White (61%), with a mean age of 26 and in their first (48%) or third year of dental school (52%). Results indicate some HPV knowledge gaps. Most dental students believe HPV prevention is within their scope of practice; however, 56% reported feeling somewhat/not at all confident in recommending the vaccine and performing oral cancer exams. Our data supports the timeliness and need to strengthen HPV-related content in dental school curricula to effectively train and engage future dental providers in HPV prevention.
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Affiliation(s)
- Essie Torres
- Department of Health Education and Promotion, East Carolina University, 2309 Carol Belk Bldg, Mail Stop 529, Greenville, NC, 27858, USA.
| | - Alice Richman
- Department of Health Education and Promotion, East Carolina University, 2309 Carol Belk Bldg, Mail Stop 529, Greenville, NC, 27858, USA
| | - Wanda Wright
- School of Dental Medicine, East Carolina University, Greenville, NC, USA
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville, NC, USA
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23
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Davidoff AJ, Akif K, Halpern MT. Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature. J Natl Cancer Inst Monogr 2022; 2022:12-20. [PMID: 35788372 DOI: 10.1093/jncimonographs/lgac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 01/16/2023] Open
Abstract
We reviewed current literature reviews regarding economics of cancer-related health care to identify focus areas and gaps. We searched PubMed for systematic and other reviews with the Medical Subject Headings "neoplasms" and "economics" published between January 1, 2010, and April 1, 2020, identifying 164 reviews. Review characteristics were abstracted and described. The majority (70.7%) of reviews focused on cost-effectiveness or cost-utility analyses. Few reviews addressed other types of cancer health economic studies. More than two-thirds of the reviews examined cancer treatments, followed by screening (15.9%) and survivorship or end-of-life (13.4%). The plurality of reviews (28.7%) cut across cancer site, followed by breast (20.7%), colorectal (11.6%), and gynecologic (8.5%) cancers. Specific topics addressed cancer screening modalities, novel therapies, pain management, or exercise interventions during survivorship. The results indicate that reviews do not regularly cover other phases of care or topics including financial hardship, policy, and measurement and methods.
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Affiliation(s)
- Amy J Davidoff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kaitlin Akif
- Office of the Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michael T Halpern
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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24
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Mott NM, Mierzwa ML, Casper KA, Shah JL, Mallen-St Clair J, Ho AS, Zumsteg ZS, Prince ME, Dossett LA, Chen MM. Financial Hardship in Patients With Head and Neck Cancer. JCO Oncol Pract 2022; 18:e925-e937. [PMID: 35167324 PMCID: PMC9797234 DOI: 10.1200/op.21.00683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Financial hardship is a growing concern for patients with cancer. Patients with head and neck cancer (HNC) are particularly vulnerable, given that a third leave the workforce following treatment. The goal of our study was to characterize financial hardship in the psychologic response (response to increased expenses) and coping behaviors (behaviors patients adopt to manage their care in the setting of increased expenses) domains in patients with HNC compared with patients with other cancers. METHODS This was a retrospective cohort study of nationally representative public survey data from 2013 to 2018 in the National Health Interviews Survey, an annual cross-sectional household survey. We included respondents age ≥ 18 years who reported a diagnosis of cancer and identified a subset of patients with HNC. Our main outcomes were financial hardship in the psychologic response and coping behaviors domains. RESULTS Our sample included a weighted population of 357,052 patients with HNC and 21.4 million patients with other cancers. Compared with patients with other cancers, patients with HNC reported greater levels of coping behaviors hardship (31% v 23%, P = .015), but similar levels of psychologic financial hardship (73% v 72%, P = .787). Medicaid or uninsured patients more often reported coping behaviors hardship. On multivariable analysis, HNC (odds ratio, 1.51; 95% CI, 1.01 to 2.24) was independently associated with coping behaviors hardship. CONCLUSION To our knowledge, this is the first study to evaluate financial hardship in patients with HNC compared with patients with other cancers that includes Medicaid and uninsured patients, who are more often to have financial hardship. Patients with HNC have greater levels of hardship in the coping behaviors domain compared with patients with other cancers, but similar levels in the psychologic response domain.
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Affiliation(s)
| | | | - Keith A. Casper
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI
| | - Jennifer L. Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Allen S. Ho
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Zachary S. Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark E.P. Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI
| | - Lesly A. Dossett
- Department of Surgery, University of Michigan, Ann Arbor, MI,Center for Bioethics and Social Sciences in Medicine (CBSSM), University of Michigan, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Michelle M. Chen
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA,Michelle M. Chen, MD, MHS, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, 8635 West Third St, Suite 590W, Los Angeles, CA 90048; e-mail:
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25
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Burian E, Palla B, Callahan N, Pyka T, Wolff C, von Schacky CE, Schmid A, Froelich MF, Rübenthaler J, Makowski MR, Gassert FG. Comparison of CT, MRI, and F-18 FDG PET/CT for initial N-staging of oral squamous cell carcinoma: a cost-effectiveness analysis. Eur J Nucl Med Mol Imaging 2022; 49:3870-3877. [PMID: 35606526 PMCID: PMC9399011 DOI: 10.1007/s00259-022-05843-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Treatment of oral squamous cell carcinoma (OSCC) is based on clinical exam, biopsy, and a precise imaging-based TNM-evaluation. A high sensitivity and specificity for magnetic resonance imaging (MRI) and F-18 FDG PET/CT are reported for N-staging. Nevertheless, staging of oral squamous cell carcinoma is most often based on computed tomography (CT) scans. This study aims to evaluate cost-effectiveness of MRI and PET/CT compared to standard of care imaging in initial staging of OSCC within the US Healthcare System. Methods A decision model was constructed using quality-adjusted life years (QALYs) and overall costs of different imaging strategies including a CT of the head, neck, and the thorax, MRI of the neck with CT of the thorax, and whole body F-18 FDG PET/CT using Markov transition simulations for different disease states. Input parameters were derived from literature and willingness to pay (WTP) was set to US $100,000/QALY. Deterministic sensitivity analysis of diagnostic parameters and costs was performed. Monte Carlo modeling was used for probabilistic sensitivity analysis. Results In the base-case scenario, total costs were at US $239,628 for CT, US $240,001 for MRI, and US $239,131 for F-18 FDG PET/CT whereas the model yielded an effectiveness of 5.29 QALYs for CT, 5.30 QALYs for MRI, and 5.32 QALYs for F-18 FDG PET/CT respectively. F-18 FDG PET/CT was the most cost-effective strategy over MRI as well as CT, and MRI was the cost-effective strategy over CT. Deterministic and probabilistic sensitivity analysis showed high robustness of the model with incremental cost effectiveness ratio remaining below US $100,000/QALY for a wide range of variability of input parameters. Conclusion F-18 FDG PET/CT is the most cost-effective strategy in the initial N-staging of OSCC when compared to MRI and CT. Despite less routine use, both whole body PET/CT and MRI are cost-effective modalities in the N-staging of OSCC. Based on these findings, the implementation of PET/CT for initial staging could be suggested to help reduce costs while increasing effectiveness in OSCC.
