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Barry E, Schmidt KL, Topf MC, Tassone P. Addressing the Neck: An NCDB Study of Clinically Node-Negative Supraglottic Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2024. [PMID: 39101350 DOI: 10.1002/ohn.932] [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: 10/19/2023] [Revised: 07/02/2024] [Accepted: 07/20/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE Identify the proportion of patients undergoing elective neck dissection (END) in surgically managed supraglottic squamous cell carcinoma (SCCa), assess associations between patient, tumor, and treatment factors with END, and assess associations between neck management and overall survival (OS). STUDY DESIGN Retrospective study. SETTING National Cancer Database (NCDB) 2019 Participant User File. METHODS Patients with previously untreated, clinically node-negative (cN0) supraglottic SCCa treated with partial laryngectomy were queried from NCDB. Patients without known neck management and who underwent total laryngectomy were excluded. Patient and tumor factors associated with END were evaluated by logistic regression analysis. Univariable Cox proportional hazard analysis was used to examine associations between patient factors and OS, and factors with P < .05 were included on multivariable analysis. RESULTS A total of 1352 patients met eligibility criteria. Eight hundred eleven (60%) patients had END performed with occult nodal metastasis identified in 177 (22%) patients. END was more likely to be performed at academic centers than nonacademic centers (odds ratio: [1.66], 95% confidence interval [CI]: 1.32-2.09, P < .001). On multivariable analysis, patients who underwent adjuvant radiation had worse OS (hazard ratio [HR]: 1.45, 95% CI: 1.13-3.29, P = .017). END was associated with improved OS overall on univariable analysis (HR: 0.83, 95% CI: 0.69-0.98, P = .026), but not on multivariable analysis. CONCLUSION In this NCDB study, 22% of cN0 supraglottic SCCa patients had occult nodal metastatic disease. Despite this, 40% of patients do not receive END at the time of primary resection. Patients who receive END for supraglottic SCCa are more likely to avoid adjuvant radiation without impacting OS.
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Affiliation(s)
- Elsie Barry
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Kelly L Schmidt
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Michael C Topf
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patrick Tassone
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
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Shah HP, Cohen O, Bourdillon AT, Burtness BA, Boffa DJ, Young M, Judson BL, Mehra S. Identifying Opportunities to Deliver High-Quality Cancer Care Across a Health System: A Clinical Responsibility. Otolaryngol Head Neck Surg 2024; 171:445-456. [PMID: 38606669 DOI: 10.1002/ohn.755] [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: 09/25/2023] [Revised: 02/29/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE We examined process-related quality metrics for oral squamous cell carcinoma (OSCC) depending on treating facility type across a health system and region. STUDY DESIGN Retrospective in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. SETTING Single health system and region. METHODS Patients with OSCC diagnosed between 2012 and 2018 were identified from tumor registries of 6 hospitals (1 academic and 5 community) within a single health system. Patients were categorized into 3 care groups: (1) solely at the academic center, (2) solely at community facilities, and (3) combined care at academic and community facilities. Primary outcome measures were process-related quality metrics: positive surgical margin rate, lymph node yield (LNY), adjuvant treatment initiation ≤6 weeks, National Comprehensive Cancer Network (NCCN)-guideline adherence. RESULTS A total of 499 patients were included: 307 (61.5%) patients in the academic-only group, 101 (20.2%) in the community-only group, and 91 (18.2%) in the combined group. Surgery at community hospitals was associated with increased odds of positive surgical margins (11.9% vs 2.5%, odds ratio [OR]: 47.73, 95% confidence interval [CI]: 11.2-275.86, P < .001) and lower odds of LNY ≥ 18 (52.8% vs 85.9%, OR: 0.15, 95% CI: 0.07-0.33, P < .001) relative to the academic center. Compared with the academic-only group, odds of adjuvant treatment initiation ≤6 weeks were lower for the combined group (OR: 0.30, 95% CI: 0.13-0.64, P = .002) and odds of NCCN guideline-adherent treatment were lower in the community only group (OR: 0.35, 95% CI: 0.18-0.70, P = .003). CONCLUSION Quality of oral cancer care across the health system and region is comparable to or better-than national standards, indicating good baseline quality of care. Differences by facility type and fragmentation of care present an opportunity for bringing best in-class cancer care across an entire region.
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Affiliation(s)
- Hemali P Shah
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
| | - Oded Cohen
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
- Department of Otolaryngology-Head and Neck Surgery, Ben Gurion University of the Negev Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Alexandra T Bourdillon
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine, San Francisco, California, USA
| | - Barbara A Burtness
- Yale Cancer Center, New Haven, Connecticut, USA
- Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Daniel J Boffa
- Yale Cancer Center, New Haven, Connecticut, USA
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Melissa Young
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin L Judson
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Saral Mehra
- Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
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Alapati R, Wagoner SF, Lawrence A, Bon Nieves A, Desai A, Shnayder Y, Hamill C, Kakarala K, Neupane P, Gan G, Sykes KJ, Bur AM. Impact of Adjuvant Radiotherapy Setting on Quality-of-Life in Head and Neck Squamous Cell Carcinoma. Laryngoscope 2024; 134:3645-3655. [PMID: 38436503 DOI: 10.1002/lary.31382] [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: 12/29/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To determine differences in post-treatment QoL across treatment settings in patients receiving adjuvant radiation therapy for head and neck squamous cell carcinoma (HNSCC). METHODS This was a prospective observational cohort study of patients with HNSCC initially evaluated in a head and neck surgical oncologic and reconstructive clinic at an academic medical center (AMC). Participants were enrolled prior to treatment in a prospective registry collecting demographic, social, and clinical data. Physical and social-emotional QoL (phys-QoL and soc-QoL, respectively) was measured using the University of Washington-QoL questionnaire at pre-treatment and post-treatment visits. RESULTS A cohort of 177 patients, primarily male and White with an average age of 61.2 ± 11.2 years, met inclusion criteria. Most patients presented with oral cavity tumors (n = 132, 74.6%), had non-HPV-mediated disease (n = 97, 61.8%), and were classified as Stage IVa (n = 72, 42.8%). After controlling for covariates, patients treated at community medical centers (CMCs) reported a 7.15-point lower phys-QoL compared with those treated at AMCs (95% CI: -13.96 to -0.35, p = 0.040) up to 12 months post-treatment. Additionally, patients who were treated at CMCs had a 5.77-point (-11.86-0.31, p = 0.063) lower soc-QoL score compared with those treated at an AMC, which was not statistically significant. CONCLUSION This study revealed that HNSCC patients treated with radiation at AMCs reported significantly greater phys-QoL in their first-year post-treatment compared to those treated at CMCs, but soc-QoL did not differ significantly. Further observational studies are needed to explore potential factors, including treatment planning and cancer resource engagement, behind disparities between AMCs and CMCs. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3645-3655, 2024.
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Affiliation(s)
- Rahul Alapati
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Sarah F Wagoner
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Amelia Lawrence
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Antonio Bon Nieves
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Atharva Desai
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, U.S.A
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Chelsea Hamill
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Kiran Kakarala
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Prakash Neupane
- Department of Medical Oncology, University of Kansas, Kansas City, Kansas, U.S.A
| | - Gregory Gan
- Department of Radiation Oncology, University of Kansas, Kansas City, Kansas, U.S.A
| | - Kevin J Sykes
- Baylor Scott & White, Health and Wellness Center, Dallas, Texas, U.S.A
| | - Andrés M Bur
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
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Patel AM, Haleem A, Maxwell R, Lukens JN, Lin A, Brody RM, Brant JA, Carey RM. Choice of Adjuvant Radiotherapy Facility in Major Salivary Gland Cancer. Laryngoscope 2024; 134:3620-3632. [PMID: 38400788 DOI: 10.1002/lary.31352] [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: 12/04/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Undergoing surgery and adjuvant radiotherapy (aRT) at the same facility has been associated with higher overall survival (OS) in head and neck squamous cell carcinoma. Our study investigates whether undergoing surgery and aRT at the same academic facility is associated with higher OS in major salivary gland cancer (MSGC). METHODS The 2006-2018 National Cancer Database was queried for patients with MSGC undergoing surgery at an academic facility and then aRT. Multivariable binary logistic and Cox proportional hazards regression models were implemented. RESULTS Of 2801 patients satisfying inclusion criteria, 2130 (76.0%) underwent surgery and aRT at the same academic facility. Residence in a less populated area (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.16-2.45), treatment without adjuvant chemotherapy (aOR 1.97, 95% CI 1.41-2.76), and aRT duration (aOR 1.02, 95% CI 1.01-1.04) were associated with undergoing surgery and aRT at different facilities on multivariable logistic regression adjusting for patient demographics, clinicopathologic features, and adjuvant therapy (p < 0.01). Five-year OS was higher in patients undergoing surgery and aRT at the same academic facility (68.8% vs. 61.9%, p < 0.001). Undergoing surgery and aRT at different facilities remained associated with worse OS on multivariable Cox regression (aHR 1.41, 95% CI 1.10-1.81, p = 0.007). CONCLUSION Undergoing surgery and aRT at the same academic facility is associated with higher OS in MSGC. Although undergoing surgery and aRT at the same academic facility is impractical for all patients, academic physicians should consider same-facility treatment for complex patients who would most benefit from clear multidisciplinary communication. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3620-3632, 2024.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Afash Haleem
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Russell Maxwell
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
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Dandoy CE, Adams J, Artz A, Bredeson C, Dahi PB, Dodd T, Jaglowski S, Lehmann L, LeMaistre CF, Mian A, Neal A, Page K, Rizzo JD, Rotz S, Sorror M, Steinberg A, Viswabandya A, Howard DS. In Pursuit of Optimal Outcomes: A Framework for Quality Standards in Immune Effector Cell Therapy. Transplant Cell Ther 2024:S2666-6367(24)00535-9. [PMID: 39067790 DOI: 10.1016/j.jtct.2024.07.011] [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: 05/18/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
Immune effector cell (IEC) therapy represents a transformative advancement in oncology, leveraging the immune system to combat various malignancies. This article outlines a comprehensive framework for establishing and maintaining quality standards in IEC therapy amidst rapid scientific and clinical advancements. We emphasize the integration of structured process measures, robust quality assurance, and meticulous outcome evaluation to ensure treatment efficacy and safety. Key components include multidisciplinary expertise, stringent accreditation protocols, and advanced data management systems, which facilitate standardized reporting and continual innovation. The collaborative effort among stakeholders-ranging from patients and healthcare providers to regulatory bodies-is crucial in delivering high-quality IEC therapies. This framework aims to enhance patient outcomes and cement the role of IEC therapy as a cornerstone of modern oncology, promoting continuous improvement and adherence to high standards across the therapeutic spectrum.
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Affiliation(s)
- Christopher E Dandoy
- Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio.
| | - Joan Adams
- Stephenson Cancer Center, OU Health Science Center The University of Oklahoma, Oklahoma City, Oklahoma
| | - Andrew Artz
- Division of Leukemia, Department of Hematology and HCT, City of Hope, Duarte, California
| | - Christopher Bredeson
- Ottawa Hospital Research Institute, Division of Hematology, University of Ottawa, Ottawa, Canada
| | - Parastoo B Dahi
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Therese Dodd
- Sarah Cannon Transplant and Cellular Therapy Network, Nashville, Tennessee
| | - Samantha Jaglowski
- Department of Pediatrics and Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Leslie Lehmann
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Amir Mian
- Department of Pediatric Hematology and Oncology, Department of Pediatrics at Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Alison Neal
- Department of Bone Marrow Transplant and Cellular Therapy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kristen Page
- Department of Pediatrics and Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - J Douglas Rizzo
- Department of Pediatrics and Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Seth Rotz
- Division of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Sorror
- Fred Hutchinson Cancer Center and University of Washington, Seattle, Washington
| | - Amir Steinberg
- Adult Stem Cell Transplantation, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Auro Viswabandya
- Department of Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Dianna S Howard
- Department of Internal Medicine, Section of Hematology and Oncology, Stem Cell Transplant and Cellular Therapy Program, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina
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6
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Sticker AL, Cannon ST, Russell GB, Waltonen JD. Factors associated with adjuvant treatment delays in patients treated surgically for head and neck cancer. Clin Otolaryngol 2024; 49:445-452. [PMID: 38610122 DOI: 10.1111/coa.14164] [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: 05/15/2022] [Revised: 12/17/2023] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To determine the patient and treatment characteristics associated with delay in post-operative radiation therapy (PORT) for patients treated surgically for head and neck squamous cell cancer (HNSCC) at our institution. DESIGN Single institution retrospective review. SETTING Tertiary care academic medical centre. PARTICIPANTS Patients treated surgically for HNSCC who underwent PORT between 2013 and 2016. MAIN OUTCOME MEASURES AND RESULTS One hundred forty patients met inclusion criteria. A majority did not start radiotherapy within 6 weeks. Factors associated with a delayed initiation of PORT included length of stay >8 days, 30-day readmission, no adjuvant chemotherapy, post-operative complications and fragmented care. CONCLUSIONS A majority of patients did not initiate PORT within the guideline-recommended 6 weeks. Modifiable risks factors that delay initiation of PORT were identified.
