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Fereydooni S, Valdez C, William L, Malik D, Mehra S, Judson B. Predisposing, Enabling, and Need Factors Driving Palliative Care Use in Head and Neck Cancer. Otolaryngol Head Neck Surg 2024. [PMID: 38796734 DOI: 10.1002/ohn.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/10/2024] [Accepted: 04/27/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Characterizing factors associated with palliative care (PC) use in patients with stage III and VI head and neck cancer using Anderson's behavioral model of health service use. STUDY DESIGN A retrospective study of the 2004 to 2020 National Cancer Database.gg METHODS: We used multivariate logistic regression to assess the association of predisposing, enabling, and need factors with PC use. We also investigated the association of these factors with interventional PC type (chemotherapy, radiotherapy, surgery) and refusal of curative treatment in the last 6 months of life. RESULTS Five percent of patients received PC. "Predisposing factors" associated with less PC use include Hispanic ethnicity (adjusted odds ratio [aOR], 086; 95% confidence interval [CI], 0.76-0.97) and white and black race (vs white: aOR, 1.14; 95% CI, 1.07-1.22). "Enabling factors" associated with lower PC include private insurance (vs uninsured: aOR, 064; 95% CI, 0.53-0.77) and high-income (aOR, 078; 95% CI, 0.71-0.85). "Need factors" associated with higher PC use include stage IV (vs stage III cancer: aOR, 2.25; 95% CI, 2.11-2.40) and higher comorbidity index (vs Index 1: aOR, 1.58; 95% CI, 1.42-1.75). High-income (aOR, 0.78; 95% CI, 0.71-0.85) and private insurance (aOR, 0.6; 95% CI, 0.53, 0.77) were associated with higher interventional PC use and lower curative treatment refusal (insurance: aOR, 0.82; 95% CI, 0.55, 0.67; income aOR, 0.48; 95% CI, 0.44, 0.52). CONCLUSION Low PC uptake is attributed to patients' race/culture, financial capabilities, and disease severity. Culturally informed counseling, clear guidelines on PC indication, and increasing financial accessibility of PC may increase timely and appropriate use of this service.
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Affiliation(s)
- Soraya Fereydooni
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Caroline Valdez
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Devesh Malik
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin Judson
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
- Otolaryngology Surgery, New Haven, Connecticut, USA
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Frank MH, van Dijk BAC, Schoonbeek RC, Zindler J, Devriese LA, van Es RJJ, Merkx MAW, de Bree R. Differences in the association of time to treatment initiation and survival according to various head and neck cancer sites in a nationwide cohort. Radiother Oncol 2024; 192:110107. [PMID: 38262531 DOI: 10.1016/j.radonc.2024.110107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To assess whether there are differences in the effects of time to treatment interval (TTI) on patient survival for head and neck cancer (HNC) sites in order to provide evidence that can support decision-making regarding prioritizing treatment. MATERIALS AND METHODS Patients in the Netherlands with a first primary HNC without distant metastasis between 2010 and 2014 were included for analysis (N = 10,486). TTI was defined as the time from pathologic diagnosis to the start of initial treatment. Overall survival (OS), cox regression analyses and cubic spline hazard models were calculated and visualized. RESULTS Overall, the hazard of dying was higher (HR = 1.003; 95 % CI 1.001-1.005) with each additional day until treatment initiation. The pattern, as visualized in cubic spline graphs, differed by site the hazard increased more steeply with increasing TTI for oral cavity cancer. For oropharyngeal and laryngeal cancer, a slight increase commenced after a longer TTI than for oral cavity cancer, while there was hardly an increase in hazard with increasing TTI for hypopharyngeal cancer. CONCLUSION The relationship between longer TTI and decreased survival was confirmed, but slight variations in the pattern of the hazard of dying by TTI by tumour site were observed. These findings could support decisions on prioritizing treatment. However, other aspects such as extent of treatment and quality of life should be investigated further so this can also be included.