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Affiliation(s)
- Egon Burian
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Benjamin Palla
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nicholas Callahan
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Thomas Pyka
- Department of Nuclear Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Constantin Wolff
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claudio E von Schacky
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Annabelle Schmid
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felix G Gassert
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
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Ma L, Little JV, Chen AY, Myers L, Sumer BD, Fei B. Automatic detection of head and neck squamous cell carcinoma on histologic slides using hyperspectral microscopic imaging. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-210399GR. [PMID: 35484692 PMCID: PMC9050479 DOI: 10.1117/1.jbo.27.4.046501] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
SIGNIFICANCE Automatic, fast, and accurate identification of cancer on histologic slides has many applications in oncologic pathology. AIM The purpose of this study is to investigate hyperspectral imaging (HSI) for automatic detection of head and neck cancer nuclei in histologic slides, as well as cancer region identification based on nuclei detection. APPROACH A customized hyperspectral microscopic imaging system was developed and used to scan histologic slides from 20 patients with squamous cell carcinoma (SCC). Hyperspectral images and red, green, and blue (RGB) images of the histologic slides with the same field of view were obtained and registered. A principal component analysis-based nuclei segmentation method was developed to extract nuclei patches from the hyperspectral images and the coregistered RGB images. Spectra-based support vector machine and patch-based convolutional neural networks (CNNs) were implemented for nuclei classification. The CNNs were trained with RGB patches (RGB-CNN) and hyperspectral patches (HSI-CNN) of the segmented nuclei and the utility of the extra spectral information provided by HSI was evaluated. Furthermore, cancer region identification was implemented by image-wise classification based on the percentage of cancerous nuclei detected in each image. RESULTS RGB-CNN, which mainly used the spatial information of nuclei, resulted in a 0.81 validation accuracy and 0.74 testing accuracy. HSI-CNN, which utilized the spatial and spectral features of the nuclei, showed significant improvement in classification performance and achieved 0.89 validation accuracy as well as 0.82 testing accuracy. Furthermore, the image-wise cancer region identification based on nuclei detection could generally improve the cancer detection rate. CONCLUSIONS We demonstrated that the morphological and spectral information contribute to SCC nuclei differentiation and that the spectral information within hyperspectral images could improve classification performance.
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Affiliation(s)
- Ling Ma
- University of Texas at Dallas, Department of Bioengineering, Richardson, Texas, United States
- Tianjin University, State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin, China
| | - James V. Little
- Emory University School of Medicine, Department of Pathology and Laboratory Medicine, Atlanta, Georgia, United States
| | - Amy Y. Chen
- Emory University School of Medicine, Department of Otolaryngology, Atlanta, Georgia, United States
| | - Larry Myers
- The University of Texas Southwestern Medical Center, Department of Otolaryngology, Dallas, Texas, United States
| | - Baran D. Sumer
- The University of Texas Southwestern Medical Center, Department of Otolaryngology, Dallas, Texas, United States
| | - Baowei Fei
- University of Texas at Dallas, Department of Bioengineering, Richardson, Texas, United States
- The University of Texas Southwestern Medical Center, Advanced Imaging Research Center, Dallas, Texas, United States
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, Texas, United States
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27
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YEGIN ME, GUR E, YEGIN EE, TIFTIKCIOGLU YO. Did COVID outbreak influence our management of skin tumors? EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1085659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Schmid M, Giger R, Nisa L, Mueller SA, Schubert M, Schubert AD. Association of Multiprofessional Preoperative Assessment and Information for Patients With Head and Neck Cancer With Postoperative Outcomes. JAMA Otolaryngol Head Neck Surg 2022; 148:259-267. [PMID: 35050322 PMCID: PMC8778600 DOI: 10.1001/jamaoto.2021.4048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Multidisciplinary perioperative assessment for patients undergoing complex oncologic head and neck cancer (HNC) surgery is widely implemented. However, to our knowledge, the association of multiprofessional preoperative assessment, information, and briefing with postoperative outcomes has not been evaluated. OBJECTIVE To compare postoperative complications, length of hospital stay (LOS), readmissions, mortality, and costs per case among patients undergoing complex oncologic HNC surgery before and after the implementation of a comprehensive preoperative multiprofessional assessment and information day (MUPAID). DESIGN, SETTING, AND PARTICIPANTS This retrospective, single-center case-control study was conducted at a tertiary referral head and neck anticancer center/university cancer institute and compared patients with HNC who were undergoing complex oncological surgeries between January 2012 and July 2018 before (control group) and after (intervention group) implementation of the institutional MUPAID. Data analysis was conducted between 2019 and 2020. The intervention group comprised patients who participated in the MUPAID beginning in February 2015. These patients were assessed by a multiprofessional team and provided with structured and comprehensive information on the surgical procedure and its functional, social, financial, and psychological effects, as well as the postoperative care, rehabilitation, and follow-up period. Patients in the control group had also undergone complex oncologic HNC surgery and were selected through surgical procedure codes. MAIN OUTCOMES AND MEASURES The end points were postoperative rate and severity of complications, LOS, readmissions, mortality, and costs per case. RESULTS The study included 161 patients, 81 in the intervention (25 women [30.9%]) and 80 in the control group (18 women [22.5%]). The groups showed no relevant differences in sociodemographic, disease, and procedural characteristics. The intervention cohort presented with fewer major local and systemic complications (Clavien-Dindo score, III-V: 34.6% vs 52.5%; difference proportion, -0.179; 95% CI, -0.33 to -0.03), shorter median LOS (12 days [IQR, 10-16 days] vs 16 days [IQR, 11-20] days; effect size, 0.482; 95% CI Cohen d, 0.152-0.812) and decreased median charge per case ($50 848 [IQR, $42 510-$63 479] vs $69 602 [IQR, $45 631-$96 280]; effect size, 0.534; 95% CI Cohen d, 0.22-0.85). CONCLUSIONS AND RELEVANCE The results of this case-control study suggest that MUPAID for patients who are undergoing complex oncologic HNC surgery is associated with shortened LOS and costs per case as well as decreased complications severity. These results are promising on a patient level in the potential to minimize individual treatment burden, as well as on an institutional and health care system level in the potential significant optimization of surgical outcomes and financial aspects.
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Affiliation(s)
- Manuela Schmid
- Department of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lluís Nisa
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Andreas Mueller
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria Schubert
- School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland,Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Adrian Daniel Schubert
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Lan R, Campana F, Tardivo D, Catherine JH, Vergnes JN, Hadj-Saïd M. Relationship between internet research data of oral neoplasms and public health programs in the European Union. BMC Oral Health 2021; 21:648. [PMID: 34920710 PMCID: PMC8679572 DOI: 10.1186/s12903-021-02022-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Tobacco and alcohol are the main risk factors for oral squamous cell carcinoma, the low survival rate of which is a public health problem. European-wide health policies (a prevention campaign, tobacco packaging) have been put in place to inform the population of the risks associated with consumption. Due to the increase in smoking among women, the incidence of this disease remains high. The identification of internet research data on the population could help to measure the impact of and better position these preventive measures. The objective was to analyze a potential temporal association between public health programs and interest in oral cancers on the internet in the European Union (EU). METHODS A search of data from Google ©, Wikipedia © and Twitter © users in 28 European countries relating to oral cancer between 2004 and 2019 was completed. Bibliometric analysis of press and scientific articles over the same period was also performed. The association between these data and the introduction of public health programs in Europe was studied. RESULTS There was a temporal association between changes in tobacco packaging and a significant increase in internet searches for oral cancer in seven countries. Unlike national policies and ad campaigns, the European awareness program Make Sense has had no influence on internet research. There was an asymmetric correlation in internet searches between publications on oral cancer from scientific articles or "traditional" media (weak association) and those from internet media such as Twitter © or Wikipedia © (strong association). CONCLUSION Our work highlights seven areas around which oral cancer awareness in Europe could be refocused, such as a change in the communication of health warnings on cigarette packs, the establishment of a more explicit campaign name regarding oral cancer, the involvement of public figures and associations in initiatives to be organized at the local level and the strengthening of awareness of the dangers of tobacco in the development of oral cancer.
