Characteristics of Head and Neck Cancer Patients Referred to an Oral and Maxillofacial Surgeon in the United States for Management

Abstract

The purpose of this study was to report the characteristics of patients with head and neck cancer, excluding cutaneous malignancies, referred to an oral and maxillofacial surgeon in the United States for management. We performed a retrospective chart review of all head and neck cancer patients referred to the senior author's oral and maxillofacial surgery practice over 12 consecutive months. Data were extracted from the patients' comprehensive record and included demographics, social history, site, histologic diagnosis, staging, treatment, and referral patterns. A total of 90 patients, 51 men and 39 women (male-female ratio, 1.3:1), with a mean age of 64.4 years (range, 32-91 years) were referred with head and neck cancer, excluding skin cancer, over the 12-month period and were included in the study. Regarding ethnicity, 88.8% of the patients were white, 11.1% African American, and 1.1% Asian. Most of the patients, 84.4%, were referred from within the state, but only 21.1% of these resided within the metropolitan area of the senior author's practice. Of the patients in the study population, 95.5% had either private or state-provided/federally provided insurance. Social history showed that 59.9% of patients were current or past smokers, 31.1% were nonsmokers, and 8.8% were smokeless tobacco users, and only 18.8% admitted to alcohol use. Approximately 80% of patients were initially evaluated by a general dentist, oral and maxillofacial surgeon, or periodontist, and 93% of referrals were from other oral and maxillofacial surgeons. Over 90% of lesions were located in the oral cavity, and only 6.6% were oropharyngeal primary cancers. Squamous cell carcinoma made up 89% of the lesions, whereas minor salivary gland and metastatic carcinomas comprised the other 11%. At the time of diagnosis, 64.4% of the lesions were early stage (I/II) and 35.6% were late stage (III/IV). Analysis of treatment modalities showed that 87.8% underwent surgery, excluding biopsy, as part of their therapy. Of these, 83.5% were treated with surgery only, whereas the others received both surgery and some form of adjuvant therapy. Five patients were treated with concurrent chemoradiation therapy. Our results suggest that patients referred to an oral and maxillofacial surgery practice for management of head and neck cancer are different from those described in previous reports regarding demographics, social history, site, and stage of disease at diagnosis and treatment. This finding may be explained by the unique referral pattern for oral and maxillofacial surgeons treating head and neck cancer.