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Affiliation(s)
- Michaël H Frank
- University of Utrecht, Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery, Haaglanden Medical Center, The Hague, the Netherlands.
| | - Boukje A C van Dijk
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Rosanne C Schoonbeek
- University of Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Jaap Zindler
- Department of Radiation Oncology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Lot A Devriese
- University of Utrecht, Department of Medical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert J J van Es
- University of Utrecht, Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Matthias A W Merkx
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands; Radboud University Nijmegen, IQ Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Remco de Bree
- University of Utrecht, Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
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Liu H, Zhang L, Xiong L, Wang H, Liu C, Wang C, Feng Z. The impact of comorbidity on the diagnosis delay, treatment options and prognosis for advanced oral cancer: A retrospective result of the POROMS database. J Craniomaxillofac Surg 2024; 52:260-268. [PMID: 38182475 DOI: 10.1016/j.jcms.2023.12.011] [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: 01/04/2023] [Revised: 07/30/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024] Open
Abstract
This study aimed to reveal the underlying mechanisms linking advanced oral squamous cell carcinoma (OSCC) with its comorbidities. Data extracted from the POROMS database included 448 advanced OSCC patients in stage III or IV (AJCC 8th) with primary tumors between August 2015 and August 2021. Time to diagnosis delay increased from 4.5, 5.3-6.5 months when the Adult Comorbidity Evaluation-27 (ACE-27) worsened from none, mild (RR: 1.155, 1.043-1.279; P = 0.006) to moderate-severe (RR: 1.431, 1.251-1.636; P < 0.001). With the number of comorbidities increased from 0, 1-2 (RR: 1.188, 1.078-1.310; P = 0.001) to 3 (RR: 1.563, 1.296-1.885; P < 0.001), the time to diagnosis delay increased from 4.5, 5.4-7.1 months. As the level and number of comorbidities increased, the likelihood of treatment completion gradually declined, especially in those older than 65 years (P = 0.003). The presence of comorbidity was an independent prognostic factor for disease-free survival (HR: 1.431, 1.022-2.005; P = 0.037). Comorbidities may lead to poorer prognosis by directly causing delays in diagnosis, limiting treatment options, and increasing the risk of death in advanced OSCC patients.
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Affiliation(s)
- Huan Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Lirui Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Lei Xiong
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Hao Wang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Chang Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Chong Wang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China.
| | - Zhien Feng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China.
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Seol S, Choi JR, Choi B, Kim S, Jeon JY, Park KN, Park JH, Park MW, Eun YG, Park JJ, Lee BJ, Shin YS, Kim CH, Park RW, Jang JY. Effect of statin use on head and neck cancer prognosis in a multicenter study using a Common Data Model. Sci Rep 2023; 13:19770. [PMID: 37957229 PMCID: PMC10643676 DOI: 10.1038/s41598-023-45654-7] [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: 03/26/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Few studies have found an association between statin use and head and neck cancer (HNC) outcomes. We examined the effect of statin use on HNC recurrence using the converted Observational Medical Outcome Partnership (OMOP) Common Data Model (CDM) in seven hospitals between 1986 and 2022. Among the 9,473,551 eligible patients, we identified 4669 patients with HNC, of whom 398 were included in the target cohort, and 4271 were included in the control cohort after propensity score matching. A Cox proportional regression model was used. Of the 4669 patients included, 398 (8.52%) previously received statin prescriptions. Statin use was associated with a reduced rate of 3- and 5-year HNC recurrence compared to propensity score-matched controls (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.61-1.03; and RR 0.89; 95% CI 0.70-1.12, respectively). Nevertheless, the association between statin use and HNC recurrence was not statistically significant. A meta-analysis of recurrence based on subgroups, including age subgroups, showed similar trends. The results of this propensity-matched cohort study may not provide a statistically significant association between statin use and a lower risk of HNC recurrence. Further retrospective studies using nationwide claims data and prospective studies are warranted.