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Affiliation(s)
- Alan L Sticker
- Department of Otolaryngology, Ochsner Health, Baton Rouge, Louisiana, USA
| | - Sydney T Cannon
- Department of Otolaryngology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gregory B Russell
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Joshua D Waltonen
- Department of Otolaryngology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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7
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Patel R, Patel AM, Revercomb L, Qie V, Tseng CC, Baredes S, Park RCW. Facility Volume and Changing Facilities for Postoperative Radiotherapy in Salivary Gland Cancer. Laryngoscope 2024. [PMID: 38895869 DOI: 10.1002/lary.31588] [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: 01/24/2023] [Revised: 05/14/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES Changing location of postoperative radiotherapy (PORT) after treatment at a high-volume facility (HVF) is associated with worse survival in various head and neck cancers. Our study investigates this relationship in salivary gland cancer (SGC). METHODS The 2004-2016 National Cancer Database was queried for all cases of adult SGC treated with surgery and PORT with or without adjuvant chemotherapy. Patients with multiple cancer diagnoses, metastatic disease, or unknown PORT facility were excluded. Reporting facilities with >95th percentile annual case volume were classified as HVFs, the remainder were classified low-volume facilities (LVFs). RESULTS A total of 7885 patients met inclusion criteria, of which 418 (5.3%) were treated at an HVF. Patients treated at an HVF had higher rates clinical nodal positivity (18.2% vs. 14.0%, p < 0.001) and clinical T3/T4 (27.3% vs. 20.7%, p = 0.001) disease. Patients at HVFs changed facility for PORT at lower rates (18.9% vs. 24.5%, p = 0.009). Patients treated at an HVF had higher 5-year overall survival (5-OS) than those treated at an LVF (79.0% vs. 72.0%, p = 0.042). Patients treated at an HVF that changed PORT facility had worse 5-OS (60.8% vs. 83.2%, p < 0.001). Radiation facility change was an independent predictor of worse survival in patients treated at an HVF (HR: 8.99 [3.15-25.67], p < 0.001) but not for patients treated at a LVF (HR: 1.11 [0.98-1.25], p = 0.109). CONCLUSIONS Patients treated at an HVF changing facility for PORT for SGC experience worse survival. Our data suggest patients treated surgically at an HVF should be counseled to continue their PORT at the same institution. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Rushi Patel
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic College of Medicine, Cleveland, Ohio, U.S.A
| | - Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Lucy Revercomb
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Vivienne Qie
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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Gilja S, Kumar A, Kapustin D, Su V, Rubin SJ, Chai R, Roof SA, Khan MN. The Impact of Hospital Safety-Net Burden Status on Patients with HPV-Positive Oropharyngeal Cancer. Laryngoscope 2024; 134:1733-1740. [PMID: 37933810 DOI: 10.1002/lary.31131] [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: 06/26/2023] [Revised: 09/11/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES The objective of this study was to compare treatment characteristics and outcomes between patients with HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) treated at hospitals of varying safety-net burden status. METHODS Patients with cT1-4, N0-3, M0 HPV-positive OPSCC who underwent definitive surgery or radiation were included. Patients were grouped based on their treating hospital safety-net burden status, defined as the percentage of uninsured and Medicaid-insured patients with OPSCC treated at the facility and stratified as low burden (LBH: 0-25th percentile), medium burden (MBH: 25th-75th percentile), or high burden (HBH: 75th-100th percentile). The primary outcome was primary treatment with surgery versus radiation, evaluated with multivariable-adjusted logistic regression. Secondary outcomes included TORS versus open surgical approach, and overall survival evaluated with Cox proportional hazards analysis. RESULTS Of the 19,810 patients with cT1-4, N0-3, M0 HPV-positive OPSCC included in this study, 4921 (24.8%) were treated at LBH, 12,201 (61.6%) were treated at MBH, and 2688 (13.6%) were treated at HBH. In multivariable-adjusted analysis, compared with treatment at LBH, treatment at HBH was associated with more frequent radiation over surgical treatment (OR: 1.26, 95% CI: 1.12-1.40, p < 0.001). For patients undergoing surgery, patients at HBH had less frequent transoral robotic surgery (OR: 0.30, 95% CI 0.24-0.38, p < 0.001) compared with patients treated at LBH. Overall survival of patients treated at HBH was worse than that of patients treated at LBH (HR: 1.27, 95% CI 1.13-1.43, p < 0.001). CONCLUSION These findings highlight underlying disparities at higher safety-net burden facilities that impact patterns of care and outcomes for patients with OPSCC. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1733-1740, 2024.
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Affiliation(s)
- Shivee Gilja
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Arvind Kumar
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Danielle Kapustin
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Vivian Su
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Samuel J Rubin
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Raymond Chai
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Mohemmed N Khan
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
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Choi KY, Patel SD, Lane C, Tucker J, Chan K, Pradhan S, Mahase SS, Tam SH, King TS. Elucidating survival and functional outcomes in patients with primary head and neck malignancies treated in academic versus community settings. Head Neck 2024; 46:398-407. [PMID: 38087455 DOI: 10.1002/hed.27588] [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: 04/15/2023] [Revised: 10/19/2023] [Accepted: 11/19/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Differences in treatment outcomes between community or academic centers are incompletely understood. METHODS Retrospective review of head and neck cancer patients between 2010 and 2020 in a rural health region. Kaplan-Meier curves and log-rank tests were used to evaluate survival outcomes, along with bivariate and multivariable Cox proportional hazards models. Linear regression was used for functional outcomes of tracheotomy and gastrostomy tube dependence. RESULTS Two hundred and forty-eight patients treated at an academic center were compared with 94 patients treated in community centers. In multivariable analysis, the risk of death (HR = 0.60, p = 0.019), and risk of recurrence were lower (HR = 0.29, p < 0.001) for patients treated in academic centers. Patients treated in community centers had longer gastrostomy tube dependence (p = 0.002). CONCLUSION Our findings suggest that treatment at an academic center was associated with a lower risk of recurrence and shorter gastrostomy tube dependence compared to treatment in the community.
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Affiliation(s)
- Karen Y Choi
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Shivam D Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ciaran Lane
- Department of Otolaryngology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jacqueline Tucker
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kimberly Chan
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sandeep Pradhan
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sean S Mahase
- Department of Radiation Oncology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Samantha H Tam
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Medical Center, Detroit, Michigan, USA
| | - Tonya S King
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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Morse RT, Mouw TJ, Moreno M, Erwin JT, Cao Y, DiPasco P, Al-Kasspooles M, Hoover A. Neoadjuvant Radiotherapy Facility Type Affects Anastomotic Complications After Esophagectomy. J Gastrointest Surg 2023; 27:1313-1320. [PMID: 36973500 DOI: 10.1007/s11605-023-05660-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/28/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Esophagectomy is a complex oncologic surgery that results in lower perioperative morbidity and mortality when performed in high-volume hospitals by experienced surgeons; however, limited data exists evaluating the importance of neoadjuvant radiotherapy delivery at high- versus low-volume centers. We sought to compare postoperative toxicity among patients treated with preoperative radiotherapy delivered at an academic medical center (AMC) versus community medical centers (CMC). METHODS Consecutive patients undergoing esophagectomy for locally advanced esophageal or gastroesophageal junction (GEJ) cancer at an academic medical center between 2008 and 2018 were reviewed. Associations between patient factors and treatment-related toxicities were calculated in univariate (UVA) and multivariable analyses (MVA). RESULTS One hundred forty-seven consecutive patients were identified: 89 CMC and 58 AMC. Median follow-up was 30 months (0.33-124 months). Most patients were male (86%) with adenocarcinoma (90%) located in the distal esophagus or GEJ (95%). Median radiation dose was 50.4 Gy between groups. Radiotherapy at CMCs resulted in higher rates of re-operation after esophagectomy (18% vs 7%, p = 0.055) and increased rates of anastomotic leak (38% vs 17%, p < 0.01). On MVA, radiation at a CMC remained predictive of anastomotic leak (OR 6.13, p < 0.01). CONCLUSION Esophageal cancer patients receiving preoperative radiotherapy had higher rates of anastomotic leaks when radiotherapy was completed at a community medical center versus academic medical center. Explanations for these differences are uncertain but further exploratory analyses regarding dosimetry and radiation field size are warranted.
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Affiliation(s)
- Ryan T Morse
- Department of Radiation Oncology, University of North Carolina Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
| | - Tyler J Mouw
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Matthew Moreno
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, USA
| | - Jace T Erwin
- University of Kansas School of Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Ying Cao
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, USA
| | - Peter DiPasco
- Department of Surgery, University of Kansas Medical Center, Kansas City, USA
| | - Mazin Al-Kasspooles
- Department of Surgery, University of Kansas Medical Center, Kansas City, USA
| | - Andrew Hoover
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, USA
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11
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Mohamad I, Almousa A, Taqash A, Mayta E, Abuhijla F, Ghatasheh H, Ababneh H, Wahbeh L, Abuhijlih R, Hussein T, Al‐Gargaz W, Hosni A. Primary radiation therapy for advanced-stage laryngeal cancer: A laryngo-esophageal dysfunction disease-free survival. Laryngoscope Investig Otolaryngol 2022; 7:1866-1874. [PMID: 36544959 PMCID: PMC9764778 DOI: 10.1002/lio2.972] [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: 07/06/2022] [Revised: 08/30/2022] [Accepted: 10/29/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To evaluate the outcomes of advanced-stage laryngeal squamous cell carcinoma (SCC) patients treated with functional-preservation strategy with a specific focus on laryngo-esophageal dysfunction disease-free survival (LEDDFS). Methods and materials A retrospective review was conducted of stage III-IVB laryngeal SCC patients who were treated with curative-intent radiotherapy (RT) (2007-2018). Patients were preferentially managed with upfront chemoradiation (CCRT); except for those with cN2-3, cT4, or large volume cT3 (induction chemotherapy followed by RT or CCRT is an option), and those who were unfit or declined chemotherapy (received altered RT). The primary endpoint was 3-year LEDDFS, and secondary endpoints were 3-year local failure (LF), regional failure (RF), distant metastasis (DM), overall survival (OS), disease-free survival (DFS), and acute and late toxicities. Cox proportional hazard tests were used for multivariable analysis (MVA). Results A total of 213 cases were included. With a median follow-up of 37 months, the 3-year LEDDFS was 50%, while the 3-year OS, DFS, LF, RF, and DM were 81%, 74%, 9%, 5%, and 7%, respectively. On MVA, cT4-category was the only predictor of inferior LEDDFS (HR: 0.47, [95% CI: 0.29-0.74], p < .01). The most common grade ≥ 3 acute and late radiation therapy oncology group (RTOG) toxicity were esophageal toxicity: 16.7% and 29.6%, respectively. Conclusions Primary RT resulted in favorable oncologic and functional outcomes in only half of the advanced-stage laryngeal cancer patients. Future clinical trials are required to investigate further treatment options aiming to improve the oncologic and maintain functional outcomes with utilization of LEDDFS as the primary endpoint. Level of evidence 4.
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Affiliation(s)
- Issa Mohamad
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Abdelatif Almousa
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Ayat Taqash
- Department of BiostatisticsKing Hussein Cancer CenterAmmanJordan
| | - Ebrahim Mayta
- Department of Surgical OncologyKing Hussein Cancer CenterAmmanJordan
| | - Fawzi Abuhijla
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Hamza Ghatasheh
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Hazem Ababneh
- Department of Radiation OncologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Lina Wahbeh
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Ramiz Abuhijlih
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Tariq Hussein
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Wisam Al‐Gargaz
- Department of Surgical OncologyKing Hussein Cancer CenterAmmanJordan
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer CentreUniversity Health Network, University of TorontoTorontoOntarioCanada
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12
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Melnick KF, Miller P, Carmichael E, McGrath K, Ghiaseddin A, Tran DD, Rahman M. The trial effect in patients with glioblastoma: effect of clinical trial enrollment on overall survival. J Neurooncol 2022; 159:479-484. [PMID: 35840786 DOI: 10.1007/s11060-022-04083-8] [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: 06/03/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine whether participation in a clinical trial was associated with improved survival in patients with glioblastoma (GBM). METHODS Following IRB approval, patients were identified using CPT and ICD codes. Data was collected using retrospective review of electronic medical records. When necessary, death data was obtained from online obituaries. Inverse propensity score matching was utilized to transform the two cohorts to comparable sets. Survival was compared using Kaplan-Meyer curves and Wilcoxon Rank Sum Test. RESULTS In this cohort of 365 patients, 89 were enrolled in a clinical trial and 276 were not. Patients enrolled in clinical trials had a significantly higher mean baseline KPS score, higher proportion of surgical resections, and were more likely to receive temozolomide treatment than patients not enrolled in a clinical trial. After inverse propensity score matching, patients enrolled in a clinical trial lived significantly longer than those not enrolled (28.8 vs 22.2 months, p = 0.005). A potential confounder of this study is that patients not in a clinical trial had significantly fewer visits with neuro-oncologists than patients enrolled in a clinical trial (7 ± 8 vs 12 ± 9, p < 0. 0001). CONCLUSIONS Clinical trials enroll patients with the most favorable prognostic features. Even when correcting for this bias, clinical trial enrollment is an independent predictor of increased survival regardless of treatment arm.