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Affiliation(s)
- Romain Lan
- APHM, CNRS, EFS, ADES, Timone Hospital, Oral Public Health Department, Aix Marseille Univ, Marseille, France.
| | - Fabrice Campana
- APHM, INSERM, MMG, Timone Hospital, Oral Surgery Department, Aix Marseille Univ, Marseille, France
| | - Delphine Tardivo
- APHM, CNRS, EFS, ADES, Timone Hospital, Oral Public Health Department, Aix Marseille Univ, Marseille, France
| | - Jean-Hugues Catherine
- APHM, CNRS, EFS, ADES, Timone Hospital, Oral Surgery Department, Aix Marseille Univ, 13005, Marseille, France
| | - Jean-Noel Vergnes
- Functional Unit of Epidemiology and Oral Public Health, Faculty of Odontology, Paul Sabatier University, Toulouse III, Toulouse, France.,Division of Oral Health and Society, Mc Gill University, Montreal, Canada
| | - Mehdi Hadj-Saïd
- Oral Surgery Department, APHM, CHU Timone, Marseille, France
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Wang Y, Gao Y, Yuan L, Zhang J, Wang R. RETRACTED: Psychological needs and associated factors among perioperative patients with oral cancer. Oral Oncol 2021; 123:105615. [PMID: 34742003 DOI: 10.1016/j.oraloncology.2021.105615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief, as well as the authors. After concerns about research data were raised by a reader, the journal's editorial board requested a response from the authors, who confirmed errors in analysing and editing the original data. Specifically, a series of 104 survey entries were duplicated during data input. Therefore the authors and the Editor required a retraction of the article.
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Affiliation(s)
- Yujing Wang
- Department of Nursing, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, People's Republic of China.
| | - Yuqin Gao
- Department of Nursing, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, People's Republic of China
| | - Lulu Yuan
- Department of Nursing, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, People's Republic of China
| | - Jiamei Zhang
- Department of Nursing, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, People's Republic of China
| | - Runzi Wang
- Department of Nursing, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, People's Republic of China
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Nejati M, Razavi M, Harirchi I, Zanganeh M, Salari G, Tabatabaee SM. Resource Use and Costs Associated to the Initial Phase of Treatment for Patients with Colorectal Cancer Receiving Post-Surgery Chemotherapy: A Cost Analysis from a Healthcare Perspective. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:1887-1896. [PMID: 34722385 PMCID: PMC8542811 DOI: 10.18502/ijph.v50i9.7062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/22/2020] [Indexed: 12/09/2022]
Abstract
Background: To estimate the resource use and costs associated to the initial phase of treatment for colorectal cancer in Iran. Methods: A retrospective study was conducted using routinely collected data within Electronic Health Records System (SEPAS), a national database representing public hospitals in Iran between March 20, 2016 and March 19, 2017. Primary end points included healthcare resource use, direct medical and non-medical costs of care in the 12-month study period. Results: The study population included 657 patients with colorectal cancer who underwent surgery and the follow-up chemotherapy. We estimated a total direct cost of $21,407 per patient. The results indicated that direct medical costs were primarily driven by inpatient hospital care, followed by surgery, chemotherapy, and diagnostic services. Conclusion: The initial 12-month of treatment for colorectal cancer, including surgery and the follow-up chemotherapy, is resource intensive. The total direct costs associated to the disease are remarkable, with Inpatient hospital services being the main contributor followed by surgery and chemotherapy.
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Affiliation(s)
- Mina Nejati
- The Cancer Institute at Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Moaven Razavi
- The Schneider Institutes for Health Policy at the Heller School of Brandeis University, Waltham, MA, USA
| | - Iraj Harirchi
- The Cancer Institute at Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Zanganeh
- Deputy of Medical Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Gholamreza Salari
- Iran Small Businesses and Industrial Parks Organization, Qazvin, Iran
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Dharkar D, Namdev LN, Verma S, Moses S, Sehgal S. Out Sourcing of Head and Neck Oncologic Surgery: Cost Considerations. Indian J Otolaryngol Head Neck Surg 2021; 73:408-412. [PMID: 34722224 DOI: 10.1007/s12070-020-01839-4] [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: 03/14/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022] Open
Abstract
165 surgeries for head and neck cancer have been performed by a team of the Indian Institute of Head and Neck Oncology IIHNO in 1 year. Integration of private players was necessitated because of need to share available facilities without losing objective of reducing the cost. These surgeries were performed at a private hospital using their resources for the operation theatre and post-operative intensive care services, since the IIHNO does not as yet have an operation theatre facility. The pre-op facilities and post-operative care was done at IIHNO a charitable cancer center under the Indore Cancer Foundation a public charitable trust. Cost analysis of these procedures has been done and the system of integration of the two have been analysed.
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Affiliation(s)
- Digpal Dharkar
- Indian Institute of Head and Neck Oncology, Indore Cancer Foundation, 779-D, Rajtilak, Manishpuri, Saket Extension, Indore, 452018 India
| | - Laxmi Narayan Namdev
- Indian Institute of Head and Neck Oncology, Indore Cancer Foundation, 779-D, Rajtilak, Manishpuri, Saket Extension, Indore, 452018 India
| | - Suresh Verma
- Indian Institute of Head and Neck Oncology, Indore Cancer Foundation, 779-D, Rajtilak, Manishpuri, Saket Extension, Indore, 452018 India
| | - Sonia Moses
- Indian Institute of Head and Neck Oncology, Indore Cancer Foundation, 779-D, Rajtilak, Manishpuri, Saket Extension, Indore, 452018 India
| | - Suresh Sehgal
- Indian Institute of Head and Neck Oncology, Indore Cancer Foundation, 779-D, Rajtilak, Manishpuri, Saket Extension, Indore, 452018 India
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Effect of Physical Therapy Modalities on Quality of Life of Head and Neck Cancer Survivors: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:jcm10204696. [PMID: 34682818 PMCID: PMC8539984 DOI: 10.3390/jcm10204696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 12/16/2022] Open
Abstract
The objective was to describe the effectiveness of different physical therapy modalities to improve Quality of Life (QoL) in Head and Neck Cancer (HNC) survivors. PubMed, Scopus, Web of Science, CINAHL and Cochrane Library were searched for randomized clinical controlled trials published until 30 April 2020. Risk of bias assessment and meta-analysis were conducted using the Cochrane tools. A total of 251 records were retrieved, and 10 met the inclusion criteria. Interventions whose parameters focus on a 12-week exercise programs of aerobic activity (walking) or Progressive Resistance Training (PRT) for the whole body are effective and safe modalities improving QoL in HNC survivors. Electrophysical agents did not show significant results between groups. As for the assessment of methodological quality, 4 of the 10 articles included had a high risk of overall bias. Only five articles provided sufficient information to conduct a meta-analysis for exercise program intervention on QoL, showing a tendency in favor of intervention group, even when the global results did not show statistically significant improvements (pooled Cohen's d 0.15; 95% CI: -0.25 to 0.54; I2 45.87%; p heterogeneity = 0.10). The present review and meta-analysis identified meaningful benefits of exercise on QoL of HNC survivors; this has been confirmed in a meta-analysis. This review adds evidence supporting exercise interventions on Head and Neck Cancer population whose opportunities for successful recovery after medical treatment are more limited.