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Affiliation(s)
- Soobeen Seol
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, 164 World cup-ro Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Jung Ran Choi
- Department of Otolaryngology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Byungjin Choi
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, 164 World cup-ro Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Sungryeal Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Ja Young Jeon
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ki Nam Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University, Bucheon, Republic of Korea
| | - Jae Hong Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Min Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Young-Gyu Eun
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Jung Je Park
- Department of Otorhinolaryngology, College of Medicine, Gyeongsang National University and Hospital, Jinju, Republic of Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Yoo Seob Shin
- Department of Otolaryngology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Chul-Ho Kim
- Department of Otolaryngology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Rae Woong Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, 164 World cup-ro Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
- Department of Biomedical Informatics, Ajou University School of Medicine, 164 World cup-ro Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
| | - Jeon Yeob Jang
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, 164 World cup-ro Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
- Department of Otolaryngology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
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Ramkumar SP, Bhardwaj A, Patel A, Seetharaman K, Christman A, Amondikar N, Abouelella DK, Hussaini AS, Barnes JM, Adjei Boakye E, Watts TL, Osazuwa-Peters N. Differences in Receipt of Immunotherapy Treatment Among Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:912-918. [PMID: 37651149 PMCID: PMC10472266 DOI: 10.1001/jamaoto.2023.2420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/01/2023] [Indexed: 09/01/2023]
Abstract
Importance The US Food and Drug Administration approved immune checkpoint inhibitors (immunotherapy) for select cases of head and neck squamous cell carcinoma (HNSCC) in 2016. However, it is unclear whether there are clinical or sociodemographic differences among patients receiving immunotherapy as part of their care. Given the known disparities in head and neck cancer care, we hypothesized that there are differences in receipt of immunotherapy among patients with HNSCC based on clinical and nonclinical characteristics. Objective To characterize clinical and nonclinical factors associated with receipt of immunotherapy among older patients with HNSCC. Design, Setting, and Participants This retrospective cohort study included patients 65 years or older diagnosed with HNSCC (n = 4860) in a community oncology care setting. Electronic health records from Navigating Cancer were assessed from January 1, 2017, to April 30, 2022. Main Outcomes and Measures Multivariable logistic regression was used to characterize clinical (tumor stage [localized vs advanced] and anatomical subsite [oropharyngeal vs nonoropharyngeal]) and nonclinical (age, smoking history, race and ethnicity, sex, and marital status) factors associated with receipt of immunotherapy. Results In the study cohort of 4860 patients, 3593 (73.9%) were men; 4230 (87.0%) were White and 630 (13.0%) were of other races. A total of 552 patients (11.4%) had received immunotherapy. After adjusting for covariates, in the final model, White patients with HNSCC had 80% increased odds of receiving immunotherapy (adjusted odds ratio [AOR], 1.80 [95% CI, 1.30-2.48]) compared with patients of other races. There were no statistically significant differences in the odds of receiving immunotherapy based on age, sex, or smoking history. Patients with nonoropharyngeal disease were significantly more likely to receive immunotherapy than those with oropharyngeal cancer (AOR, 1.29 [95% CI, 1.05-1.59]), as were those with advanced compared with local disease (AOR, 2.39 [95% CI, 1.71-3.34]). Conclusions and Relevance The findings of this cohort study suggest that among older patients with HNSCC, White patients may be more likely to receive immunotherapy as part of their care. Equitable access to immunotherapy and other treatment options will reduce cancer-related health disparities and improve survival of patients with HNSCC.
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Affiliation(s)
- Shreya P. Ramkumar
- currently a medical student at Saint Louis University School of Medicine, St Louis, Missouri
| | | | | | | | | | | | - Dina K. Abouelella
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Adnan S. Hussaini
- Department of Otolaryngology–Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
- Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | - Tammara L. Watts
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
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Schostag K, Lynch P, Leavitt T, Sumer B, Yang A, Shah A, Emmet T, Sher DJ, Day AT. Smoking and other patient factors in HPV-mediated oropharynx cancer: A retrospective cohort study. Am J Otolaryngol 2022; 43:103555. [DOI: 10.1016/j.amjoto.2022.103555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/18/2022] [Accepted: 07/31/2022] [Indexed: 11/01/2022]
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7
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Schoonbeek RC, de Vries J, Bras L, Sidorenkov G, Plaat BEC, Witjes MJH, van der Laan BFAM, van den Hoek JGM, van Dijk BAC, Langendijk JA, Halmos GB. The effect of treatment delay on quality of life and overall survival in head and neck cancer patients. Eur J Cancer Care (Engl) 2022; 31:e13589. [PMID: 35438210 PMCID: PMC9541370 DOI: 10.1111/ecc.13589] [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: 11/25/2021] [Revised: 01/21/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
Objective Head and neck squamous cell carcinomas (HNSCC) are rapidly developing tumours, and substantial delay in treatment initiation is associated with decreased overall survival. The effect of delay on health‐related quality of life (HRQOL) is unknown. The aim of this study was to assess the impact of delay on QOL and overall survival. Methods Patients with mucosal HNSCC were prospectively included. HRQOL and 2‐year overall survival were analysed using linear mixed‐model analyses and cox regression, respectively. Delay was defined as care pathway interval (CPI) of ≥30 days between first consultation and treatment initiation. Results Median CPI was 39 days for the 173 patients included. A trend towards higher HRQOL‐scores (indicating better HRQOL) during 2‐year follow‐up for patients with delay in treatment initiation was visible in the adjusted models (HRQOL summary score—β: 2.62, 95% CI: 0.57–4.67, p = 0.012). Factors associated with decreased overall survival were moderate comorbidities (HR: 5.10, 95% CI: 1.65–15.76, p = 0.005) and stage‐IV tumours (HR: 12.37, 95% CI: 2.81–54.39, p = 0.001). Delay was not associated with worse overall survival. Conclusion Timely treatment initiation is challenging, especially for patients with advanced tumours and initial radiotherapy treatment. Encountering delay in treatment initiation did not result in clinically relevant differences in HRQOL‐scores or decreased overall survival during 2‐year follow‐up.