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Affiliation(s)
- Kaitlyn F Melnick
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA.
| | - Patricia Miller
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA
| | - Ethan Carmichael
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA
| | - Kyle McGrath
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Ashley Ghiaseddin
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA
| | - David D Tran
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA
| | - Maryam Rahman
- Department of Neurological Surgery, University of Florida, Gainesville, FL, USA
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13
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Emerging Disparities in Prevention and Survival Outcomes for Patients with Head and Neck Cancer and Recommendations for Health Equity. Curr Oncol Rep 2022; 24:1153-1161. [PMID: 35420396 PMCID: PMC9008381 DOI: 10.1007/s11912-022-01273-5] [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] [Accepted: 01/30/2022] [Indexed: 11/05/2022]
Abstract
Purpose of Review The aim of this review is to describe less known and emerging disparities found in the prevention and survival outcomes for patients with head and neck cancer (HNC) that are likely to play an increasingly important role in HNC outcomes and health inequities. Recent Findings The following factors contribute to HNC incidence and outcomes: (1) the effect of rurality on prevention and treatment of HNC, (2) dietary behavior and nutritional factors influencing the development of and survival from HNC, and (3) barriers and benefits of telehealth for patients with HNC. Summary Rurality, nutrition and diet, and telehealth usage and access are significant contributors to the existing health disparities associated with HNC. Population and culturally specific interventions are urgently needed as well as more research to further define the issues and develop appropriate population and individual level solutions.
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14
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Tanavde VA, Broderick J, Windon MJ, Fakhry C, Stewart CM, Eisele DW, Creighton FX. Factors and Outcomes Associated With Temporal Bone Resection for Primary Parotid Malignancy. Laryngoscope 2021; 131:E2461-E2468. [PMID: 33797071 DOI: 10.1002/lary.29547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE(S) Although parotid cancer invading into the temporal bone makes up only a small fraction of all parotid cancers, it is more common and relatively understudied compared with primary cancer of the external auditory canal. The objective of this study was to determine what factors are associated with receiving parotidectomy with temporal bone resection (TBR) and the immediate postoperative outcomes. METHODS We reviewed the National Cancer Database (2004-2015) for patients with primary parotid malignancy who received parotidectomy with or without TBR. Patient demographic, clinical, and perioperative variables were collected and then compared. Multivariate logistic regression was performed to determine factors associated with receiving TBR. RESULTS We identified 134 patients who received parotidectomy with TBR and 16,595 who received parotidectomy only. Reported in terms of odds ratios (95% confidence interval), our multivariate model showed having surgery at an academic facility (1.91 [1.34-2.71], P < .001), clinical stage III or IV (7.48 [1.65-33.96] and 31.37 [7.61-129.32], P = .009 and P < .001, respectively), histologic grade II to IV (4.36 [1.51-12.57], 4.31 [1.53-12.15], and 6.74 [2.26-20.13], P = .006, .006, and .001, respectively), and adenoid cystic histology (3.23 [2.02-5.17], P < .001) were significantly and independently associated with receiving TBR. There was no significant difference in 30-day readmission, or 30-day or 90-day mortality, but the rate of positive surgical margins was significantly higher in those who underwent TBR. CONCLUSION Demographic variables are not significant factors for receiving TBR. Tumor characteristics, such as clinical stage and histologic type, and receiving surgical treatment at an academic facility were more strongly associated with receiving TBR. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2461-E2468, 2021.
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Affiliation(s)
- Ved A Tanavde
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Joseph Broderick
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Melina J Windon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | | | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Francis X Creighton
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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15
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Qureshi MM, Oladeru OT, Lam CM, Dyer MA, Mak KS, Hirsch AE, Truong MT. Disparities in Laryngeal Cancer Treatment and Outcomes: An Analysis by Hospital Safety-Net Burden. Laryngoscope 2021; 131:E1987-E1997. [PMID: 33555062 DOI: 10.1002/lary.29416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/28/2020] [Accepted: 01/10/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVES/HYPOTHESIS To analyze the impact of hospital safety-net burden on survival outcomes for laryngeal squamous cell carcinoma (LSCC) patients. STUDY DESIGN Retrospective cohort study. METHODS From 2004 to 2015, 59,733 LSCC patients treated with curative intent were identified using the National Cancer Database. Low (LBH) <25th, medium (MBH) 25th-75th, and high (HBH) >75th safety-net burden hospitals were defined by the percentage quartiles (%) of uninsured/Medicaid-insured patients treated. Social and clinicopathologic characteristics and overall survival (using Kaplan-Meier survival analysis) were evaluated. Crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed using Cox regression modeling. RESULTS There were 324, 647, and 323 hospitals that met the criteria as LBH, MBH, and HBH, respectively. The median follow-up was 38.6 months. A total of 27,629 deaths were reported, with a median survival of 75.8 months (a 5-year survival rate of 56.6%). Median survival was 83.2, 77.8, and 69.3 months for patients from LBH, MBH, and HBH, respectively (P < .0001). The median % of uninsured/Medicaid-insured patients treated among LBH, MBH, and HBH were 3.6%, 14.0%, and 27.0%, respectively. Patients treated at HBH were significantly more likely to be young, Black, Hispanic, of low income, and present with more advanced disease compared to LBH and MBH. Survival was comparable for LBH and MBH (HR = 1.02; 95% CI = 0.97-1.07, P = .408) on multivariate analysis. HBH, compared to LBH patients, had inferior survival (HR = 1.07; 95% CI = 1.01-1.13, P = .023). CONCLUSIONS High burden safety-net hospitals receive disproportionately more patients with advanced-stage and low socioeconomic status, yielding inferior survival compared to low burden hospitals. LEVEL OF EVIDENCE 3 (individual cohort study) Laryngoscope, 131:E1987-E1997, 2021.
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Affiliation(s)
- Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Oluwadamilola T Oladeru
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Christa M Lam
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Michael A Dyer
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Kimberley S Mak
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
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16
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Cummings MA, Ma SJ, Van Der Sloot P, Milano MT, Singh DP, Singh AK. Squamous cell carcinoma of the head and neck with unknown primary: trends and outcomes from a hospital-based registry. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:284. [PMID: 33708911 PMCID: PMC7944267 DOI: 10.21037/atm-20-4631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Squamous cell carcinoma of unknown primary of the head and neck region is a known entity described mainly by retrospective reports. We searched a hospital-based registry to better describe the changing incidence, and to assess diagnostic and treatment strategies. Methods The National Comprehensive Cancer Database was queried for head and neck cancers from oropharynx, tonsil, tongue, larynx, hypopharynx primary sites with a designation of clinical T0, representing an unknown primary. Kaplan Meier, Cox multivariate models, and propensity matched cohorts were used to assess significant factors for overall survival. Results There were 964 cases that met the criteria, and 468 cases with known treatments, staging, and survival data. The incidence increased over time, with the highest rates supported in the last 5 years. In patients who underwent HPV testing, 72% were positive. Patients with AJCC 7th clinical N2c or N3 disease had significantly worse outcomes despite the majority receiving neck dissection, radiation, and chemotherapy. Local surgery, compared to incisional or excisional biopsy, had the highest diagnostic yield of finding a primary tumor. In multivariate models, no combination of surgical approach, radiation, or systemic therapy was significantly associated with improved survival. This remained true in 1:1 propensity matched cohorts for age, comorbidities, and clinical nodal burden. In a subset of cN1 patients, combined chemoradiation therapy after excisional biopsy or local surgery was associated with (not statistically significant) improved survival compared to radiation alone (P=0.054). Conclusions The incidence of unknown primary head and neck carcinoma is increasing, and current cases have a high proportion of HPV positivity. HPV positivity predicts strongly for a tonsil primary. Local surgery was associated with the highest diagnostic yield. Clinical nodal burden strongly predicts for overall outcome, and type of treatment facility is an important driver of survival. A subset of cN1 patients may benefit from the addition of chemotherapy to radiation.
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Affiliation(s)
- Michael A Cummings
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Paul Van Der Sloot
- Department of Ear Nose and Throat Surgery, University of Rochester, Rochester, NY, USA
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Deepinder P Singh
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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17
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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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18
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An Analysis and Comparison of Survival and Functional Outcomes in Oropharyngeal Squamous Cell Carcinoma Patients Treated with Concurrent Chemoradiation Therapy within City of Hope Cancer Center Sites. J Clin Med 2020; 9:jcm9103083. [PMID: 32987866 PMCID: PMC7601157 DOI: 10.3390/jcm9103083] [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: 07/08/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/02/2022] Open
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC) is a subset of head and neck cancers that can arise due to human papillomavirus (HPV) infection. We designed a retrospective analysis to determine differences in outcomes of OPSCC patients treated at City of Hope (COH) Cancer Center’s main campus versus selected satellite sites with COH-associated faculty and facilities. Patients diagnosed with OPSCC and treated with concurrent chemoradiation therapy (n = 94) were identified and included in the study. Patients underwent treatment at the COH main campus site (n = 50) or satellite sites (n = 44). The majority of patients were Caucasian, male, and diagnosed with p16 positive stage IV locally advanced OPSCC by AJCC 7th edition. Most patients completed their prescribed cumulative radiation therapy dose and had a complete response to treatment. No significant difference in overall survival and progression-free survival was observed between the main campus and the satellite sites. Our study demonstrates successful treatment completion rates as well as comparable recurrence rates between the main campus and COH-associated satellite sites. A trend toward significant difference in feeding tube dependency at 6-months was observed. Differences in feeding tube placement and dependency rates could be addressed by the establishment of on-site supportive services in satellite sites.
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19
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Sullivan CB, Al-Qurayshi Z, Anderson CM, Seaman AT, Pagedar NA. Factors Associated With the Choice of Radiation Therapy Treatment Facility in Head and Neck Cancer. Laryngoscope 2020; 131:1019-1025. [PMID: 32846018 DOI: 10.1002/lary.29033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the clinicodemographic characteristics and treatment outcomes of patients receiving postoperative radiation therapy (PORT) at a different treatment facility rather than the initial surgical facility for head and neck cancer. STUDY DESIGN Retrospective cohort analysis. METHODS Utilizing the National Cancer Data Base, 2004 to 2015, patients with a diagnosis of oral cavity/oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinoma were studied. Multivariate analysis was completed with multivariate regression and Cox proportional hazard model, and survival outcomes were examined using Kaplan-Meier analysis. RESULTS A total of 15,181 patients who had surgery for a head and neck cancer at an academic/research center were included in the study population. Of the study population, 4,890 (32.2%) patients completed PORT at a different treatment facility. Treatment at a different facility was more common among patients who were ≥65 years old, white, Medicare recipients, those with a greater distance between residence and surgical treatment facility, and with lower income within area of residence (each P < .05). Overall survival was worse in patients completing PORT at a different treatment facility versus at the institution where surgery was completed (61.9% vs. 66.4%; P = .002). CONCLUSIONS PORT at a different facility was more common in older individuals, Medicare recipients, those with greater distance to travel, and lower-income individuals. Completing PORT outside the hospital where surgery was performed was associated with inferior survival outcomes among head and neck cancer patients. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1019-1025, 2021.
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Affiliation(s)
- Christopher B Sullivan
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Zaid Al-Qurayshi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Aaron T Seaman
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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20
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Nahleh ZA, Elimimian EB, Elson LC, Hobbs B, Wei W, Blake CN. Endocrine Therapy Plus Anti-HER2 Therapy as Adjuvant Systemic Therapy for Luminal HER2-Positive Breast Cancer: An Analysis of the National Cancer Database. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2020; 14:1178223420945694. [PMID: 32821110 PMCID: PMC7412624 DOI: 10.1177/1178223420945694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/12/2020] [Indexed: 01/04/2023]
Abstract
Background: Guidelines regarding the usage of adjuvant systemic therapy in patients with small human epidermal growth factor receptor 2 (HER2)-positive and estrogen receptor/progesterone receptor–positive (luminal HER2 positive) tumors are nonspecific. Outcomes of chemotherapy followed by endocrine therapy (ET), with or without anti-HER2 therapy, vs ET alone (no chemotherapy) have not been widely studied in this disease subtype. We sought to examine the usage and outcomes of adjuvant systemic therapy (ET vs chemotherapy with or without trastuzumab) in stage I luminal HER2-positive breast cancer (BC), based on the large National Cancer Database. Methods: We conducted a retrospective analysis of patients with luminal HER2-positive stage I BC, diagnosed between 2010 and 2015, in the United States, using univariable and multivariable logistic regression analyses. The Kaplan-Meier method estimated overall survival (OS). Results: A total of 37 777 patients were included in the analysis; of these, n = 32 594 (86%) received adjuvant ET and n = 5183 (14%) received chemotherapy. Around 40% of all patients received anti-HER2 therapy (trastuzumab). Patients who received trastuzumab had a better 5-year OS (93.4% vs 92.0%, P = .0002) compared with those who did not. Patients who received anti-HER2 therapy plus ET had the best OS rate at 5 years (93.5%, confidence interval [CI]: 89.2%-98%, P < .0001) compared with those receiving anti-HER2 therapy plus chemotherapy (92.7%, CI: 89.4%-96.1%, P < .0001). Conclusions: Most patients in the United States, with stage I luminal HER2 positive BC, received ET, not chemotherapy but most of them do not receive anti-HER2 therapy resulting in inferior outcome. Future trials exploring the de-escalation of systemic adjuvant therapy for early-stage luminal HER2-positive BC to ET plus anti-HER2 therapy would be desirable.