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Yang W, Nie W, Zhou X, Guo W, Mou J, Yong J, Wu T, Liu X. Review of prophylactic swallowing interventions for head and neck cancer. Int J Nurs Stud 2021; 123:104074. [PMID: 34536908 DOI: 10.1016/j.ijnurstu.2021.104074] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Head and neck cancer treatment destroys nerves and/or organs associated with swallowing. Previous studies have investigated the efficacy of exercises for muscles used in swallowing before treatment in reducing disuse atrophy and delaying the occurrence of muscle fibrosis. However, the rehabilitation effects of training and the optimal intervention strategy are unknown. OBJECTIVES To establish evidence for the efficacy of prophylactic swallowing interventions in reducing aspiration and restoring oral intake in patients with head and neck cancer with dysphagia. METHODS We searched electronic databases (PubMed, Embase, Cochrane and MEDLINE) for studies published up to June 2021 reporting outcomes following prophylactic swallowing interventions in patients with head and neck cancer with dysphagia and the related influencing factors. The methodological quality of the literature was assessed using the Joanna Briggs Institute appraisal tools. RESULTS The search identified 1468 articles, and 13 studies were eventually included. Four categories involving 12 different swallowing interventions were classified. Regarding the descriptive analysis of the rehabilitation effects across all studies, in terms of oropharyngeal safety, five studies showed that swallowing interventions reduced the risk of aspiration, penetration or residue. In terms of oral intake and tube feeding dependence, four studies demonstrated reduced time to return to oral intake in the intervention group compared with the control group. In terms of intervention adherence, three studies showed that speech-language pathologist- and nurse-supervised training was a potential promoter of adherence, and five studies showed that the negative factors affecting adherence included pain, fatigue, forgetting, smoking, decreased exercise motivation, side effects of radiotherapy and distance to the rehabilitation site. CONCLUSIONS Preventive swallowing interventions may be effective at reducing aspiration, improving swallowing function, and restoring oral intake. However, due to the lack of standardization and consistency of interventions and measurement results, which prevented the production of a best practice guide, future rigorous methodological trials will be needed to determine the most effective interventions for maximizing exercise adherence over the long term.
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Affiliation(s)
- Wenwen Yang
- The First Hospital of Jilin University, No.71 Xinmin street, Changchun, Jilin 130021, China.
| | - Wenbo Nie
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, Jilin 130000, China.
| | - Xue Zhou
- The First Hospital of Jilin University, No.71 Xinmin street, Changchun, Jilin 130021, China.
| | - Wenjie Guo
- Henan Vocational College of Nursing, No.480 Zhonghua Street, Anyang, Henan 455000, China.
| | - Jingjing Mou
- The First Hospital of Jilin University, No.71 Xinmin street, Changchun, Jilin 130021, China.
| | - Jun Yong
- The First Hospital of Jilin University, No.71 Xinmin street, Changchun, Jilin 130021, China.
| | - Tianxing Wu
- The First Hospital of Jilin University, No.71 Xinmin street, Changchun, Jilin 130021, China.
| | - Xinmei Liu
- The First Hospital of Jilin University, No.71 Xinmin street, Changchun, Jilin 130021, China.
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Morais E, El Mouaddin N, Schuurman S, De A. Landscape assessment for gender neutral human papillomavirus vaccination recommendations including head and neck cancer burden data. Vaccine 2021; 39:5461-5473. [PMID: 34452775 DOI: 10.1016/j.vaccine.2021.08.043] [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: 04/01/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Head and neck cancers (HNC) accounted for over 450,000 deaths and 900,000 cases in 2018 worldwide. Of those, 38,000 cases were attributable to human papillomavirus (HPV). HNC is two to four times more prevalent in men than in women. The incidence of oropharyngeal cancers (OPC) and oral cavity cancers caused by HPV has increased in recent decades. Given the substantial burden of HPV-related HNC in males, this study aimed to assess whether and how national agencies included HPV-related HNC when evaluating HPV genderneutral vaccination (GNV) programs. METHODS A systematic literature review was conducted in MEDLINE® and EMBASE®, and on the websites of selected national agencies. RESULTS Searches identified a potential 205 records; seventeen were eligible for the review. Seventy percent of assessments were published by European countries and most were recent (2014-2019). Eleven (65%) reports considered OPC when discussing HNC, and a few included other anatomic sites. All reports that considered incidence data were in consensus that incidence of OPC was higher in men and showed that the mortality rates for HPV-related HNC were also higher in men. When looking at the economic impact, the incremental cost-effectiveness ratios in the assessments varied widely, as the inputs into the analyses were heterogeneous. However, several reports concluded GNV programs were likely to be cost-effective versus not vaccinating males. CONCLUSION The burden of HPV-related HNC in the general male population has been recognized by several Heatlth Technology Assessment (HTA) agencies and National Immunization Technical Advisory Groups (NITAGs) when evaluating HPV GNV programs. The assessments identified on GNV programs strongly indicate a cost-effective clinical benefit. Nevertheless, the epidemiological burden of HNC may have been underestimated in some countries due to limited data. Further research is crucial to obtain more robust data that will help address the information gap in epidemiological and economic burden of HPV-associated HNC in men.
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Affiliation(s)
- Edith Morais
- Center for Observational and Real-World Evidence, MSD, Lyon.
| | | | | | - Atish De
- ICON plc, New York, United States
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Aponte-Ortiz JA, Greenberg-Worisek AJ, Marinelli JP, May M, Spears GM, Labott JR, Mecham JC, Moore EJ, Visscher SL, Borah BJ, Janus JR. Cost and clinical outcomes of postoperative intensive care unit versus general floor management in head and neck free flap reconstructive surgery patients. Am J Otolaryngol 2021; 42:103029. [PMID: 33857778 DOI: 10.1016/j.amjoto.2021.103029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/04/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare clinical, surgical, and cost outcomes in patients undergoing head and neck free-flap reconstructive surgery in the setting of postoperative intensive care unit (ICU) against general floor management. METHODS Retrospective analysis of head and neck free-flap reconstructive surgery patients at a single tertiary academic medical center. Clinical data was obtained from medical records. Cost data was obtained via the Mayo Clinic Rochester Cost Data Warehouse, which assigns Medicare reimbursement rates to all professional billed services. RESULTS A total of 502 patients were included, with 82 managed postoperatively in the ICU and 420 on the general floor. Major postoperative outcomes did not differ significantly between groups (Odds Ratio[OR] 1.54; p = 0.41). After covariate adjustments, patients managed in the ICU had a 3.29 day increased average length of hospital stay (Standard Error 0.71; p < 0.0001) and increased need for take-back surgery (OR 2.35; p = 0.02) when compared to the general floor. No significant differences were noted between groups in terms of early free-flap complications (OR 1.38;p = 0.35) or late free-flap complications (Hazard Ratio 0.81; p = 0.61). Short-term cost was $8772 higher in the ICU (range = $5640-$11,903; p < 0.01). Long-term cost did not differ significantly. CONCLUSION Postoperative management of head and neck oncologic free-flap patients in the ICU does not significantly improve major postoperative outcomes or free-flap complications when compared to general floor care, but does increase short-term costs. General floor management may be appropriate when cardiopulmonary compromise is not present.