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Affiliation(s)
- Rosanne C Schoonbeek
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Julius de Vries
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Linda Bras
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Grigory Sidorenkov
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johanna G M van den Hoek
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boukje A C van Dijk
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - György B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Petrović-Lazić M, Babac S, Ilić-Savić I. The impact of the COVID-19 pandemic on the quality of life of laryngectomized patients. ACTA FACULTATIS MEDICAE NAISSENSIS 2022. [DOI: 10.5937/afmnai39-36517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introduction: Quality of life is a state of complete physical, mental and social well-being. Due to the COVID-19 pandemic, which led to changes in the daily routine, there was a change in the psychosocial functioning of individuals. Given that laryngectomized patients belong to a vulnerable group that requires psychological support after surgery, specific epidemiological measures during the COVID-19 pandemic could only further increase the fear and reluctance that is especially pronounced after surgery. Aim: The aim of this study was to investigate whether there was a link between the quality of life of laryngectomized patients and the COVID-19 pandemic. Method: The literature review was performed through the Google Scholar Advanced Search search engine and the Consortium of Libraries of Serbia for Unified Acqusition - KoBSON. Results: The first wave of the COVID-19 pandemic significantly disrupted the emotional well-being of patients with head and neck cancer. These patients became even more anxious due to the high mortality from the COVID-19 viral infection, hospital occupancy and missed therapeutic examinations. The need for togetherness, impaired concentration and attention, irritability and fear that family members might suffer from a deadly disease were the most common behavioral problems identified during the COVID-19 pandemic. Conclusion: The psychological burden associated with the direct and indirect effects of the COVID-19 pandemic should not be overlooked, given the fact that laryngectomized patients have twice the risk of suicide compared to patients who have undergone other types of cancer. Assessing the quality of life in laryngectomized patients is very important because it enables the timely identification of mental disorders and suggests the necessary support measures.
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Cohen O, Brauer PR, Judson BL, Burtness BA, Earles J, Mehra S. Guideline - Adherence in advanced stage head and neck cancer is associated with improved survival - A National study. Oral Oncol 2021; 125:105694. [PMID: 34971883 DOI: 10.1016/j.oraloncology.2021.105694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Understanding the prevalence of guideline non-adherence among patients with advanced head and neck cancer (HNC) and its impact on survival may facilitate increased adherence. Our objective was to perform a detailed analysis of overall National Comprehensive Care Network (NCCN) guideline adherence in a national cohort. METHODS Using the National Cancer Database, we analyzed site-specific NCCN guideline adherence for treatment of 100,074 overall stage III and IVA HNC patients from 2004 to 2013. Main outcomes were guideline adherence rates and overall survival (OS). Adherence was categorized by treatment: surgery/ radiation. Reasons were categorized as: (1) high risk; (2) refusal; (3) not planned. RESULTS After exclusion, the care of 25,620 patients was defined as non-adherent (25.6%), yet adherence rates significantly improved across the study's years. After multivariate analysis, non-adherence was associated with age ≥ 65, female gender, black race, comorbidity score ≥ 1, insurance status, clinical staging, primary site, and facility type. Patients not managed according to NCCN guidelines had a significantly reduced OS compared with patients treated on-guideline (hazard ratio (HR) = 1.51 (95 %CI 1.48-1.54), p < 0.001). 'Not planned' patients had reduced OS when compared to adherent patients (HR = 1.27 (95 %CI 1.23-1.30), p < 0.001). Off-guideline treated patients due to 'risk factors' had a decrease in overall survival (OS) compared with other reasons (p < 0.001 for all). CONCLUSIONS Despite improvement over time, non-adherence to NCCN guidelines for advanced stage HNC remains high. Non-adherence is associated with decreased OS, regardless of the reason. Despite concerns from both patient and physician, efforts should be made to increase guideline awareness and adherence.