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Affiliation(s)
- Zeina A Nahleh
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Elizabeth B Elimimian
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Leah C Elson
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Brian Hobbs
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Wei Wei
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Cassann N Blake
- Department of Surgery, Cleveland Clinic Florida, Weston, FL, USA
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21
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Farquhar DR, Masood MM, Lenze NR, Sheth S, Patel SN, Lumley C, Zanation AM, Weissler MC, Olshan AF, Hackman TG. Academic Affiliation and Surgical Volume Predict Survival in Head and Neck Cancer Patients Receiving Surgery. Laryngoscope 2020; 131:E479-E488. [PMID: 32449832 DOI: 10.1002/lary.28744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether the academic affiliation or surgical volume affects the overall survival (OS) of human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC) patients receiving surgery. METHODS A retrospective study of 39 North Carolina Medical Centers was conducted. Treatment centers were classified as academic hospitals, community cancer centers, or community hospitals and were divided into thirds by volume. The primary outcome was 5-year OS. Hazard ratios (HR) were determined using Cox proportional hazard models, adjusting for demographics, tumor site, stage, insurance status, tobacco use, alcohol use, stage, chemotherapy, and radiation therapy. Patients were also stratified by stage (early stage and advanced stage). RESULTS Patients treated at community cancer centers had significantly better 5-year OS (HR 0.68, 95% confidence interval [CI] = 0.48-0.98), and patients treated at academic hospitals trended toward better 5-year OS (HR 0.72, 95% CI = 0.50-1.04) compared to patients treated at community hospitals. The effect for academic affiliation on survival was more pronounced for patients with advanced stage cancer at diagnosis (HR 0.60, 95% CI = 0.37-0.95). There were no significant survival differences among early stage patients by treatment center type. Top-third (HR = 0.64, 95% CI = 0.42-0.96) centers by surgical volume had significantly better 5-year OS, and middle-third (HR = 0.71, 95% CI = 0.51-1.03) centers by volume trended toward better 5-year OS when compared to the bottom-third centers by volume. CONCLUSION Patients treated at academic hospitals, community cancer centers, and hospitals in the top third by case volume have favorable survival for HPV-negative HNSCC. The effect for academic hospitals is most pronounced among advanced stage patients. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E479-E488, 2021.
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Affiliation(s)
- Douglas R Farquhar
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Maheer M Masood
- Department of Otolaryngology/Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Missouri, U.S.A
| | - Nicholas R Lenze
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Siddharth Sheth
- Department of Hematology/Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Samip N Patel
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Catherine Lumley
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Adam M Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Mark C Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Trevor G Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
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22
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W Kim D, Raoof S, Lamba N, Lee G, S Bitterman D, R Mahal A, N Sanford N, B Lam M, J Mamon H. Definitive re-irradiation of locally recurrent esophageal cancer after trimodality therapy in patients with a poor performance status. Mol Clin Oncol 2020; 13:27-32. [PMID: 32454972 PMCID: PMC7241232 DOI: 10.3892/mco.2020.2044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023] Open
Abstract
There are few treatment guidelines for locally recurrent esophageal cancer after trimodality treatment (pre-operative chemoradiation followed by surgery) in patients with a poor performance status. The purpose of this single institutional, retrospective study was to evaluate the clinical outcomes and toxicities of definitive-intent re-irradiation for patients with recurrent esophageal cancer with a poor performance status [ECOG (Eastern Cooperative Oncology Group) ≥2]. Seven patients were identified with a median age of 74 years (range, 61-81 years). Four patients were ECOG 2 and three patients were ECOG 3. The median follow-up time after re-irradiation was 49 months. The median interval between initial radiotherapy and re-treatment was 32 months. Six patients received concurrent chemotherapy [carboplatin + paclitaxel in three patients; folinic acid, fluorouracil, oxaliplatin (FOLFOX) + 5-fluorouracil in one patient; FOLFOX in one patient, and capecitabine in one patient]. At the last follow-up, the six patients who underwent concurrent chemotherapy had stable disease (86%), while the one who did not receive chemotherapy progressed (14%). Two patients developed metastases. Three patients developed acute (<6 months) grade 4 toxicities (dysphagia, anemia, esophagitis). There were no early deaths attributable to treatment. Late toxicities (>6 months) were limited to grades 1 and 2 dysphagia and pneumonitis in four patients. In conclusion, definitive re-irradiation of recurrent esophageal cancer in patients with a poor performance status appears to be safe with acceptable acute toxicity and late complications. It also appears to result in durable local control when combined with chemotherapy, albeit with a small number of patients and limited follow-up.
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Affiliation(s)
- Daniel W Kim
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Sana Raoof
- Harvard Medical School, Boston, MA 02115, USA
| | - Nayan Lamba
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Grace Lee
- Harvard Medical School, Boston, MA 02115, USA
| | - Danielle S Bitterman
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA 02115, USA
| | | | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Miranda B Lam
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Harvey J Mamon
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA 02115, USA
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23
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Elicin O, Giger R. Comparison of Current Surgical and Non-Surgical Treatment Strategies for Early and Locally Advanced Stage Glottic Laryngeal Cancer and Their Outcome. Cancers (Basel) 2020; 12:cancers12030732. [PMID: 32244899 PMCID: PMC7140062 DOI: 10.3390/cancers12030732] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 12/27/2022] Open
Abstract
For the treatment of early and locally advanced glottic laryngeal cancer, multiple strategies are available. These are pursued and supported by different levels of evidence, but also by national and institutional traditions. The purpose of this review article is to compare and discuss the current evidence supporting different loco-regional treatment approaches in early and locally advanced glottic laryngeal cancer. The focus is kept on randomized controlled trials, meta-analyses, and comparative retrospective studies including the treatment period within the last twenty years (≥ 1999) with at least one reported five-year oncologic and/or functional outcome measure. Based on the equipoise in oncologic and functional outcome after transoral laser surgery and radiotherapy, informed and shared decision-making with and not just about the patient poses a paramount importance for T1-2N0M0 glottic laryngeal cancer. For T3-4aN0-3M0 glottic laryngeal cancer, there is an equipoise regarding the partial/total laryngectomy and non-surgical modalities for T3 glottic laryngeal cancer. Patients with extensive and/or poorly functioning T4a laryngeal cancer should not be offered organ-preserving chemoradiotherapy with salvage surgery as a back-up plan, but total laryngectomy and adjuvant (chemo) radiation. The lack of high-level evidence comparing contemporary open or transoral robotic organ-preserving surgical and non-surgical modalities does not allow any concrete conclusions in terms of oncological and functional outcome. Unnecessary tri-modality treatments should be avoided. Instead of offering one-size-fits-all approaches and over-standardized rigid institutional strategies, patient-centered informed and shared decision-making should be favored.
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Affiliation(s)
- Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland;
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
- Correspondence:
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24
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Bradford CR, Ferlito A, Devaney KO, Mäkitie AA, Rinaldo A. Prognostic factors in laryngeal squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2020; 5:74-81. [PMID: 32128433 PMCID: PMC7042656 DOI: 10.1002/lio2.353] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 01/12/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The current treatment results of laryngeal squamous cell carcinoma still remain modest. Various prognostic factors have been investigated and need to be included in the management decision making. METHODS We reviewed the pertinent literature regarding host, tumor, and treatment factors as prognostic indicators that influence outcome in patients diagnosed with laryngeal squamous cell carcinoma. RESULTS Host, tumor, and treatment factors all have an important impact upon an individual patient's prognosis with laryngeal squamous cell carcinoma, whereas staging systems only take into account tumor factors. There is much work yet to be done to establish reliable, independent biomarkers that predict survival and response to treatment. CONCLUSIONS Optimal outcomes for an individual patient can be achieved when taking into account tumor, host, and treatment factors.
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Affiliation(s)
- Carol R. Bradford
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - Alfio Ferlito
- International Head and Neck Scientific GroupPaduaItaly
| | | | - Antti A. Mäkitie
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Research Program in Systems Oncology, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and TechnologyKarolinska Institutet and Karolinska HospitalStockholmSweden
| | - Alessandra Rinaldo
- Former Department of Otolaryngology‐Head and Neck Surgery, University of Udine School of MedicineUdineItaly
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25
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Ng SP, Bahig H, Jethanandani A, Pollard C, Berends J, Sturgis EM, Johnson FM, Elgohari B, Elhalawani H, Rosenthal DI, Skinner HD, Gunn GB, Phan J, Frank SJ, Mohamed ASR, Fuller CD, Garden AS. Lymphopenia during radiotherapy in patients with oropharyngeal cancer. Radiother Oncol 2020; 145:95-100. [PMID: 31931292 DOI: 10.1016/j.radonc.2019.12.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE/OBJECTIVE Radiation-induced lymphopenia has been associated with poor survival outcomes in certain solid tumors such as esophageal, lung, cervical and pancreatic cancers. We aim to determine the effect of treatment-related lymphopenia during radiotherapy on outcomes of patients with oropharyngeal cancer. MATERIALS/METHODS A retrospective analysis of all patients who completed definitive radiotherapy for oropharyngeal cancer at The University of Texas MD Anderson Cancer Center and had blood counts taken during radiotherapy from 2002 to 2013 were included. Patient, tumor and treatment characteristics, clinical outcomes and lymphocyte counts during radiotherapy were recorded. Lymphopenia was graded according to the CTCAE v4.0. Survival rates were estimated using the Kaplan-Meier method and compared with log-rank tests. RESULTS 850 patients were evaluated. The median age was 57 years. The majority of the cohort had p16/HPV-positive disease (71%), 8% had HPV-negative disease and 21% were unknown. The median radiation total dose was 70 Gy. 45% of patients had induction chemotherapy, and 87% had concurrent chemotherapy. 703 (83%) patients developed ≥grade 3 (G3) lymphopenia and 209 (25%) had grade 4 (G4) lymphopenia during radiotherapy. The median follow-up was 59 months; the 5-year overall survival rate was 81%. There were no significant differences in overall survival rates nor in disease control rates, in those who developed G3/G4 lymphopenia compared with those who did not. No significant effect of lymphopenia on survival was observed when analyzed according to p16/HPV status. CONCLUSION In this large cohort of patients with oropharyngeal cancer, the development of lymphopenia during radiotherapy did not impact outcomes.
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Affiliation(s)
- Sweet Ping Ng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Canada
| | - Amit Jethanandani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Courtney Pollard
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Joel Berends
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Faye M Johnson
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Baher Elgohari
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Hesham Elhalawani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Heath D Skinner
- Department of Radiation Oncology, UPMC Hillman Cancer Centers, Pittsburgh, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Carey RM, Fathy R, Shah RR, Rajasekaran K, Cannady SB, Newman JG, Ibrahim SA, Brant JA. Association of Type of Treatment Facility With Overall Survival After a Diagnosis of Head and Neck Cancer. JAMA Netw Open 2020; 3:e1919697. [PMID: 31977060 PMCID: PMC6991286 DOI: 10.1001/jamanetworkopen.2019.19697] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Patients with head and neck cancer receive care at academic comprehensive cancer programs (ACCPs), integrated network cancer programs (INCPs), comprehensive community cancer programs (CCCPs), and community cancer programs (CCPs). The type of treatment facility may be associated with overall survival. OBJECTIVE To examine whether type of treatment facility is associated with overall survival after a diagnosis of head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study included patients from the National Cancer Database, a prospectively maintained, hospital-based cancer registry of patients treated at more than 1500 US hospitals. Participants were diagnosed with malignant tumors of the head and neck from January 1, 2004, through December 31, 2016. Data were analyzed from May 1 through November 30, 2019. EXPOSURES Treatment at facilities classified as ACCPs, INCPs, CCCPs, or CCPs. MAIN OUTCOMES AND MEASURES Overall survival after diagnosis and treatment of head and neck cancer was the primary outcome. The secondary outcome was the odds of receiving treatment at ACCPs and INCPs vs CCCPs and CCPs. Multivariable Cox proportional hazards regression and univariable and multivariable logistic regression models were used for analysis. RESULTS A total of 525 740 patients (368 821 men [70.2%]; mean [SD] age, 63.3 [14.0] years) were diagnosed with malignant tumors of the head and neck during the study period. Among them, 36 595 patients (7.0%) were treated at CCPs; 174 658 (33.2%), at CCCPs; 232 867 (44.3%), at ACCPs; and 57 857 (11.0%), at INCPs. The median survival for patients with aerodigestive cancers was 69.2 (95% CI, 68.6-69.8) months; salivary gland cancers, 107.2 (95% CI, 103.9-110.2) months; and skin cancers, 113.2 (95% CI, 111.4-114.6) months. Improved overall survival was associated with treatment at ACCPs (hazard ratio [HR], 0.89; 95% CI, 0.88-0.91), INCPs (HR, 0.94; 95% CI, 0.92-0.96), and CCCPs (HR, 0.94; 95% CI, 0.92-0.95) compared with CCPs. Compared with patients with private insurance, those with government insurance (odds ratio [OR], 1.35; 95% CI, 1.29-1.41), no insurance (OR, 1.12; 95% CI, 1.09-1.16), or Medicaid (OR, 1.17; 95% CI, 1.14-1.20) were more likely to receive treatment at ACCPs and INCPs, whereas patients with Medicare were less likely to receive treatment at ACCPs and INCPs (OR, 0.95; 95% CI, 0.94-0.97). Compared with white patients, black (OR, 1.55; 95% CI, 1.52-1.59) and Asian (OR, 1.56; 95% CI, 1.49-1.63) patients were more likely to receive care at ACCPs and INCPs. Compared with patients from lower-income areas, patients from high-income areas were more likely to receive treatment at ACCPs and INCPs (OR, 1.25; 95% CI, 1.22-1.28). CONCLUSIONS AND RELEVANCE These findings suggest that treatment at ACCPs and INCPs was associated with a better overall survival rate in patients with head and neck cancer. Key social determinants of health such as race/ethnicity, socioeconomic status, and type of insurance were associated with receiving treatment at ACCPs and INCPs.