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Affiliation(s)
- Jaime A Aponte-Ortiz
- Center for Clinical and Translational Science, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; University of Puerto Rico School of Medicine, PO Box 365067, San Juan, PR 00936-5067, USA. http://t.co/JAO_MDMS
| | | | - John P Marinelli
- Mayo Clinic School of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Matthew May
- Department of Otolaryngology- Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Grant M Spears
- Biomedical Statistics and Informatics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Joshua R Labott
- Mayo Clinic School of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Jeffrey C Mecham
- Mayo Clinic School of Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA. http://t.co/Jffmchm
| | - Eric J Moore
- Department of Otolaryngology- Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. http://t.co/EricJMooreMayo
| | - Sue L Visscher
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Bijan J Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; Division of Health Care Policy and Research, Department of Health Sciences, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Jeffrey R Janus
- Department of Otolaryngology- Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
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Virgone A, Badreh S. The 4P: Preventing Preneoplasia through Patients Partnership. Cancers (Basel) 2021; 13:cancers13174408. [PMID: 34503221 PMCID: PMC8430674 DOI: 10.3390/cancers13174408] [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: 07/29/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022] Open
Abstract
The early diagnosis and management of oral potentially malignant disorders (OPMD) represent a unique opportunity to develop strategies that will prevent malignant transformation. Despite a high prevalence, awareness remains low, patient outcomes poor, and quality of life highly affected. How can patient advocacy groups (PAGs) bring more awareness to preneoplasia preceding oral cancers and help patients after the identification of a suspicious oral leukoplakia presented as white patches in the mouth? PAGs are today involved with awareness campaigns, lobbying, and education of both health care systems as well as the survivor and the newly diagnosed. PAGs are a link between the clinician and the patient, making sure that the medical terminology used is explained in layman language and that psychological support is available during and after treatment. This review outlines the actions that could be deployed by PAGs to successfully complete OPMD prevention challenge. The added value of researchers and patient representatives working together is the increased awareness of the problem. To know at which angle to best approach it for encouraging early diagnosis, improved education of disease signs and symptoms will condition effective prevention from the beginning.
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Affiliation(s)
- Angélique Virgone
- Tumor Escape, Resistance and Immunity Department, Université Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre De Recherche En Cancérologie De Lyon, 69008 Lyon, France
- Centre Léon Bérard, Department of Translational Medicine, 69008 Lyon, France
- Correspondence:
| | - Sara Badreh
- Secretariat Department of the European Cancer Patient Coalition (ECPC), 1000 Bruxelles, Belgium;
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Real-world study of the impact of recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) on quality of life and productivity in Europe. BMC Cancer 2021; 21:854. [PMID: 34303346 PMCID: PMC8310582 DOI: 10.1186/s12885-021-08557-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background Although current therapy for patients with early-stage squamous cell carcinoma of the head and neck (SCCHN) is potentially curative, the recurrence rate is high. Patients with recurrent or metastatic (R/M) SCCHN have a poor prognosis and substantial disease burden, including impaired health-related quality of life (HRQoL), productivity loss and indirect costs, such as need for caregiver support. The aim of this study was to characterize the impact of R/M SCCHN and its first-line treatment on patient and caregiver quality of life, daily activities and work productivity using real-world evidence from Europe. Methods This was a multicentre retrospective study of patients with R/M SCCHN in France, Germany, Italy, Spain and the United Kingdom incorporating patient and caregiver surveys, and a physician-reported medical chart review, conducted between January and May 2019. Patients aged 18 or over with a physician confirmed diagnosis R/M SCCHN completed four validated measures of disease activity and its impact on quality of life and work productivity, while caregivers also completed questionnaire to assess the burden of providing care. Physicians provided data for clinical characteristics, patient management, testing history and treatment patterns. Results A total of 195 medical/clinical oncologists provided data for 937, predominantly male (72%) patients, with almost half of patients aged over 65 years. The most frequently reported symptoms were fatigue (43%), weight loss (40%), pain (35%) and difficulty swallowing (32%). The EXTREME regimen was the most common first line therapy in over half of patients, who reported moderate or extreme pain/discomfort, and anxiety/depression, and problems with self-care resulting in a diminished health status compared with the general population. Only 14% were employed with high absenteeism or presenteeism, and over half of patients had a caregiver for whom the burden of care was substantial. Conclusion Our results provide real-world insight into the multi-faceted burden associated with R/M SCCHN. The combination of poor HRQoL and the impairment in daily activities, social life and employment illustrates the wider impact of R/M SCCHN on patients and their caregivers, and highlights a need for novel 1 L treatment regimens to improve the humanistic and productivity burdens of this cancer. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08557-2.
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Baddour K, Fadel M, Zhao M, Corcoran M, Owoc MS, Thomas TH, Sabik LM, Nilsen ML, Ferris RL, Mady LJ. The cost of cure: Examining objective and subjective financial toxicity in head and neck cancer survivors. Head Neck 2021; 43:3062-3075. [PMID: 34235804 DOI: 10.1002/hed.26801] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 06/15/2021] [Accepted: 06/28/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Little is documented regarding objective financial metrics and their impact on subjective financial toxicity in head and neck cancer (HNC) survivors. METHODS In a cross-sectional analysis, 71 survivors with available claims data for HNC-specific out-of-pocket expenses (OOPE) completed a survey including patient-reported, subjective financial toxicity outcome tools: the Comprehensive Score for financial Toxicity (COST) and the Financial Distress Questionnaire (FDQ). RESULTS Worse COST scores were significantly associated with lower earnings at survey administration (coefficient = 3.79; 95% CI 2.63-4.95; p < 0.001); loss of earnings after diagnosis (coefficient = 6.03; 95% CI 0.53-11.52; p = 0.032); and greater annual OOPE as a proportion of earnings [log10(Annual OOPE:Earnings at survey): coefficient = -5.66; 95% CI -10.28 to -1.04; p = 0.017]. Similar results were found with FDQ. CONCLUSION Financial toxicity is associated with particular socioeconomic characteristics which, if understood, would assist the development of pre-treatment screening tools to detect at-risk individuals and intervene early in the HNC cancer survivorship trajectory.
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Affiliation(s)
- Khalil Baddour
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mark Fadel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Meng Zhao
- Strategic Analysis of Clinical Affairs, UPMC Insurance Services, Pittsburgh, Pennsylvania, USA
| | - Michael Corcoran
- Strategic Analysis of Clinical Affairs, UPMC Insurance Services, Pittsburgh, Pennsylvania, USA
| | - Maryanna S Owoc
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Teresa H Thomas
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Marci L Nilsen
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Leila J Mady
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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40
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Nocon CC, Kennedy A, Jaffe J, Pruitt J, Kuchta K, Bhayani MK. Costs Associated With Imaging Surveillance After Treatment for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 147:632-637. [PMID: 33983375 DOI: 10.1001/jamaoto.2021.0835] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Importance The National Comprehensive Cancer Network recommends imaging within 6 months after treatment for head and neck cancer (HNC). Further imaging is recommended only if the patient has symptoms or abnormal findings on physical examination. However, in many instances, asymptomatic patients continue to have imaging evaluations. Objectives To assess practice patterns in surveillance imaging in patients with HNC and evaluate the costs associated with these imaging practices. Design, Setting, and Participants This single-institution retrospective economic evaluation study screened 435 patients to identify patients newly diagnosed with head and neck mucosal and salivary gland malignant tumors between January 1, 2010, and December 31, 2016. Data analyses were performed from October 25, 2018, to November 24, 2020. Exposure Imaging practice patterns. Main Outcomes and Measures Number and costs of imaging studies during the surveillance period for all patients, patients who remained disease free, and patients who developed recurrence. Results A total of 136 patients (mean [SD] age at diagnosis, 62 [14] years; 84 [61.8%] male; 106 [77.9%] White) with HNC were included in the study. The oropharynx was the most common subsite (64 [47.1%]), most HNCs were stage IVA (62 [45.6%]), and most patients received definitive radiation-based treatment (71 [52.2%]). During the median surveillance period of 3.2 years (range, 0.3-6.8 years), a mean (SD) of 14 (10) imaging studies were performed for all patients, with a mean (SD) total cost of $36 800 ($24 500). In patients who remained disease free, a mean (SD) of 13 (10) imaging studies were performed during the surveillance period, with a mean (SD) total cost of $35 000 ($21 700). Patients who lacked symptoms had a mean (SD) of 4 (3) studies performed per year, resulting in a mean cost of $9600 ($5900) per year. Patients who developed recurrence had more studies per year of follow-up (mean difference, 5.0; 95% CI, 3.4-6.6) and higher associated mean costs (mean difference, $10 600; 95% CI, $6100-$15 000) than patients who remained disease free. Conclusions and Relevance In this economic evaluation study, many patients treated for HNCs received imaging studies beyond what is recommended by National Comprehensive Cancer Network guidelines. These findings suggest that the cost burden of imaging in the asymptomatic patient needs to be considered against the value obtained from routine imaging in this current health care environment.