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Affiliation(s)
- Oded Cohen
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA
| | - Philip R Brauer
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Benjamin L Judson
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA
| | - Barbara A Burtness
- Yale Cancer Center, New Haven, CT, USA; Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Joseph Earles
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA.
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10
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Guiard E, Clatot F, Even C, Perréard M, Abdeddaim C, Johnson A, Vauléon E, Rambeau A. Impact of previous nivolumab treatment on the response to taxanes in patients with recurrent/metastatic head and neck squamous cell carcinoma. Eur J Cancer 2021; 159:125-132. [PMID: 34743067 DOI: 10.1016/j.ejca.2021.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/25/2021] [Accepted: 09/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors are widely used in recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC). We aimed to describe response rates to taxanes after progression on nivolumab in R/M HNSCC patients. METHODS In this multicentric retrospective comparative study, we included patients treated with taxane monotherapy from 2014 to 2020. Patients were divided into two groups depending on whether they received nivolumab before taxanes (post-nivolumab group) or not (control group). The primary end-point was objective response rate (ORR) comparison between the two groups. The secondary end-points included disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and PFS ratio (PFSr=PFS associated with taxanes divided by PFS associated with the previous line of treatment), a survival marker used for comparison of different treatment lines. RESULTS Between July 2014 and August 2020, 185 patients were included (114 in the control group and 71 in the post-nivolumab group). ORR was significantly higher in the post-nivolumab group (39.4% versus 26.3%, p = 0.03) as was DCR (69% versus 50%, P = 0.06). The median OS (7.5 months) and PFS (3.5 months) were not significantly different in the two groups, whereas PFSr was significantly improved in the post-nivolumab group (1.63 versus 1.11, P = 0.004). CONCLUSION Response and DCRs with taxanes are improved after prior exposure to nivolumab. Thus, taxane monotherapy could be a good choice as third-line therapy after nivolumab following a platinum-based first line. These results currently apply to patients without access to or potential benefit from first-line pembrolizumab.
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Affiliation(s)
- Emeline Guiard
- Medical Oncology Department, Centre François Baclesse, Caen, France.
| | - Florian Clatot
- Medical Oncology Department, Centre Henri Becquerel, Rouen, France
| | - Caroline Even
- Head and Neck Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Marion Perréard
- Head and Neck Surgery Department, University Hospital, Caen, France
| | - Cyril Abdeddaim
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - Alison Johnson
- Medical Oncology Department, Centre François Baclesse, Caen, France
| | - Elodie Vauléon
- Medical Oncology Department, Centre Eugène Marquis, Rennes, France
| | - Audrey Rambeau
- Medical Oncology Department, Centre François Baclesse, Caen, France
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11
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Nilbert M. Timely treatment initiation; a reminder about effort to reduce system-related lead times. Acta Oncol 2021; 60:1081-1082. [PMID: 34224295 DOI: 10.1080/0284186x.2021.1945143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mef Nilbert
- Clinical Research Department, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Institute of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
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12
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Ferreira AK, Carvalho SH, Granville-Garcia AF, Sarmento DJ, Agripino GG, Abreu MH, Melo MC, Caldas AD, Godoy GP. Survival and prognostic factors in patients with oral squamous cell carcinoma. Med Oral Patol Oral Cir Bucal 2021; 26:e387-e392. [PMID: 33037796 PMCID: PMC8141315 DOI: 10.4317/medoral.24242] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022] Open
Abstract
Background This study aimed to evaluate sociodemographic and clinical factors influencing overall survival (OS) in patients with oral squamous cell carcinoma (OSCC).
Material and Methods Medical charts of 547 patients with OSCC from a public hospital in northeastern Brazil seen between 1999 and 2013 were evaluated. Survival analysis was performed using the Kaplan-Meier method. The influence of age, sex, ethnicity, clinical stage, anatomical location, type of treatment, and comorbidities on the patients’ prognosis was evaluated. Cox proportional hazards regression model was used to identify independent prognostic factors.
Results The 5-year OS was 39%. Multivariate analysis showed that age < 40 years (HR = 2.20; 95%CI: 1.02-4.72) and a single treatment modality (HR = 1.91; 95%CI: 1.37-2.67) were associated with a poor prognosis, while early clinical stage resulted in better outcomes (HR = 0.38; 95%CI: 0.25-0.58).