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Affiliation(s)
- Ryan M. Carey
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ramie Fathy
- currently a medical student at Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ravi R. Shah
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Steven B. Cannady
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jason G. Newman
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Said A. Ibrahim
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Jason A. Brant
- Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Yu J, Choi JS, Giannoni C, Patel AJ, Gallagher KK. Juvenile Nasopharyngeal Angiofibroma Outcomes and Cost: Analysis of the Kids’ Inpatient Database. Ann Otol Rhinol Laryngol 2019; 129:498-504. [DOI: 10.1177/0003489419896597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: To report trends in Juvenile Nasopharyngeal Angiofibroma (JNA) hospitalizations and identify key factors affecting treatment outcomes and cost of care in JNA patients. Methods: The Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database was queried for all cases of JNA between the years of 1997 and 2016. Key factors extracted were patient demographics, geographic region, hospital size, teaching status, elective admissions, and number of diagnoses and procedures performed during the hospitalization. These elements were correlated to length of stay (LOS) and cost-per-day (CPD) using a multiple linear regression (MLR). Regional variation in JNA diagnosis and changes in LOS and CPD trends over time were also analyzed. Results: A total of 614 JNA patients were hospitalized in this time period, with a majority of patients identifying as male (98%) and Caucasian/White (55%). The average LOS has decreased by 0.14 day per year since 1997 ( P = .0034) whereas the CPD has steadily increased by $2 380 per year ( P < .001). MLR analysis revealed that while holding all other factors constant, patients who stayed at teaching hospitals had an increased LOS of 1.7 days ( P = .026), but paid $11 961 less per day ( P = .05). Regional variation in CPD was found in the Northeast region, where hospitalizations were more expensive by $9 801 per day compared to the South ( P = .017). Conclusion: These results indicate hospital characteristics, such as teaching status and geographic region, may predict differences in JNA outcomes and cost. Healthcare providers should be cognizant of these variations to ensure optimal patient outcomes and expenditures.
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Affiliation(s)
- Justin Yu
- Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan S. Choi
- Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Carla Giannoni
- Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Akash J. Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - K. Kelly Gallagher
- Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
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Massa ST, Liebendorfer AP, Zevallos JP, Mazul AL. Distance Traveled to Head and Neck Cancer Provider: A Measure of Socioeconomic Status and Access. Otolaryngol Head Neck Surg 2019; 162:193-203. [DOI: 10.1177/0194599819892015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective Improved head and neck cancer survival has been associated with traveling farther distances for treatment, potentially due to patients seeking higher-quality facilities. This study investigates the role of both facility and confounding patient factors on this relationship. Study Design Review of national registry data. Setting National Cancer Database. Subjects and Methods Adults with head and neck cancer diagnosed from 2004 to 2014 were identified. Overall survival was compared among distance-to-facility quartiles via univariate and multivariate survival models. Then, the analysis was stratified by facility and patient factors, and the association between distance and survival was compared among strata. Results Overall survival was worst in the shortest-distance quartile (<5 miles; median survival, 80.7 months; 95% CI, 79.2-82.3), while other distance groups showed similar survival (range, 96.4-104 months). This finding remained in the multivariate model (adjusted hazard ratio vs first distance quartile: 0.88; 95% CI, 0.87-0.89). The association between survival and distance persisted in all subgroups when stratified by facility volume and type (adjusted hazard ratio range, 0.82-0.91), suggesting that facility quality does not fully account for this association. When stratified by income, distance remained statistically associated with survival but with a smaller effect size than that of income. Conclusion The association between distance to treating facility and head and neck cancer survival is limited to patients with worse survival outcomes living within 5 miles of the facility and is not fully explained by measures of facility quality.
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Affiliation(s)
- Sean T. Massa
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Jose P. Zevallos
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Angela L. Mazul
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Parvathaneni U, Lavertu P, Gibson MK, Glastonbury CM. Advances in Diagnosis and Multidisciplinary Management of Oropharyngeal Squamous Cell Carcinoma: State of the Art. Radiographics 2019; 39:2055-2068. [PMID: 31603733 DOI: 10.1148/rg.2019190007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
During the past decade and a half, the most common cause of oropharyngeal squamous cell carcinoma (OPSCC) has shifted from tobacco and alcohol to the human papillomavirus (HPV). HPV-driven p16-positive OPSCC and tobacco-related OPSCC differ in their underlying molecular and genetic profiles, socioeconomic demographics, and response to treatment. HPV-related OPSCC tends to occur in younger patients and has a significantly better response to treatment and excellent prognosis. The stark contrast in prognosis-with around 90% overall 5-year survival for HPV-related p16-positive OPSCC and 40% for non-HPV-related p16-negative OPSCC-has prompted major changes in the eighth edition of the staging manual of the AJCC (American Joint Committee on Cancer). The past 10-15 years have also witnessed major advances in surgery, radiation therapy (RT), and systemic therapy. Minimally invasive surgery has come of age, with transoral robotic procedures and laser microsurgery. Intensity-modulated RT (IMRT) and more recently proton-beam RT have markedly improved the conformity of RT, with an ability to precisely target the cancer and cancer-bearing regions while sparing normal structures and significantly reducing long-term treatment-related morbidity. Progress in systemic therapy has come in the form of immunotherapy and targeted agents such as cetuximab. Owing to the better prognosis of HPV-driven OPSCC as well as the morbidity associated with treatment, de-escalation of therapy via multiple strategies is being explored. The article reviews the advances in diagnosis and multidisciplinary management of OPSCC in the HPV era.©RSNA, 2019.
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Affiliation(s)
- Upendra Parvathaneni
- From the Department of Radiation Oncology, University of Washington, 1959 NE Pacific Ave, Seattle, WA 98195-6043 (U.P.); Ear Nose and Throat Institute, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio (P.L.); Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tenn (M.K.G.); and Department of Radiology, University of California, San Francisco, San Francisco, Calif (C.M.G.)
| | - Pierre Lavertu
- From the Department of Radiation Oncology, University of Washington, 1959 NE Pacific Ave, Seattle, WA 98195-6043 (U.P.); Ear Nose and Throat Institute, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio (P.L.); Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tenn (M.K.G.); and Department of Radiology, University of California, San Francisco, San Francisco, Calif (C.M.G.)
| | - Michael K Gibson
- From the Department of Radiation Oncology, University of Washington, 1959 NE Pacific Ave, Seattle, WA 98195-6043 (U.P.); Ear Nose and Throat Institute, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio (P.L.); Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tenn (M.K.G.); and Department of Radiology, University of California, San Francisco, San Francisco, Calif (C.M.G.)
| | - Christine M Glastonbury
- From the Department of Radiation Oncology, University of Washington, 1959 NE Pacific Ave, Seattle, WA 98195-6043 (U.P.); Ear Nose and Throat Institute, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio (P.L.); Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tenn (M.K.G.); and Department of Radiology, University of California, San Francisco, San Francisco, Calif (C.M.G.)
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30
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Nocon CC, Ajmani GS, Bhayani MK. Association of Facility Volume With Positive Margin Rate in the Surgical Treatment of Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2019; 144:1090-1097. [PMID: 30347018 DOI: 10.1001/jamaoto.2018.2421] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance The achievement of complete tumor resection with tumor-free margins is one of the main principles of oncologic surgery for head and neck squamous cell carcinoma (HNSCC). The negative prognostic influence of a positive margin (PM) across all head and neck subsites has been well established. National guidelines recommend the use of adjuvant chemoradiation therapy (CRT) in the setting of PM. Objective To determine the incidence of PM in HNSCC across multiple subsites, as well as the factors associated with its occurrence. Design, Setting, and Participants This retrospective cohort study used the National Cancer Database to identify patients diagnosed with HNSCC between 2010 and 2014 and who underwent surgical resection (n = 28 840). Main Outcomes and Measures Predictors of PM rate and likelihood to receive adjuvant CRT. Results Among the 28 840 patients included in this study, 19 727 (68.4 %) were men, and the average age was 62.4 years (range, 40 to ≥90 years). In univariable analysis, a lower PM rate was associated with higher facility volume (26.3% for the lowest volume quartile, 16.5% for the middle 2 quartiles, and 10.8% for the highest volume quartile) and treatment at academic vs nonacademic facilities (14.0% vs 22.7%). In multivariate analysis, those treated at higher-volume facilities remained significantly less likely to have PM (adjusted odds ratio, 0.85; 95% CI, 0.83-0.88). The trend of decreasing PM rate with increasing facility volume was observed in both academic (aOR, 0.88 per 10-case volume increase [95% CI, 0.85-0.91]) and nonacademic (aOR, 0.73 per 10-case volume increase [95% CI, 0.68-0.80]) facilities. There was no association between facility volume and patient likelihood of receiving adjuvant CRT in the setting of PM (compared with CCPs: aOR, 0.98 per 10-case volume increase [95% CI, 0.84-1.14] for CCCPs; and aOR, 1.24 [95% CI, 0.99-1.55] for INCPs). Conclusions and Relevance These findings suggest that high-volume facilities are associated with lower rates of PM in the surgical treatment of HNSCC in both academic and nonacademic settings. Facility volume for head and neck oncologic surgeries may be considered a benchmark for quality of care.
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Affiliation(s)
- Cheryl C Nocon
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.,Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Gaurav S Ajmani
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Mihir K Bhayani
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.,Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
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Obayemi A, Cracchiolo JR, Migliacci JC, Husain Q, Rahmati R, Roman BR, Cohen MA. Elective neck dissection (END) and cN0 hard palate and upper gingival cancers: A National Cancer Database analysis of factors predictive of END and impact on survival. J Surg Oncol 2019; 120:1259-1265. [PMID: 31549410 DOI: 10.1002/jso.25706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The reported risk of nodal metastasis in hard palate and upper gingival squamous cell carcinoma (SCC) has been inconsistent with inadequate consensus regarding the utility of neck dissection in the clinically negative (cN0) neck. MATERIALS AND METHODS Using the National Cancer Database, cN0 patients diagnosed with SCC of the head and neck with the subsites of the hard palate and upper gingiva were identified from 2004 to 2014. RESULTS A total of 1830 patients were identified, and END was performed on 422 patients with cN0 tumors. Pathologically positive nodes occurred in 14% (59/422) of patients in this cohort. Higher tumor stage, academic hospital type, and large hospital volume (>28 cancer-specific cases/year) were associated with a higher likelihood of END both in univariate and multivariate analyses (P < .05). Patients >80 years of age were less likely to receive END on multivariate analysis (OR 0.52, 0.32-0.84). No variables, including advanced T stage, predicted occult metastases. Cox proportional hazards regression analysis showed that patients who underwent END demonstrated improved OS over an 11-year period (hazard ratio 0.75, P = .002). On subgroup analysis, this improvement was significant in patients with both stage T1 and T4 tumors. CONCLUSIONS Tumor stage, hospital type, and hospital volume were associated with higher rates of END for patients with cN0 hard palate SCC and after controlling for clinical factors, END was associated with improved overall survival.
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Affiliation(s)
- Adetokunbo Obayemi
- Department of Otolaryngology Head and Neck Surgery, Columbia University Medical Center, New York, New York
| | - Jennifer R Cracchiolo
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jocelyn C Migliacci
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Qasim Husain
- Coastal Ear, Nose, and Throat, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey
| | - Rahmatullah Rahmati
- Department of Otolaryngology Head and Neck Surgery, Columbia University Medical Center, New York, New York
| | - Benjamin R Roman
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc A Cohen
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Merlano M, Denaro N, Benasso M, Licitra L, Bossi P, Locati L, Vecchio S, Bruzzi P. Difficulties in conducting pure academic research, obstacles in data collection and quality of informations: The example of the INTERCEPTOR study. Oral Oncol 2019; 97:99-104. [PMID: 31472438 DOI: 10.1016/j.oraloncology.2019.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/20/2019] [Accepted: 08/25/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE/OBJECTIVE On September 2009: We started a randomized multicenter phase III study comparing chemoradiation (CRT) (Aldestein RTOG regimen) versus induction chemotherapy followed by Cetuximab radiation (IBRT). The main study's aim was comparison of overall survival but no formal analyses have been made between the two arms because of low accrual and high amount of missing data. The goal of this paper is to identify the reasons of difference in accrual and quality of data among participating centers. MATERIAL/METHODS Statistic: We correlated data collection quality with relevance of the centers, accrual and number of scientific papers (both specific on HNC and other topics) of each PI. We created an HNC publishing score dividing the number of HNC specific papers for the overall number of published papers. RESULTS We observed a strong difference in the accrual of pts as well as in the quality of data among the participating centers. The accrual was independent from the quality of data since some centers with low accrual produced high quality data with an excellent follow up. We found a correlation among both number of published papers of each PI and HNC publishing score with the quality of data. CONCLUSION The study demonstrated that expertise in HNC is important not only to ensure a better outcomes but also to provide high quality data in phase III trials.