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Affiliation(s)
- Cheryl C Nocon
- Department of Surgery, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.,Now with Department of Surgery, Adventist White Memorial Hospital, Los Angeles, California
| | - Aimee Kennedy
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago, Chicago, Illinois.,Now with OSF Healthcare, Peoria, Illinois
| | - Jennifer Jaffe
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.,Now with AbbVie Inc, Northbrook, Illinois
| | - Jaclyn Pruitt
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Kristine Kuchta
- Research Institute, NorthShore University HealthSystem, Evanston, Illinois
| | - Mihir K Bhayani
- Department of Surgery, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.,Now with Department of Otorhinolaryngology-Head and Neck Surgery, Rush University, Chicago, Illinois
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Wagner VP, Spuldaro TR, Nör F, Gaio EJ, Castilho RM, Carrard VC, Rösing CK. Can propranolol act as a chemopreventive agent during oral carcinogenesis? An experimental animal study. Eur J Cancer Prev 2021; 30:315-321. [PMID: 33136608 DOI: 10.1097/cej.0000000000000626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The multistep process of oral carcinogenesis provides a biological rationale for the use of chemoprevention in individuals at increased risk of developing oral cancer. We aimed to determine if low doses of propranolol can prevent the development of oral cancer using a tobacco-relevant and p53-associated animal model of cancer initiation. Twenty-six Wistar rats were randomly allocated into two groups, vehicle, and propranolol. All animals received 4-nitroquinoline N-oxide (4NQO) at 25 ppm diluted in the drinking water for 20 weeks. Animals from the propranolol group received propranolol (0.1 mg/kg) 5 days per week by gavage for 18 weeks. The clinical analysis was performed by measuring the area of the lesion and assessment of scores based on lesion appearance (papule; plaque; nodule or ulcerated). Histopathological analysis was performed to determine the presence of epithelial dysplasia or invasive squamous cell carcinoma (SCC). The average lesion area in 4NQO + vehicle and in 4NQO + propranolol groups were 0.20 and 0.28 mm2, respectively (P = 0.53). The percentage of cases clinically graded as papules, thick plaques, nodular areas, and ulcerated lesions was similar between groups (P = 0.94). Histopathological diagnosis also did not differ between groups (P = 0.65), with 54.5 and 70% of cases being diagnosed as SCC in 4NQO and in 4NQO + propranolol groups, respectively. In conclusion, daily doses propranolol at 0.1 mg/kg were not as effective as a chemopreventive therapy in an animal model of 4NQO-induced carcinogenesis.
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Affiliation(s)
- Vivian P Wagner
- Department of Oral Pathology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul
- Department of Oral Diagnosis, University of Campinas, Piracicaba, São Paulo
| | - Tobias R Spuldaro
- Department of Periodontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Nör
- Department of Oral Pathology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul
- Department of Oral Pathology, Radiology and Medicine, University of Iowa College of Dentistry, Iowa City, Iowa
| | - Eduardo J Gaio
- Department of Periodontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rogerio M Castilho
- Department of Periodontics and Oral Medicine, Laboratory of Epithelial Biology, University of Michigan School of Dentistry; Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Vinicius C Carrard
- Department of Oral Pathology, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul
| | - Cassiano K Rösing
- Department of Periodontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Outcomes for head and neck cancer patients admitted to intensive care in Australia and New Zealand between 2000 and 2016. The Journal of Laryngology & Otology 2021; 135:702-709. [PMID: 34154686 DOI: 10.1017/s0022215121001602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To report intensive care unit admission outcomes for head and neck cancer patients. METHODS A retrospective, observational cohort analysis of all Australian and New Zealander head and neck cancer patient intensive care unit admissions from January 2000 to June 2016, including data from 192 intensive care units. RESULTS There were 10 721 head and neck cancer patients, with a median age of 64 years (71.6 per cent male). Of admissions, 76.4 per cent were in public hospitals, 96.9 per cent were post-operative and 43.6 per cent required mechanical ventilation. Annual head and neck cancer admissions increased from 2000 to 2015 (from 348 to 1132 patients), but the overall proportion of intensive care unit admissions remained constant. In-hospital mortality was 2.7 per cent, and intensive care unit mortality was 0.7 per cent. The in-hospital mortality risk decreased three-fold (p < 0.001). CONCLUSION Head and neck cancer patients had low mortality in the intensive care unit and in hospital. Risk of dying decreased despite more intensive care unit admissions. This is the first large-scale cohort study quantifying intensive care unit utilisation by head and neck cancer patients. It informs future work investigating alternatives to the intensive care unit for these patients.
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Biopsychosocial Factors Associated with Supportive Care Needs in Canadian Adolescent and Young Adult Cancer Survivors. J Clin Med 2021; 10:jcm10122628. [PMID: 34203795 PMCID: PMC8232806 DOI: 10.3390/jcm10122628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 12/16/2022] Open
Abstract
Adolescents and young adults (AYAs) represent an overlooked population in cancer survivorship care. Identifying the needs of AYAs can guide the development of tailored programs for this population. We conducted a cross-sectional descriptive analysis to identify biopsychosocial factors associated with AYA post-treatment supportive care needs and unmet needs using data obtained from the Experiences of Cancer Patients in Transitions Study of the Canadian Partnership Against Cancer, in collaboration with cancer agencies in the 10 Canadian provinces. The analysis focused on data from n = 530 AYAs between the ages of 18 and 34 who had undergone treatment within the past 5 years. Respondents reported a median of two moderate to big (MTB) physical needs (out of 9) and one unmet physical need, two MTB emotional needs (out of 6) with two unmet MTB emotional needs, and one (out of 5) practical need reported and one unmet MTB practical need. We found some common associations across supportive care domains. Income (lower) and more complex treatment were associated with high needs and unmet needs across the three domains. Respondents with a family doctor who was “very involved” in their cancer care had a lower number of unmet physical and emotional needs. Identifying those at risk of supportive care needs and developing tailored pathways in which they are proactively connected with tailored and appropriate resources and programs may help to reduce the number of unmet needs and improve cancer survivors’ quality of life.