Conclusions OSCC patients in advanced clinical stages, diagnosed at a younger age, and submitted to a single therapeutic modality have a poorer prognosis. Key words:Head and neck cancer, oral cancer, oral squamous cell carcinoma, survival, prognosis.
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Affiliation(s)
- A-K Ferreira
- Department of Pathology Avenida Professor Moraes Rego, 1235 CEP 50670-901, Recife, Pernambuco, Brazil
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13
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Schoonbeek RC, Zwertbroek J, Plaat BEC, Takes RP, Ridge JA, Strojan P, Ferlito A, van Dijk BAC, Halmos GB. Determinants of delay and association with outcome in head and neck cancer: A systematic review. Eur J Surg Oncol 2021; 47:1816-1827. [PMID: 33715909 DOI: 10.1016/j.ejso.2021.02.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Head and neck cancers (HNC) are relatively fast-growing tumours, and delay in treatment initiation is associated with tumour progression and adverse outcome. An overview of factors contributing to delay can provide critical insights on necessary adjustments to optimize care pathways. This systematic review aims to identify factors associated with delay and summarize the effect of delay on oncological outcome measures. METHODS A search strategy was conducted according to PRISMA guidelines to search electronic databases for studies assessing the carepathway interval (days between first visit in head and neck oncology center and treatment initiation) and/or time-to-treatment-initiation interval (days between histological diagnosis and treatment initiation) and 1) determinants of delay and/or 2) effect of delay on outcome within these timeframes. Due to heterogeneity between included studies, a meta-analysis was not possible. RESULTS Fifty-two studies were eligible for quantitative analysis. Non-Caucasian race, academic setting, Medicaid/no insurance and radiotherapy as primary treatment were associated with delay. Advanced tumour stage was related to increased time-to-treatment initiation in the four common sites combined (oral cavity, oropharynx, hypopharynx, larynx). Separate determinants for delay in different tumour locations were identified. In laryngeal, oral cavity cancer and the four common HNC sites combined, delay in start of treatment is associated with decreased overall survival, although no cut-off time point could be determined. CONCLUSION Race, facility type, type of insurance and radiotherapy as primary treatment were associated with delay and subsequent inferior survival in the four common sites combined.
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Affiliation(s)
- Rosanne C Schoonbeek
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands.
| | - Julia Zwertbroek
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Boudewijn E C Plaat
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Robert P Takes
- Radboud University Medical Center, Department of Otolaryngology/Head and Neck Surgery, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands
| | - John A Ridge
- Fox Chase Cancer Center, Department of Surgical Oncology, Head and Neck Surgery Section, 333 Cottman Avenue, 19111, Philadelphia, PA, USA
| | - Primož Strojan
- Institute of Oncology, Department of Radiation Oncology, Zaloška Cesta 2, 1000, Ljubljana, Slovenia
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| | - Boukje A C van Dijk
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research, Godebaldkwartier 419, 3511, DT, Utrecht, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - György B Halmos
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
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14
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Ghanizada M, Jakobsen KK, Jensen JS, Wessel I, Filtenborg Tvedskov J, Grønhøj C, von Buchwald C. The impact of comorbidities on survival in oral cancer patients: a population-based, case-control study. Acta Oncol 2021; 60:173-179. [PMID: 33103528 DOI: 10.1080/0284186x.2020.1836393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Comorbidities have shown to highly influence the outcome and risk of death of head and neck cancer patients. The purpose of this study was to examine the comorbidities among oral cavity squamous cell carcinoma (OSCC) patients, and to investigate the impact of comorbidities on overall survival (OS) and recurrence free survival (RFS). METHODS Patients diagnosed with OSCC in Eastern Denmark in the period 2000-2014 and treated with curative intend were included. Patients data were linked to the Danish National Patients Register to identify comorbidities based on the Charlson Comorbidity Index (CCI) at the time of diagnosis and five years after diagnosis. Each patient was age-and sex-matched in a 1:10 ratio with an age and sex matched reference group. RESULTS A total of 1,183 patients and 11,830 controls were included. Overall this study found comorbidities to be more common among OSCC compared to the reference group both at the time of diagnosis and five years after. The 5-year OS among patients with a CCI score of zero, one, two, and three or above was 60%, 44%, 41%, and 40%, respectively. Similarly, the multivariate cox-regression analysis showed that patients with increasing CCI score also had an increasing risk of death compared to patients with no comorbidities. CONCLUSION OSCC patients had significantly higher comorbidity burden at diagnosis and risk of developing additional comorbidities after diagnosis compared to the reference population. Survival outcomes decreased significantly with higher CCI.