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Affiliation(s)
- M Merlano
- Medical Oncology, St. Croce & Carle University Teaching Hospital, ARCO Foundation, Cuneo, Italy
| | - N Denaro
- Medical Oncology, St. Croce & Carle University Teaching Hospital, Cuneo, Italy.
| | - M Benasso
- Medical Oncology, San Paolo General Hospital Savona, Italy
| | - L Licitra
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, University of Milan, Milan, Italy.
| | - P Bossi
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, University of Milan, Milan, Italy.
| | - L Locati
- Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, University of Milan, Milan, Italy.
| | - S Vecchio
- Medical Oncology, IRCCS San Martino, IST National Cancer Institute and University of Genova, Genova, Italy.
| | - P Bruzzi
- Statistic Unit, Genova University, Italy
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Locati LD, Piovesan A, Durante C, Bregni M, Castagna MG, Zovato S, Giusti M, Ibrahim T, Puxeddu E, Fedele G, Pellegriti G, Rinaldi G, Giuffrida D, Verderame F, Bertolini F, Bergamini C, Nervo A, Grani G, Rizzati S, Morelli S, Puliafito I, Elisei R. Real-world efficacy and safety of lenvatinib: data from a compassionate use in the treatment of radioactive iodine-refractory differentiated thyroid cancer patients in Italy. Eur J Cancer 2019; 118:35-40. [PMID: 31299580 DOI: 10.1016/j.ejca.2019.05.031] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/22/2019] [Accepted: 05/26/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lenvatinib is a multi-kinase inhibitor approved for patients with radioactive iodine (RAI)-resistant differentiated thyroid cancer (DTC). Before the drug approval from the Italian National Regulatory Agency, a compassionate use programme has been run in Italy. This retrospective study aimed to analyse data from the first series of patients treated with lenvatinib in Italy. METHODS The primary aim was to assess the response rate (RR) and progression-free survival (PFS). Secondary end-points include overall survival (OS) and toxicity data. RESULTS From November 2014 to September 2016, 94 patients were treated in 16 Italian sites. Seventeen percent of patients had one or more comorbidities, hypertension being the most common (60%). Ninety-eight percent of patients were treated by surgery, followed by RAI in 98% of cases. Sixty-four percent of patients received a previous systemic treatment. Lenvatinib was started at 24 mg in 64 subjects. Partial response and stable disease were observed in 36% and in 41% of subjects, respectively; progression was recorded in 14% of patients. Drug-related side-effects were common; the most common were fatigue (13.6%) and hypertension (11.6%). Overall, median PFS and OS were 10.8 months (95% confidence interval [CI], 7.7-12.6) and 23.8 months (95% CI, 19.7-25.0) respectively. CONCLUSION Lenvatinib is active and safe in unselected, RAI-refractory, progressive DTC patients in real-life setting. RR and PFS seem to be less favourable than those observed in the SELECT trial, likely due to a negative selection that included heavily pretreated patients or with poor performance status.
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Affiliation(s)
- L D Locati
- Head and Neck Medical Oncology; Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - A Piovesan
- Dept. Oncology, Oncological Endocrinology, A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Torino, Italy.
| | - C Durante
- Dept Internal Medicine and Medical Specialties, Policlinico Umberto I, Roma, Italy.
| | - M Bregni
- Dept Medical Oncology, Ospedale Busto Arsizio-ASST Valle Olona, Busto Arsizio, Italy.
| | - M G Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.
| | - S Zovato
- Familial Cancer Clinic and Oncoendocrinology Veneto Institute of Oncology IOV- IRCCS, Padua, Italy.
| | - M Giusti
- Dept Internal Medicine and Medical Specialties, Clinical Endocrinology, IRCCS San Martino Hospital, Genova, Italy.
| | - T Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| | - E Puxeddu
- Department of Medicine, University of Perugia, Perugia, Italy
| | - G Fedele
- High Research Srl, Milano, Italy.
| | - G Pellegriti
- Endocrinology Division, Garibaldi Nesima Hospital, Catania, Italy.
| | - G Rinaldi
- Dept Surgical and Oncological Sciences, Policlinico Paolo Giaccone, Palermo, Italy.
| | - D Giuffrida
- Dept Medical Oncology, Istituto Oncologico del Mediterraneo, Viagrande, Italy.
| | - F Verderame
- Dept Hematology and Oncology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
| | - F Bertolini
- Dept Oncology and Haematology, Modena University Hospital, Modena, Italy.
| | - C Bergamini
- Head and Neck Medical Oncology; Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - A Nervo
- Dept. Oncology, Oncological Endocrinology, A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Torino, Italy.
| | - G Grani
- Dept Internal Medicine and Medical Specialties, Policlinico Umberto I, Roma, Italy.
| | - S Rizzati
- Familial Cancer Clinic and Oncoendocrinology Veneto Institute of Oncology IOV- IRCCS, Padua, Italy.
| | - S Morelli
- Department of Medicine, University of Perugia, Perugia, Italy.
| | - I Puliafito
- Dept Medical Oncology, Istituto Oncologico del Mediterraneo, Viagrande, Italy.
| | - R Elisei
- Dept Clinical and Experimental Medicine, A.O Universitaria Pisana, Pisa, Italy.
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Bossi P, Miceli R, Benasso M, Corvò R, Bacigalupo A, Sanguineti G, Fallai C, Merlano MC, Infante G, Dani C, Di Giannantonio V, Licitra L. Impact of treatment expertise on the outcome of patients with head and neck cancer treated within 6 randomized trials. Head Neck 2018; 40:2648-2656. [PMID: 30447127 DOI: 10.1002/hed.25389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/14/2018] [Accepted: 05/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We evaluated the impact of center expertise, in terms of number of patients treated, on the overall survival (OS) and progression-free survival (PFS) of patients with head and neck squamous cell carcinoma (SCC). METHODS We performed a pooled analysis including data from 6 randomized trials in head and neck SCC conducted in Italy. We evaluated the association between OS or PFS and the number of patients recruited by the center. RESULTS The outcome of 903 patients who had received radiotherapy (RT) was analyzed (median follow-up 76 months). The hazard ratio (HR) comparing the third and the first quartiles of the distribution of number of patients per center showed an advantage in PFS (HR 0.59, range 0.53-0.65, P < .0001) and in OS (HR 0.70, 0.60-0.81, P < .0001) for centers with a higher number of patients recruited. A similar benefit was observed in PFS (HR 0.63, 0.60-0.66) and OS (HR 0.74, 0.69-0.79) considering the mean number of patients per year. CONCLUSIONS The PFS and OS were longer for patients treated in high-case-volume centers.
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Affiliation(s)
- Paolo Bossi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and University of Milano, Italy
| | - Rosalba Miceli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and University of Milano, Italy
| | - Marco Benasso
- Ospedale San Paolo Savona and Ospedale Santa Corona Pietra Ligure, Savona, Italy
| | - Renzo Corvò
- AOU IRCCS San Martino-IST National Cancer Research Institute and University, Genoa, Italy
| | - Andrea Bacigalupo
- AOU IRCCS San Martino-IST National Cancer Research Institute and University, Genoa, Italy
| | | | - Carlo Fallai
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and University of Milano, Italy
| | | | - Gabriele Infante
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and University of Milano, Italy
| | - Carla Dani
- AOU IRCCS San Martino-IST National Cancer Research Institute and University, Genoa, Italy
| | | | - Lisa Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and University of Milano, Italy
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Park JC, Gourin CG, Kiess AP, Mehra R, Forastiere AA, Kang H. Pattern of planned systemic therapy usage in newly diagnosed, nonmetastatic squamous cell carcinoma of the head and neck in a commercially insured population in the United States. Head Neck 2018; 40:2612-2620. [PMID: 30421818 DOI: 10.1002/hed.25333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/20/2018] [Accepted: 04/19/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We analyzed systemic therapy plans submitted for commercially insured patients with untreated, newly diagnosed squamous cell carcinoma of the head and neck (SCCHN) to investigate patterns of practice. METHODS Consecutive chemotherapy treatment plans were submitted using Eviti Connect (https://www.marylandphysicianscare.com/content/dam/centene/maryland/pdfs/evitiConnectFactSheet.pdf) portal for preauthorization between June 1, 2011, and June 30, 2015, were analyzed. RESULTS A total of 387 treatment plans were submitted for 340 patients; 68 and 272 patients were from academic centers and community practices, respectively. Single agent cisplatin (57%), cetuximab (18%), and carboplatin (9%) were the most commonly proposed regimens concurrent with definitive radiotherapy (RT). The frequency of cetuximab use was not significantly different between academic centers and community practices. A clinical trial was proposed in only 15% of patients. CONCLUSION Among commercially insured patients with newly diagnosed, nonmetastatic SCCHN, the choice of systemic therapy in initial treatment plans was not significantly different between academic centers and community practices. Clinical trials are underutilized and should be encouraged.
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Affiliation(s)
- Jong Chul Park
- Department of Medicine, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
| | - Christine G Gourin
- Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ana P Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ranee Mehra
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arlene A Forastiere
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,NantHealth, Philadelphia, Pennsylvania
| | - Hyunseok Kang
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Lai YC, Tang PL, Chu CH, Kuo TJ. Effects of income and residential area on survival of patients with head and neck cancers following radiotherapy: working age individuals in Taiwan. PeerJ 2018; 6:e5591. [PMID: 30245932 PMCID: PMC6147123 DOI: 10.7717/peerj.5591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/16/2018] [Indexed: 01/29/2023] Open
Abstract
Objectives The five-year survival rate of head and neck cancer (HNC) after radiotherapy (RT) varies widely from 35% to 89%. Many studies have addressed the effect of socioeconomic status and urban dwelling on the survival of HNC, but a limited number of studies have focused on the survival rate of HNC patients after RT. Materials and methods During the period of 2000–2013, 40,985 working age individuals (20 < age < 65 years) with HNC patients treated with RT were included in this study from a registry of patients with catastrophic illnesses maintained by the Taiwan National Health Insurance Research Database (NHIRD). Results The cumulative survival rate of HNC following RT in Taiwan was 53.2% (mean follow-up period, 3.75 ± 3.31 years). The combined effects of income and geographic effect on cumulative survival rates were as follows: high income group > medium income group > low income group and northern > central > southern > eastern Taiwan. Patients with moderate income levels had a 36.9% higher risk of mortality as compared with patients with high income levels (hazard ratio (HR) = 1.369; p < 0.001). Patients with low income levels had a 51.4% greater risk of mortality than patients with high income levels (HR = 1.514, p < 0.001). Conclusion In Taiwan, income and residential area significantly affected the survival rate of HNC patients receiving RT. The highest income level group had the best survival rate, regardless of the geographic area. The difference in survival between the low and high income groups was still pronounced in more deprived areas.
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Affiliation(s)
- Yu Cheng Lai
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Department of Occupational Therapy, Shu Zen junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Pei Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan.,College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi Hsiang Chu
- Department of Clinical Trial Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Tsu Jen Kuo
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Department of Dental Technology, Shu-Zen junior College of Medicine and Management, Kaohsiung, Taiwan.,Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Lin DJ, McConkey CC, Nankivell P, Dunn J, Mehanna H. The impact of institutional clinical trial recruitment versus hospital volume on survival outcomes of patients with head and neck cancer: An analysis of the PET-NECK trial outcomes, UKCRN portfolio, and Hospital Episode Statistics (HES) in England. Oral Oncol 2018; 85:40-43. [PMID: 30220318 DOI: 10.1016/j.oraloncology.2018.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES High institutional clinical trial recruitment and high hospital volume are reported to be independent indicators of better patient outcomes following cancer treatment. However, their relationship in head and neck cancers (HNC) remains less clear. METHODS We aimed to assess the relationship between institutional clinical trial recruitment, hospital throughput of HNC cases, and survival of patients with advanced HNC treated with primary chemoradiotherapy at hospitals which recruited to the PET-NECK trial (2008-2012). The impact on outcome was assessed using Cox's proportional hazards regression analysis and multivariate analysis. RESULTS HNC RCT recruitment positively correlated with hospital throughput (r = 0.57, p < 0.0001). Low-recruiters (1-5 patients) had a 107% increased risk of death when compared to high-recruiters (>5 patients) (HR = 2.07, p = 0.05). There was no significant impact of hospital throughput on overall or disease-specific HNC survival. Multivariate analysis identified p16 status, N-stage, smoking, and RCT recruitment volume as the only significant predictors of survival. There was a significant difference in chemotherapy regimen between low and high-recruiters (p = 0.003) where a higher proportion of patients (50%, n = 13) in low-recruiting compared to high-recruiting hospitals (29%, n = 92) received neoadjuvant chemotherapy. A higher proportion of these patients died at low-recruiting hospitals (46% versus 23%). DISCUSSION A significant association exists between high recruitment and better OS for patients with HNC. However, no significance was found between hospital throughput and outcomes. The significance of individual centre differences in chemotherapy regimen needs further investigation. Future studies need a greater number of patient outcome events to support the trends found in this study.
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Affiliation(s)
- Daniel J Lin
- Warwick Clinical Trials Unit, University of Warwick, United Kingdom.
| | | | - Paul Nankivell
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, United Kingdom.
| | - Janet Dunn
- Warwick Clinical Trials Unit, University of Warwick, United Kingdom.
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, United Kingdom.