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Mittal R, Talikoti MA, Kumar S, Sud V. Comparison between functional pectoralis major myocutaneous flap and conventional flap in oral cancer patients. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01738-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Katsura K, Soga Y, Zenda S, Nishi H, Soga M, Usubuchi M, Mitsunaga S, Tomizuka K, Konishi T, Yatsuoka W, Ueno T, Aragaki T, Hayashi T. A cost-minimization analysis of measures against metallic dental restorations for head and neck radiotherapy. JOURNAL OF RADIATION RESEARCH 2021; 62:374-378. [PMID: 33618357 PMCID: PMC7973474 DOI: 10.1093/jrr/rrab003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/14/2020] [Indexed: 05/12/2023]
Abstract
The aim of this study was to compare the estimated public medical care cost of measures to address metallic dental restorations (MDRs) for head and neck radiotherapy using high-energy mega-voltage X-rays. This was considered a first step to clarify which MDR measure was more cost-effective. We estimated the medical care cost of radiotherapy for two representative MDR measures: (i) with MDR removal or (ii) without MDR removal (non-MDR removal) using magnetic resonance imaging and a spacer. A total of 5520 patients received head and neck radiation therapy in 2018. The mean number of MDRs per person was 4.1 dental crowns and 1.3 dental bridges. The mean cost per person was estimated to be 121 720 yen for MDR removal and 54 940 yen for non-MDR removal. Therefore, the difference in total public medical care cost between MDR removal and non-MDR removal was estimated to be 303 268 800 yen. Our results suggested that non-MDR removal would be more cost-effective than MDR removal for head and neck radiotherapy. In the future, a national survey and cost-effectiveness analysis via a multicenter study are necessary; these investigations should include various outcomes such as the rate of local control, status of oral mucositis, frequency of hospital visits and efforts of the medical professionals.
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Affiliation(s)
- Kouji Katsura
- Corresponding author: Division of Oral and Maxillofacial Radiology, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Chuo-ku, Niigata City, Niigata 951-8514, Japan. Tel: +81-25-227-0810;
| | - Yoshihiko Soga
- Division of Hospital Dentistry, Okayama University Hospital, Japan
| | - Sadatomo Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Japan
| | - Hiromi Nishi
- Department of General Dentistry, Hiroshima University Hospital, Japan
| | - Marie Soga
- Department of Oral Radiology, Niigata University Medical and Dental Hospital, Japan
| | | | - Sachiyo Mitsunaga
- Department of Oral and Maxillofacial Surgery, Kanagawa Cancer Center, Japan
| | - Ken Tomizuka
- Department of Dentistry, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Tetsuhito Konishi
- Department of Dentistry, National Cancer Center Hospital East, Japan
| | | | - Takao Ueno
- Dental Division, National Cancer Center Hospital, Japan
| | - Tadanobu Aragaki
- Division of Dentistry and Oral Surgery, Gunma Prefectural Cancer Center, Japan
| | - Takafumi Hayashi
- Department of Oral Radiology, Niigata University Medical and Dental Hospital, Japan
- Division of Oral and Maxillofacial Radiology, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, Japan
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Menezes ASDS, Sanches GLG, Gomes ESB, Soares RG, Durães CP, Fonseca LL, Filho ADPS, Ribeiro AAADA, Nascimento JE, Santos SHS, de Paula AMB, Farias LC, Guimarães ALS. The combination of traditional and auricular acupuncture to prevent xerostomia and anxiety in irradiated patients with HNSCC: a preventive, parallel, single-blind, 2-arm controlled study. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:675-683. [PMID: 33839061 DOI: 10.1016/j.oooo.2021.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of the present study was to investigate the effect of acupuncture on xerostomia in irradiated patients with head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN A preventive, 2-arm, parallel, single-blind trial was performed. Patients with HNSCC (N = 296) were checked for eligibility, and 107 patients were enrolled in the study. The study comprised 1 group that did not receive the intervention (n = 55) and the interventional group that received traditional and auricular acupuncture (n = 52). The primary outcome was the reduction of the patients' xerostomia after treatment. In addition, the secondary outcome was the reduction of anxiety. RESULTS The current acupuncture protocol reduced the xerostomia score and increased saliva volume and density without changing salivary pH. Additionally, acupuncture decreased the Beck Anxiety Inventory (BAI) score after radiation therapy. CONCLUSION Combining traditional and auricular acupuncture reduced xerostomia and increased saliva volume without changing the saliva's pH in irradiated patients with HNSCC. Additionally, the combination of traditional and auricular acupuncture reduced BAI scores.
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Affiliation(s)
| | | | | | - Raquel Gusmão Soares
- Department of Dentistry, Universidade Estadual de Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Cristina Paixão Durães
- Department of Dentistry, Universidade Estadual de Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Larissa Lopes Fonseca
- Department of Dentistry, Universidade Estadual de Montes Claros, Montes Claros, Minas Gerais, Brazil
| | | | | | | | | | | | - Lucyana Conceição Farias
- Department of Dentistry, Universidade Estadual de Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - André Luiz Sena Guimarães
- Department of Dentistry, Universidade Estadual de Montes Claros, Montes Claros, Minas Gerais, Brazil; Dilson Godinho Hospital, Montes Claros, Minas Gerais, Brazil.
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Adjei Boakye E, Osazuwa-Peters N, Chen B, Cai M, Tobo BB, Challapalli SD, Buchanan P, Piccirillo JF. Multilevel Associations Between Patient- and Hospital-Level Factors and In-Hospital Mortality Among Hospitalized Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 146:444-454. [PMID: 32191271 DOI: 10.1001/jamaoto.2020.0132] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Risk factors for in-hospital mortality of patients with head and neck cancer (HNC) are multilevel. Studies have examined the effect of patient-level characteristics on in-hospital mortality; however, there is a paucity of data on multilevel correlates of in-hospital mortality. Objective To examine the multilevel associations of patient- and hospital-level factors with in-hospital mortality and develop a nomogram to predict the risk of in-hospital mortality among patients diagnosed with HNC. Design, Setting, and Participants This cross-sectional study used the 2008-2013 National Inpatient Sample database. Hospitalized patients 18 years and older diagnosed (both primary and secondary diagnosis) as having HNC using the International Classification of Diseases, Ninth Revision, Clinical Modification codes were included. Analysis began December 2018. Main Outcomes and Measures The primary outcome of interest was in-hospital mortality. A weighted multivariable hierarchical logistic regression model estimated patient- and hospital-level factors associated with in-hospital mortality. Moreover, a multivariable logistic regression analysis was used to build an in-hospital mortality prediction model, presented as a nomogram. Results A total of 85 440 patients (mean [SD] age, 62.2 [13.5] years; 61 281 men [71.1%]) were identified, and 4.2% (n = 3610) died in the hospital. Patient-level risk factors associated with higher odds of in-hospital mortality included age (adjusted odds ratio [aOR], 1.03 per 1-year increase; 95% CI, 1.02-1.03), male sex (aOR, 1.23; 95% CI, 1.12-1.35), higher number of comorbidities (aOR, 1.14; 95% CI, 1.11-1.17), having a metastatic cancer (aOR, 1.49; 95% CI, 1.36- 1.64), having a nonelective admission (aOR, 3.26; 95% CI, 2.83-3.75), and being admitted to the hospital on a weekend (aOR, 1.30; 95% CI, 1.16-1.45). Of the hospital-level factors, admission to a nonteaching hospital (aOR, 1.48; 95% CI, 1.24-1.77) was associated with higher odds of in-hospital mortality. The nomogram showed fair in-hospital mortality discrimination (area under the curve of 72%). Conclusions and Relevance This cross-sectional study found that both patient- and hospital-level factors were associated with in-hospital mortality, and the nomogram estimated with fair accuracy the probability of in-hospital death among patients with HNC. These multilevel factors are critical indicators of survivorship and should thus be considered when planning programs or interventions aimed to improve survival among this unique population.