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Affiliation(s)
- Mustafa Ghanizada
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Schmidt Jensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Filtenborg Tvedskov
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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15
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Locatello LG, Mastronicola R, Cortese S, Beulque E, Salleron J, Gallo O, Dolivet G. Estimating the risks and benefits before salvage surgery for recurrent head and neck squamous cell carcinoma. Eur J Surg Oncol 2021; 47:1718-1726. [PMID: 33549376 DOI: 10.1016/j.ejso.2021.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/18/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The risks associated with salvage surgery of head and neck squamous cell carcinoma (SCC) in a previously irradiated field needs to be balanced against the expected survival benefits. We want to identify preoperative predictive factors for overall and disease-specific survival (OS/DSS) and for the development of serious (Clavien-Dindo, CD≥III) complications following salvage surgery for radiorecurrent SCC to help surgeons, patients, and caregivers in the decision-making process in this setting. MATERIALS AND METHODS The records of 234 patients presenting to the Lorraine Cancer Institute with locoregional radiorecurrent SCC were reviewed. The primary endpoint was OS, secondary endpoints were DSS, OS without tracheostomy/gastrostomy, and the risk of CD≥III complications. Multivariate analyses were carried out to explore preoperative factors associated with survival and the risk of postoperative complications. RESULTS With a median follow-up time of 19 months, 5-year OS since the first salvage surgery was 28.3%, 5-year DSS was 38.9%. 2- and 5-year functional OS were 45.6% and 27.2%. rcT-rcN, and WUNHCI ≥4 were both independent significant preoperative predictors of OS and DSS. 30-days postoperative complications occurred in 44.4% of patients (28 CD I, 24 CD II, 34 CD III, 11 CD IV, 7 CD V). A salvage procedure involving T+N plus the presence of a WUHNCI ≥4 was the only independent predictor of CD≥III complications. CONCLUSION When discussing with the patients and the caregivers salvage surgery for recurrent head and neck SCC, a careful evaluation of the preoperative comorbidities by the WUHNCI tool can reliably predict the expected risks and benefits from the procedure.
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Affiliation(s)
- Luca Giovanni Locatello
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy.
| | - Romina Mastronicola
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; University of Lorraine, CNRS, CRAN, F-54000, Nancy, France
| | - Sophie Cortese
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Emilie Beulque
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Julia Salleron
- Biostatistics Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3 - 50134, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gilles Dolivet
- Department of Surgical Oncology, Head and Neck Unit, Institut de Cancérologie de Lorraine, Université de Lorraine, F-54519, Vandœuvre-lès-Nancy, France; University of Lorraine, CNRS, CRAN, F-54000, Nancy, France
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16
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Alterio D, Volpe S, Bacigalupo A, Bonomo P, De Felice F, Dionisi F, D'Onofrio I, D'Angelo E, Di Rito A, Fanetti G, Franco P, Maddalo M, Merlotti A, Micciché F, Orlandi E, Paiar F, Ursino S, Pepa M, Corvò R, Di Muzio NG, Magrini SM, Russi E, Sanguineti G, Jereczek-Fossa BA, Donato V, Musio D. Head and neck radiotherapy amid the COVID-19 pandemic: practice recommendations of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Med Oncol 2020; 37:85. [PMID: 32808089 PMCID: PMC7430932 DOI: 10.1007/s12032-020-01409-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/05/2020] [Indexed: 12/27/2022]
Abstract
Management of patients with head and neck cancers (HNCs) is challenging for the Radiation Oncologist, especially in the COVID-19 era. The Italian Society of Radiotherapy and Clinical Oncology (AIRO) identified the need of practice recommendations on logistic issues, treatment delivery and healthcare personnel’s protection in a time of limited resources. A panel of 15 national experts on HNCs completed a modified Delphi process. A five-point Likert scale was used; the chosen cut-offs for strong agreement and agreement were 75% and 66%, respectively. Items were organized into two sections: (1) general recommendations (10 items) and (2) special recommendations (45 items), detailing a set of procedures to be applied to all specific phases of the Radiation Oncology workflow. The distribution of facilities across the country was as follows: 47% Northern, 33% Central and 20% Southern regions. There was agreement or strong agreement across the majority (93%) of proposed items including treatment strategies, use of personal protection devices, set-up modifications and follow-up re-scheduling. Guaranteeing treatment delivery for HNC patients is well-recognized in Radiation Oncology. Our recommendations provide a flexible tool for management both in the pandemic and post-pandemic phase of the COVID-19 outbreak.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy. .,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | | | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Dionisi