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Akkina SR, Kim RY, Stucken CL, Pynnonen MA, Bradford CR. Is There a Difference in Staging and Treatment of Head and Neck Squamous Cell Tumors Between Tertiary Care and Community-Based Institutions? Laryngoscope Investig Otolaryngol 2018; 3:290-295. [PMID: 30186960 PMCID: PMC6119783 DOI: 10.1002/lio2.178] [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: 12/01/2017] [Revised: 05/05/2018] [Accepted: 05/18/2018] [Indexed: 11/13/2022] Open
Abstract
Objective To characterize the differences in the staging and treatment of patients with head and neck squamous cell carcinoma between a tertiary care center and community‐based practices. Methods This study is a retrospective chart review of 943 adult patients with head and neck squamous cell cancer presenting to a tertiary care center between 2008 and 2014 as part of the University of Michigan Head and Neck Cancer Specialized Program of Research Excellence (UM HN‐SPORE) database. Demographic information, diagnostic testing, staging information, and treatment recommendations were recorded. Results Of 943 patients reviewed, 159 had documentation of tumor stage that was assigned by the community‐based practice. Of these, 53% had a tumor staging change made at the tertiary care center, with 43% of patients upstaged and 10% of patients downstaged. Fifty‐one percent received different treatment than had previously been offered at the community‐based practice, although only 31% of these patients had a change in tumor staging. Conclusion Over half of patients with head and neck squamous cell carcinoma who are evaluated at a tertiary care center after the initial evaluation at a community‐based practice have their tumors staged differently, with the majority upstaged. A significant number of these patients also received different treatment than was initially offered at the referring practice. Future studies are required to determine whether these differences have an effect on tumor recurrence and patient survival rates. Level of Evidence 2c (Outcomes Research).
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Affiliation(s)
- Sarah R Akkina
- University of Michigan Medical School Ann Arbor Michigan.,Department of Otolaryngology-Head and Neck Surgery University of Washington Seattle Washington
| | - Roderick Y Kim
- University of Michigan Medical School Ann Arbor Michigan.,Department of Surgery University of Michigan Health System Ann Arbor Michigan
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Health System Ann Arbor Michigan
| | - Melissa A Pynnonen
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Health System Ann Arbor Michigan
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Health System Ann Arbor Michigan
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Naghavi AO, Echevarria MI, Strom TJ, Abuodeh YA, Venkat PS, Ahmed KA, Demetriou S, Frakes JM, Kim Y, Kish JA, Russell JS, Otto KJ, Chung CH, Harrison LB, Trotti A, Caudell JJ. Patient choice for high-volume center radiation impacts head and neck cancer outcome. Cancer Med 2018; 7:4964-4979. [PMID: 30175512 PMCID: PMC6198196 DOI: 10.1002/cam4.1756] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 01/28/2023] Open
Abstract
Background Studies suggest treatment outcomes may vary between high (HVC)‐ and low‐volume centers (LVC). Radiation therapy (RT) for head and neck cancer (HNC) requires weeks of treatment, the inconvenience of which may influence a patient's choice for treatment location. We hypothesized that receipt of RT for HNC at a HVC would influence outcomes compared to patients evaluated at a HVC, but who chose to receive RT at a LVC. Methods From 1998 to 2011, 1930 HNC patients were evaluated at a HVC and then treated with RT at either a HVC or LVC. Time‐to‐event outcomes and treatment factors were compared. Results Median follow‐up was 34 months. RT was delivered at a HVC for 1368 (71%) patients and at a LVC in 562 (29%). Patients were more likely to choose HVC‐RT if they resided in the HVC's county or required definitive RT (all P < 0.001). HVC‐RT was associated with a significant improvement in 3‐year LRC (84% vs 68%), DFS (68% vs 48%), and OS (72% vs 57%) (all P < 0.001). On multivariate analysis (MVA), HVC‐RT independently predicted for improved LRC, DFS, and OS (all P < 0.05). Conclusions In patients evaluated at a HVC, the choice of RT location was primarily influenced by their residing distance from the HVC. HVC‐RT was associated with improvements in LRC, DFS, and OS in HNC. As treatment planning and delivery are technically demanding in HNC, the choice to undergo treatment at a HVC may result in more optimal delivered dose, RT duration, and outcome.
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Affiliation(s)
- Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Michelle I Echevarria
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Tobin J Strom
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Yazan A Abuodeh
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Puja S Venkat
- Department of Radiation Oncology, UCLA Health, Los Angeles, California
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Stephanie Demetriou
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jessica M Frakes
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Julie A Kish
- Department of Senior Adult Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jeffery S Russell
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kristen J Otto
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Christine H Chung
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Andy Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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Spraker-Perlman H, Smits-Seeman RR, Li H, Kirchhoff AC. Statewide Treatment Center Referral Patterns for Adolescent and Young Adult Patients with Cancer in Utah. J Adolesc Young Adult Oncol 2018; 7:688-691. [PMID: 30036101 DOI: 10.1089/jayao.2018.0059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cancer therapy is selected by individual oncology providers. For adolescent and young adults (AYAs), the type of provider, adult or pediatric, and medical facility type, non- or academic, influence regimens offered. We evaluated the proportions of 15-29-year-old cancer patients in Utah seen at pediatric and adult academic centers between 1994 and 2013 and examined factors that influence treatment location. Of all AYA patients, 31.6% were treated in academic centers and those with sarcomas, central nervous system tumors, and leukemias were more likely to be treated at academic centers. Further determinants of AYA healthcare access and cooperation between adult and pediatric providers are needed.
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Affiliation(s)
- Holly Spraker-Perlman
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rochelle R Smits-Seeman
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.,Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Hongyan Li
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Anne C Kirchhoff
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.,Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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Deek MP, Kim S, Beck R, Yegya-Raman N, Langenfeld J, Malhotra J, Mahmoud O, Aisner J, Jabbour SK. Variations in Initiation Dates of Chemotherapy and Radiation Therapy for Definitive Management of Inoperable Non-Small Cell Lung Cancer Are Associated With Decreases in Overall Survival. Clin Lung Cancer 2018; 19:e381-e390. [PMID: 29752011 PMCID: PMC10868642 DOI: 10.1016/j.cllc.2018.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/10/2018] [Accepted: 03/10/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND We evaluated trends in administration of concurrent chemoradiation therapy (CRT) and how variations in start dates of chemotherapy and radiotherapy affected overall survival (OS) in patients with non-small cell lung cancer (NSCLC) undergoing a course of definitive CRT. MATERIALS AND METHODS Cases of NSCLC treated with definitive CRT were obtained from the National Cancer Database. A survival analysis was performed with Kaplan-Meier curves and Cox proportional hazards models. Propensity score matching was conducted. RESULTS On a national level, only 48.6% of patients began concurrent CRT on the same day. In a propensity-matched population, starting CRT within 6 days was associated with improved OS (17.9 months) compared with starting 7 to 13 days apart (16.5 months; P = .04). Starting dual therapy within 6 days of each other was associated with a 7% reduction in the risk of death (hazard ratio, 0.93; P = .05). Furthermore, in a propensity-matched cohort, starting CRT within 3 days was associated with longer survival (18.7 months) compared with 4 to 6 days apart (17.5 months; P = .02). Starting treatment 4 to 6 days apart was associated with an 8% increased risk of death (hazard ratio, 1.08; P = .04). CONCLUSION A large proportion (48.6%) of patients with unresectable NSCLC do not initiate CRT on the same day as is considered standard by national guidelines. In this population, nonsimultaneous initiation of CRT was associated with differences in OS. Further efforts to understand the mitigating factors and barriers that interfere with timely delivery of concurrent CRT are needed.
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Affiliation(s)
- Matthew P Deek
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins Hospital, Baltimore, MD; Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Sinae Kim
- Department of Biostatistics, School of Public Health, Rutgers University, Piscataway, NJ; Biometrics Division, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robert Beck
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Nikhil Yegya-Raman
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - John Langenfeld
- Rutgers Cancer Institute of New Jersey, Division of Thoracic Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Joyti Malhotra
- Rutgers Cancer Institute of New Jersey, Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Omar Mahmoud
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Joseph Aisner
- Rutgers Cancer Institute of New Jersey, Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Salma K Jabbour
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ.
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Morse E, Fujiwara RJT, Husain Z, Judson B, Mehra S. Pediatric Salivary Cancer: Epidemiology, Treatment Trends, and Association of Treatment Modality with Survival. Otolaryngol Head Neck Surg 2018; 159:553-563. [PMID: 29688836 DOI: 10.1177/0194599818771926] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective To characterize the epidemiology of pediatric salivary cancer and associate patient, tumor, and treatment factors with treatment modality and survival. Study Design Cross-sectional analysis. Setting US national database. Subjects and Methods We identified 588 patients 19 years or younger diagnosed with salivary cancer in the National Cancer Database 2004-2013. We characterized patient, tumor, and treatment factors as proportions and associated these factors with treatment modality and overall survival via multivariable logistic regression and multivariable Cox proportional hazards regression, respectively. Results In total, 588 patients were included. Mucoepidermoid carcinoma was identified in 234 of 588 patients (40%) and acinar cell carcinoma in 215 of 588 (37%). Parotid tumors were seen in 504 (86%) of patients. Surgery alone was used to treat 351 (60%) of patients; surgery plus adjuvant radiation was used to treat 145 (25%). Overall 5-year survival was 93%. Controlling for patient and tumor characteristics, treatment with surgery and radiation vs surgery alone was associated with improved overall survival (hazard ratio [HR] = 0.15; 95% confidence interval [CI], 0.02-0.92; P = .041). High tumor grade was associated with decreased overall survival (HR = 33.17; 95% CI, 5.89-186.8; P < .001). Treatment with surgery plus radiation remained associated with improved overall survival in the subset of patients with high tumor grade (HR = 0.12; 95% CI, 0.02-0.64; P = .014). Conclusion Tumor grade is an important predictor of survival in pediatric patients with salivary gland cancer. Surgery plus adjuvant radiation vs surgery alone is associated with improved overall survival and may be considered for high-risk patients, particularly those with high-grade tumors.
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Affiliation(s)
- Elliot Morse
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rance J T Fujiwara
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zain Husain
- 2 Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin Judson
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA.,3 Yale Cancer Center, New Haven, Connecticut, USA
| | - Saral Mehra
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA.,3 Yale Cancer Center, New Haven, Connecticut, USA
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Gupta A, Sonis ST, Schneider EB, Villa A. Impact of the insurance type of head and neck cancer patients on their hospitalization utilization patterns. Cancer 2017; 124:760-768. [PMID: 29112234 DOI: 10.1002/cncr.31095] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/14/2017] [Accepted: 10/02/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Head and neck cancer (HNC) patients with Medicaid, Medicare, or no insurance show poor outcomes in comparison with privately insured patients. It was hypothesized that nonprivate insurance coverage biases the selection of the treatment site to favor hospitals that are not associated with optimum treatment outcomes. This study assessed the relation between the insurance type of HNC patients and the hospital type for inpatient care. METHODS Adult HNC patients were identified from the Nationwide Inpatient Sample (2012 and 2013). The primary exposure was the insurance provider type. The outcome was the hospital type, which was classified by the hospital's ownership and its location and teaching status. Multivariate multinomial logistic regression models were constructed to control for the patient's age, sex, race, income, mortality risk, and geographic location. The analysis was weighted and was adjusted for multiple comparisons. RESULTS In all, 37,466 HNC patients representing 187,330 patients nationally were identified. After adjustments for age, sex, race, income, and mortality risk, in comparison with privately insured patients, Medicaid, Medicare, and uninsured patients demonstrated 1.14 to 2.29 increased odds of undergoing treatment at rural, urban nonteaching, private investor-owned, or government (nonfederal) hospitals (P < .05). This trend remained apparent even after adjustments for the geographic location. CONCLUSIONS Uninsured patients or patients insured by government programs predominantly underwent care for HNC at hospital types most often associated with inferior survival outcomes. This finding could explain some proportion of insurance-related disparities in HNC outcomes. Further studies are warranted to determine whether interventions to promote equitable access to optimal hospital settings for patients, regardless of their insurance type, might improve outcomes among nonprivate insurance holders. Cancer 2018;124:760-8. © 2017 American Cancer Society.
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Affiliation(s)
- Avni Gupta
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephen T Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Oral Medicine, Harvard School of Dental Medicine, Boston, Massachusetts
| | | | - Alessandro Villa
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Oral Medicine, Harvard School of Dental Medicine, Boston, Massachusetts
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Abstract
OPINION STATEMENT In the past few years, several evidences reported better outcomes, in terms of reduced toxicities and longer survival, for head and neck cancer (HNC) patients when "regionalized," namely if they are managed at "high-volume" cancer referral centers (CRC). The benefit of case volume has been demonstrated in HNC patients primarily treated with surgery and in those receiving curative radiotherapy and chemotherapy. Many factors could explain these positive results: organization, facilities, processes of care, quality assurance programs, professional expertise, technology, and patient referral bias. In other words, the "high volume" could be linked both to all hospital-related volume and to the expertise of each involved professional figure (e.g., surgeon, radiation oncologist, medical oncologist, etc.). In this context, it is still debatable whether there is a need to understand which one of these factors is more able to influence the final outcomes of HNC patients. Considering the complexity and heterogeneity of HNC, all of these aspects are likely to impact and plot each other. However, there is no consensus regarding the criteria and the cut-off used to define as "high" the case volume. Moreover, some limitations or biases of the regionalization process have to be highlighted: (1) personal and financial discomfort of patients, their caregivers, and families; (2) a frequent referral of the healthiest or youngest patients to CRC could change the survival outcomes; (3) potential higher difficulties for colleagues working outside of CRC in the emergency. Nevertheless, the case volume represents one of the factors impacting on the quality of the treatment itself, in terms of reduced toxicity and better treatment outcome. Therefore, it should be considered as a stratifying factor in randomized controlled trials for HNC patients.