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Affiliation(s)
- Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield.,Simmons Cancer Institute at SIU, Southern Illinois University School of Medicine, Springfield
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri.,Saint Louis University Cancer Center, St Louis, Missouri
| | - Betty Chen
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Miao Cai
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St Louis, Missouri
| | | | - Sai D Challapalli
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, Houston, Texas
| | - Paula Buchanan
- Saint Louis University Center for Health Outcomes Research, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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Ma L, Shahedi M, Shi T, Halicek M, Little JV, Chen AY, Myers LL, Sumer BD, Fei B. Pixel-level Tumor Margin Assessment of Surgical Specimen with Hyperspectral Imaging and Deep Learning Classification. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2021; 11598:1159811. [PMID: 35755403 PMCID: PMC9232191 DOI: 10.1117/12.2581046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Surgery is a major treatment method for squamous cell carcinoma (SCC). During surgery, insufficient tumor margin may lead to local recurrence of cancer. Hyperspectral imaging (HSI) is a promising optical imaging technique for in vivo cancer detection and tumor margin assessment. In this study, a fully convolutional network (FCN) was implemented for tumor classification and margin assessment on hyperspectral images of SCC. The FCN was trained and validated with hyperspectral images of 25 ex vivo SCC surgical specimens from 20 different patients. The network was evaluated per patient and achieved pixel-level tissue classification with an average area under the curve (AUC) of 0.88, as well as 0.83 accuracy, 0.84 sensitivity, and 0.70 specificity across all the 20 patients. The 95% Hausdorff distance of assessed tumor margin in 17 patients was less than 2 mm, and the classification time of each tissue specimen took less than 10 seconds. The proposed methods can potentially facilitate intraoperative tumor margin assessment and improve surgical outcomes.
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Affiliation(s)
- Ling Ma
- Department of Bioengineering, University of Texas at Dallas
- State Key Laboratory of Precision Measurement Technology and Instrument, Tianjin University
| | - Maysam Shahedi
- Department of Bioengineering, University of Texas at Dallas
| | - Ted Shi
- Department of Bioengineering, University of Texas at Dallas
| | - Martin Halicek
- Department of Bioengineering, University of Texas at Dallas
| | - James V. Little
- Department of Pathology and Laboratory Medicine, Emory University
| | - Amy Y. Chen
- Department of Otolaryngology, Emory University
| | - Larry L. Myers
- Department of Otolaryngology, University of Texas Southwestern Medical Center
| | - Baran D. Sumer
- Department of Otolaryngology, University of Texas Southwestern Medical Center
| | - Baowei Fei
- Department of Bioengineering, University of Texas at Dallas
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center
- Department of Radiology, University of Texas Southwestern Medical Center
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49
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Ma L, Zhou X, Little JV, Chen AY, Myers LL, Sumer BD, Fei B. Hyperspectral Microscopic Imaging for the Detection of Head and Neck Squamous Cell Carcinoma on Histologic Slides. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2021; 11603:116030P. [PMID: 35783088 PMCID: PMC9248908 DOI: 10.1117/12.2581970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The purpose of this study is to investigate hyperspectral microscopic imaging and deep learning methods for automatic detection of head and neck squamous cell carcinoma (SCC) on histologic slides. Hyperspectral imaging (HSI) cubes were acquired from pathologic slides of 18 patients with SCC of the larynx, hypopharynx, and buccal mucosa. An Inception-based two-dimensional convolutional neural network (CNN) was trained and validated for the HSI data. The automatic deep learning method was tested with independent data of human patients. This study demonstrated the feasibility of using hyperspectral microscopic imaging and deep learning classification to aid pathologists in detecting SCC on histologic slides.
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Affiliation(s)
- Ling Ma
- Center for Imaging and Surgical Innovation and Department of Bioengineering, University of Texas at Dallas
- State Key Laboratory of Precision Measurement Technology and Instrument, Tianjin University
| | - Ximing Zhou
- Center for Imaging and Surgical Innovation and Department of Bioengineering, University of Texas at Dallas
| | - James V. Little
- Department of Pathology and Laboratory Medicine, Emory University
| | - Amy Y. Chen
- Department of Otolaryngology, Emory University
| | - Larry L. Myers
- Department of Otolaryngology, University of Texas Southwestern Medical Center
| | - Baran D. Sumer
- Department of Otolaryngology, University of Texas Southwestern Medical Center
| | - Baowei Fei
- Center for Imaging and Surgical Innovation and Department of Bioengineering, University of Texas at Dallas
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center
- Department of Radiology, University of Texas Southwestern Medical Center
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50
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Panth N, Barnes J, Sethi RKV, Varvares MA, Osazuwa-Peters N. Socioeconomic and Demographic Variation in Insurance Coverage Among Patients With Head and Neck Cancer After the Affordable Care Act. JAMA Otolaryngol Head Neck Surg 2021; 145:1144-1149. [PMID: 31670798 DOI: 10.1001/jamaoto.2019.2724] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Importance Health insurance status has a significant association with early diagnosis and stage at presentation, which are the most important predictors of survival among patients with head and neck cancer (HNC). Literature on the association of the Patient Protection and Affordable Care Act (ACA) with changes in insurance status among patients with HNC remains limited. To our knowledge, no studies have evaluated changes in insurance rates across sociodemographic subgroups of patients with HNC. Objective To assess the association of the implementation of the ACA with insurance status across socioeconomic and demographic subpopulations of patients with HNC. Design, Setting, and Participants A retrospective cohort study using data from the National Cancer Database (NCDB), a hospital-based cancer registry (2011-2015) for adults diagnosed with a malignant primary HNC was carried out. The analyses were conducted from November 2018 through December 2018. Main Outcomes and Measures Changes in the percentage of patients with insurance. Results A total of 131 779 patients with HNC were identified in the pre-ACA (77 071) and post-ACA (54 708) periods. Overall, 98 207 (74.5%) participants were men and 33 572 (25.5) were women, with 73 124 (55.5%) being aged between 50 to 64 years. There was a 2.68 percentage point decrease (PPD) (95% CI, 2.93-2.42) in the percentage of patients with HNC without insurance from the pre-ACA to the post-ACA period. Changes in the percentage of uninsured patients varied significantly by age, with the largest reduction in uninsured status among patients with HNC aged 18 to 34 years (5.12 PPD; 95% CI, 3.18-7.06) and the smallest reduction in uninsured among those aged 65 to 74 years (0.24 PPD; 95% CI, 0.03-0.45). There was a significantly greater reduction in uninsured status in low-income zip codes (3.45 PPD; 95% CI, 2.76-4.14) than in high-income zip codes (1.99 PPD; 95% CI, 1.63-2.36). Conclusions and Relevance There was a significant association between ACA implementation and percentage decrease in uninsured patients. Young adults and those residing in low-income zip codes experienced a significantly higher rate of insurance uptake compared with older adults and residents of high-income areas. This suggests that coverage expansions enacted through the ACA are not only associated with increased access to care among the broader HNC population, but that they may also yield a greater benefit among subpopulations with historically limited insurance coverage.
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Affiliation(s)
- Neelima Panth
- Duke University School of Medicine, Durham, North Carolina
| | - Justin Barnes
- St Louis University School of Medicine, St Louis, Missouri
| | - Rosh K V Sethi
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
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