- Proton Therapy Unit, Department of Oncology, Azienda Provinciale Per I Servizi Sanitari, APSS, 38123, Trento, Italy
| | - Ida D'Onofrio
- Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy
| | - Elisa D'Angelo
- Radiation Oncology Department, University Hospital of Modena, Modena, Italy
| | - Alessia Di Rito
- Radiotherapy Unit, Ospedale "Mons. A.R. Dimiccoli", Bari, Italy
| | - Giuseppe Fanetti
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Marta Maddalo
- Department of Radiation Oncology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Anna Merlotti
- Department of Radiation Oncology, S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Francesco Micciché
- Dipartimento Diagnostica Per Immagini, Radioterapia Oncologica, UOC Di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ester Orlandi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Fabiola Paiar
- Department of Radiation Oncology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Stefano Ursino
- Radiation Oncology Unit S. Chiara University Hospital of Pisa Via Roma, Pisa, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Renzo Corvò
- Radiation Oncology Policlinico San Martino IRCCS, Genova, Italy.,Health Science Department (DISSAL), University of Genova, Genova, Italy
| | - Nadia Gisella Di Muzio
- Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy.,Department of Radiotherapy, Università Vita Salute S. Raffaele, Milan, Italy
| | | | - Elvio Russi
- Department of Radiation Oncology, S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Vittorio Donato
- Radiation Oncology Division, Oncology and Specialty Medicine Department, San Camillo-Forlanini Hospital, Rome, Italy.,AIRO (Italian Association of Radiotherapy and Clinical Oncology), Milan, Italy
| | - Daniela Musio
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.,Radiotherapy Unit, Ospedale V Fazzi, Lecce, Italy
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17
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Alterio D, Volpe S, Marvaso G, Turturici I, Ferrari A, Leonardi MC, Lazzari R, Fiore MS, Bufi G, Cattani F, Arrobbio C, Patti F, Casbarra A, Cavallo I, Mastrilli F, Orecchia R, Jereczek‐Fossa BA. Head and neck cancer radiotherapy amid COVID-19 pandemic: Report from Milan, Italy. Head Neck 2020; 42:1482-1490. [PMID: 32557972 PMCID: PMC7323327 DOI: 10.1002/hed.26319] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Management of head and neck cancers (HNC) in radiation oncology in the coronavirus disease 2019 (COVID-19) era is challenging. Aim of our work is to report organization strategies at a radiation therapy (RT) department in the first European area experiencing the COVID-19 pandemic. METHODS We focused on (a) dedicated procedures for HNC, (b) RT scheduling, and (c) health care professionals' protection applied during the COVID-19 breakdown (from March 1, 2020 to April 30, 2020). RESULTS Applied procedures are reported and discussed. Forty-three patients were treated. Image-guided, intensity modulated RT was performed in all cases. Median overall treatment time was 50 (interquartile range: 47-54.25) days. RT was interrupted/delayed in seven patients (16%) for suspected COVID-19 infection. Two health professionals managing HNC patients were proven as COVID-19 positive. CONCLUSION Adequate and well-timed organization allowed for the optimization of HNC patients balancing at the best of our possibilities patients' care and personnel's safety.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Stefania Volpe
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Giulia Marvaso
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Irene Turturici
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Annamaria Ferrari
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | | | - Roberta Lazzari
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Massimo Sarra Fiore
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Giammaria Bufi
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Federica Cattani
- Medical Physics UnitIEO, European Institute of Oncology IRCCSMilanItaly
| | - Camilla Arrobbio
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Filippo Patti
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Alessia Casbarra
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Iacopo Cavallo
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Fabrizio Mastrilli
- Medical Administration, CMOIEO, European Institute of Oncology, IRCCSMilanItaly
| | - Roberto Orecchia
- Scientific DirectionIEO, European Institute of Oncology, IRCCSMilanItaly
| | - Barbara Alicja Jereczek‐Fossa
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
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