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45
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Falchook AD, Green R, Knowles ME, Amdur RJ, Mendenhall W, Hayes DN, Grilley-Olson JE, Weiss J, Reeve BB, Mitchell SA, Basch EM, Chera BS. Comparison of Patient- and Practitioner-Reported Toxic Effects Associated With Chemoradiotherapy for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2017; 142:517-23. [PMID: 27149571 DOI: 10.1001/jamaoto.2016.0656] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
IMPORTANCE Agreement between patient- and practitioner-reported toxic effects during chemoradiotherapy for head and neck cancer is unknown. OBJECTIVE To compare patient-reported symptom severity and practitioner-reported toxic effects among patients receiving chemoradiotherapy for head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS Forty-four patients participating in a phase 2 trial of deintensified chemoradiotherapy for oropharyngeal carcinoma were included in the present study (conducted from February 8, 2012, to March 2, 2015). Most treatment (radiotherapy, 60 Gy, with concurrent weekly administration of cisplatin, 30 mg/m2) was administered at academic medical centers. Included patients had no prior head and neck cancers, were 18 years or older, and had a smoking history of 10 pack-years or less or more than 10 pack-years but 30 pack-years or less and abstinent for the past 5 years. Cancer status was untreated human papillomavirus or p16-positive squamous cell carcinoma of the oropharynx or unknown head and neck primary site; and cancer staging was category T0 to T3, category N0 to N2c, M0, and Eastern Cooperative Oncology Group performance status 0 to 1. Baseline, weekly, and posttreatment toxic effects were assessed by physicians or nurse practitioners using National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. Patient-reported symptom severity was measured using the Patient-Reported Outcomes version of the CTCAE (PRO-CTCAE). Descriptive statistics were used to characterize raw agreement between CTCAE grades and PRO-CTCAE severity ratings. INTERVENTIONS Baseline, weekly, and posttreatment toxic effects assessed using CTCAE, version 4.0, and PRO-CTCAE. MAIN OUTCOMES AND MEASURES Raw agreement indices between patient-reported toxic effects, including symptom frequency, severity, and interference with daily activities (score range, 0 [none] to 4 [very severe]), and practitioner-measured toxic effects, including swallowing, oral pain, and hoarseness (score range, 1 [mild] to 5 [death]). RESULTS Of the 44 patients included in the analysis (39 men, 5 women; mean [SD] age, 61 [8.4] years), there were 327 analyzable pairs of CTCAE and PRO-CTCAE symptom surveys and no treatment delays due to toxic effects. Patient-reported and practitioner-reported symptom severity agreement was high at baseline when most symptoms were absent but declined throughout treatment as toxic effects increased. Most disagreement was due to lower severity of toxic effects reported by practitioners (eg, from 45% agreement at baseline to 27% at the final week of treatment for pain). This was particularly noted for domains that are not easily evaluated by physical examination, such as anxiety and fatigue (eg, severity of fatigue decreased from 43% at baseline to 12% in the final week of treatment). CONCLUSIONS AND RELEVANCE Practitioner-reported toxic effects are lower than patient self-reports during head and neck chemoradiotherapy. The inclusion of patient-reported symptomatic toxic effects provides information that can potentially enhance clinical management and improve data quality in clinical trials.
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Affiliation(s)
- Aaron D Falchook
- Department of Radiation Oncology, University of North Carolina, Chapel Hill
| | - Rebecca Green
- Department of Radiation Oncology, University of North Carolina, Chapel Hill
| | - Mary E Knowles
- Department of Radiation Oncology, University of North Carolina, Chapel Hill
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville3Shands Cancer Center, University of Florida Hospitals, Gainesville
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville3Shands Cancer Center, University of Florida Hospitals, Gainesville
| | - David N Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill5Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill
| | - Juneko E Grilley-Olson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill5Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill
| | - Jared Weiss
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill5Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill
| | - Bryce B Reeve
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ethan M Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill5Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill
| | - Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina, Chapel Hill4Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
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Rubin SJ, Cohen MB, Kirke DN, Qureshi MM, Truong MT, Jalisi S. Comparison of facility type outcomes for oral cavity cancer: Analysis of the national cancer database. Laryngoscope 2017; 127:2551-2557. [DOI: 10.1002/lary.26632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Samuel J. Rubin
- Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Michael B. Cohen
- Department of Otolaryngology Head and Neck Surgery; Boston Massachusetts U.S.A
- Division of Otolaryngology, Department of Surgery; VA Boston Healthcare System; Boston Massachusetts U.S.A
| | - Diana N. Kirke
- Department of Otolaryngology Head and Neck Surgery; Boston Massachusetts U.S.A
| | - Muhammad M. Qureshi
- Department of Radiation Oncology, Boston Medical Center; Boston Massachusetts U.S.A
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center; Boston Massachusetts U.S.A
- Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Scharukh Jalisi
- Department of Otolaryngology Head and Neck Surgery; Boston Massachusetts U.S.A
- Boston University School of Medicine; Boston Massachusetts U.S.A
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Fujiwara RJT, Burtness B, Husain ZA, Judson BL, Bhatia A, Sasaki CT, Yarbrough WG, Mehra S. Treatment guidelines and patterns of care in oral cavity squamous cell carcinoma: Primary surgical resection vs. nonsurgical treatment. Oral Oncol 2017; 71:129-137. [PMID: 28688680 DOI: 10.1016/j.oraloncology.2017.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/17/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The 2017 National Comprehensive Cancer Network Clinical Practice Guidelines recommend surgical resection or definitive radiation therapy for early-stage oral cavity malignancies, and surgical resection or multimodality clinical trials for late-stage disease. Few studies have been conducted to identify predictors of choice of treatment modality for oral cavity malignancies. METHODS All patients in the National Cancer Data Base (NCDB) diagnosed with oral cavity squamous cell carcinoma (OCSCC) between 1998 and 2011 were identified. Chi-square and binary logistic regression were used to identify factors predictive of surgical or nonsurgical treatment; multiple imputation was used for missing data. Cox proportional hazards models were generated to identify associations between treatment modality and overall survival (OS). RESULTS Of 23,459 patients, 4139 (17.6%) underwent primary nonsurgical treatment. Among NCDB-registered facilities, there has been a decrease in use of nonsurgical treatment for OCSCC (OR 0.97, p<0.001). Older age, non-white race, Medicaid insurance, low income, low education, and later-stage disease were associated with nonsurgical therapy, while patients at academic/research programs were more likely to undergo surgery (OR 0.38, p<0.001). Nonsurgical treatment was associated with decreased OS (HR=2.02, p<0.001); this was upheld on subgroup analysis of early- and late-stage disease. CONCLUSIONS Use of primary nonsurgical treatment for OCSCC has decreased over time among NCDB-registered facilities and is associated with factors related to access to care. Surgical resection for the primary treatment of oral cavity cancer may be associated with improved OS, though conclusions regarding survival are limited by the non-randomized nature of the data.
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Affiliation(s)
- Rance J T Fujiwara
- Yale University School of Medicine, Department of Surgery (Otolaryngology), New Haven, CT, United States
| | - Barbara Burtness
- Yale Cancer Center, New Haven, CT, United States; Yale University School of Medicine, Department of Internal Medicine, United States
| | - Zain A Husain
- Yale Cancer Center, New Haven, CT, United States; Yale University School of Medicine, Department of Therapeutic Radiology, United States
| | - Benjamin L Judson
- Yale University School of Medicine, Department of Surgery (Otolaryngology), New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States
| | - Aarti Bhatia
- Yale Cancer Center, New Haven, CT, United States; Yale University School of Medicine, Department of Internal Medicine, United States
| | - Clarence T Sasaki
- Yale University School of Medicine, Department of Surgery (Otolaryngology), New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States
| | - Wendell G Yarbrough
- Yale University School of Medicine, Department of Surgery (Otolaryngology), New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States; Yale University School of Medicine, Department of Pathology, United States
| | - Saral Mehra
- Yale University School of Medicine, Department of Surgery (Otolaryngology), New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States.
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David JM, Ho AS, Luu M, Yoshida EJ, Kim S, Mita AC, Scher KS, Shiao SL, Tighiouart M, Zumsteg ZS. Treatment at high-volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer. Cancer 2017. [DOI: 10.1002/cncr.30843] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- John M. David
- Department of Radiation Oncology; Cedars-Sinai Medical Center; Los Angeles California
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Allen S. Ho
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
- Department of Surgery; Cedars-Sinai Medical Center; Los Angeles California
| | - Michael Luu
- Biostatistics and Bioinformatics Research Center; Cedars-Sinai Medical Center; Los Angeles California
| | - Emi J. Yoshida
- Department of Radiation Oncology; Cedars-Sinai Medical Center; Los Angeles California
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Sungjin Kim
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
- Biostatistics and Bioinformatics Research Center; Cedars-Sinai Medical Center; Los Angeles California
| | - Alain C. Mita
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Kevin S. Scher
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Stephen L. Shiao
- Department of Radiation Oncology; Cedars-Sinai Medical Center; Los Angeles California
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Mourad Tighiouart
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
- Biostatistics and Bioinformatics Research Center; Cedars-Sinai Medical Center; Los Angeles California
| | - Zachary S. Zumsteg
- Department of Radiation Oncology; Cedars-Sinai Medical Center; Los Angeles California
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
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49
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Fujiwara RJT, Judson BL, Yarbrough WG, Husain Z, Mehra S. Treatment delays in oral cavity squamous cell carcinoma and association with survival. Head Neck 2017; 39:639-646. [PMID: 28236349 DOI: 10.1002/hed.24608] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 05/04/2016] [Accepted: 08/22/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Treatment durations and factors associated with delays for oral cavity squamous cell carcinoma (SCC) have previously been described but are not fully understood. Impact of delays on overall survival (OS) remains unclear. METHODS The National Cancer Data Base (NCDB) was used to analyze 4868 patients with oral cavity SCC from 1998 to 2011. Diagnosis-to-surgery, surgery-to-radiotherapy (RT)start , RT duration, total treatment package (surgery-to-RTend ), and diagnosis-to-RTend were evaluated. Associations between delays and various factors were analyzed using binary logistic regression. Associations with OS were analyzed using the Cox proportional hazards model. RESULTS Medians for diagnosis-to-surgery, surgery-to-RTstart , RT duration, total treatment package, and diagnosis-to-RTend were 30, 50, 49, 101, and 136 days, respectively. Age ≥60 years, uninsured or Medicaid insurance, comorbidity, late pT, and treatment at an academic/research institution were associated with diagnosis-to-surgery delays. Only delays in RT duration were significantly associated with decreased OS (hazard ratio [HR] = 1.21; p = .02). CONCLUSION Numerous factors are associated with treatment delays. RT duration is significantly associated with OS. © 2017 Wiley Periodicals, Inc. Head Neck 39: 639-646, 2017.
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Affiliation(s)
- Rance J T Fujiwara
- Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin L Judson
- Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Wendell G Yarbrough
- Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Zain Husain
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Saral Mehra
- Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
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50
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Divi V, Chen MM, Nussenbaum B, Rhoads KF, Sirjani DB, Holsinger FC, Shah JL, Hara W. Lymph Node Count From Neck Dissection Predicts Mortality in Head and Neck Cancer. J Clin Oncol 2016; 34:3892-3897. [DOI: 10.1200/jco.2016.67.3863] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Multiple smaller studies have demonstrated an association between overall survival and lymph node (LN) count from neck dissection in patients with head and neck cancer. This is a large cohort study to examine these associations by using a national cancer database. Patients and Methods The National Cancer Database was used to identify patients who underwent upfront nodal dissection for mucosal head and neck squamous cell carcinoma between 2004 and 2013. Patients were stratified by LN count into those with < 18 nodes and those with ≥ 18 nodes on the basis of prior work. A multivariable Cox proportional hazards regression model was constructed to predict hazard of mortality. Stratified models predicted hazard of mortality both for patients who were both node negative and node positive. Results There were 45,113 patients with ≥ 18 LNs and 18,865 patients with < 18 LNs examined. The < 18 LN group, compared with the ≥ 18 LN group, had more favorable tumor characteristics, with a lower proportion of T3 and T4 lesions (27.9% v 39.8%), fewer patients with positive nodes (46.6% v 60.5%), and lower rates of extracapsular extension (9.3% v 15.1%). Risk-adjusted Cox models predicting hazard of mortality by LN count showed an 18% increased hazard of death for patients with < 18 nodes examined (hazard ratio [HR] 1.18; 95% CI, 1.13 to 1.22). When stratified by clinical nodal stage, there was an increased hazard of death in both groups (node negative: HR, 1.24; 95% CI, 1.17 to 1.32; node positive: HR, 1.12; 95% CI, 1.05 to 1.19). Conclusion The results of our study demonstrate a significant overall survival advantage in both patients who are clinically node negative and node positive when ≥ 18 LNs are examined after neck dissection, which suggests that LN count is a potential quality metric for neck dissection.
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Affiliation(s)
- Vasu Divi
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michelle M. Chen
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Brian Nussenbaum
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Kim F. Rhoads
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Davud B. Sirjani
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - F. Christopher Holsinger
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Jennifer L. Shah
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Wendy Hara
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
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