Diagnosis Of Oropharyngeal Cancer Research Articles

CT-perfusion in the diagnosis of oropharyngeal cancer and monitoring of chemoradiotherapy.

Purpose of the study: to identify diagnostic effectiveness of the CT perfusion method in diagnosing squamous cell carcinoma of the oropharynx and in assessing dynamic changes in the affected area after chemoradiotherapy.Materials and methods. The results of CT perfusion and CT with intravenous contrast were analyzed in 27 patients aged 40 to 76 years, who were divided into three groups: 1) a control group of patients with suspected oropharyngeal tumors – 9 people (33.4%); 2) group of primary (untreated) patients – 8 people. (29.6%) with a verified diagnosis of squamous cell carcinoma; 3) a group of patients with this diagnosis only after chemoradiotherapy – 10 people (37.0%).Results. Our own algorithm for CT perfusion of the oropharynx region was developed. Digital indicators characterizing the presence of tumor tissue in the tissues of the oropharynx were determined: arterial blood flow (AF) and blood volume (BV). When studying CT perfusion indicators, the following was established: in the group of untreated patients, in contrast to the control group of patients, the values of equivalent blood volume (BV), arterial blood flow velocity (AF) and permeability (FE) were statistically significantly increased. Whereas in patients after chemoradiation treatment, compared with the group of untreated patients, CT perfusion indices were statistically significantly reduced in the following parameters: equivalent blood volume (BV), arterial blood flow velocity (AF). The vascular permeability indicator (FE) is only of secondary importance in identifying the tumor process. Analysis of the results of CT perfusion in patients after chemoradiation treatment revealed an almost complete restoration of tissue perfusion indices in terms of AF and BV relative to perfusion indices in patients in the control group.Conclusion. The results of our study indicate the diagnostic effectiveness of CT perfusion in detecting oropharyngeal cancer and in assessing the corresponding changes in the affected area that occur after chemoradiotherapy. Changes in CT perfusion parameters are associated with microcirculation in the tumor area, which is confirmed by a statistically significant decrease in BV and AF parameters after chemoradiotherapy.

Serum and Saliva Level of miR-31-5p and miR-let 7a in EBV Associated Oropharyngeal Cancer.

Epstein-Barr virus (EBV) has a well-documented association with head and neck neoplasms, including nasopharyngeal carcinoma (NPC). In the last few years, research aimed at elucidating the role of the miRs in the pathogenesis of head and neck cancer (HNC) has gained importance. The study of miRs expression has set new directions in the search for biomarkers with diagnostic and prognostic value, and even in the search for new therapeutic targets for various tumors, including HNC. The aim of current study was to approximate the importance of miR-31-5p and miR-let 7a in the pathogenesis of EBV associated oropharyngeal cancer. For this purpose, experiments were carried out to determine the level of mentioned miRs in serum among patients diagnosed with oropharyngeal cancer linked to EBV infection, depending on histological differentiation-grading (G1-G3) and TNM classification. All clinical specimens stratified by HPV status were HPV negative. The level of antibodies EBNA and EBVCA was also assessed. The obtained results showed a significantly increased serum level of miR-31-5p but decreased level of miR-let 7a in EBV positive oropharyngeal cancer patients. We demonstrated association between the level of tested miRs and clinical stage. Our findings showed that miR-31-5p and miR-let-7a may be involved in development and progression of EBV associated oropharyngeal cancer. Therefore, it seems important to further study these molecules, as well as to determine whether they could be important biomarkers in the diagnosis of oropharyngeal cancer associated with EBV infection.

The collateral impact of the COVID-19 pandemic on HPV-positive oropharyngeal cancer diagnosis

PurposeWe aim to assess the potential impact of the COVID-19 pandemic on diagnostic delays in HPV-positive oropharyngeal cancer (OPC), and to describe their underlying reasons. MethodsAll HPV + OPC referred to a tertiary cancer centre and diagnosed between June-December 2019 (Pre-Pandemic cohort) vs June-December 2020 (Pandemic cohort) were reviewed. TNM classification, gross-tumor-volumes (GTV) and intervals between sign/symptom onset and treatment initiation were compared between the cohorts. Reasons for delay (>6 months from onset of signs/symptoms to a positive biopsy of the primary tumor, or a delay specifically mentioned in the patient chart) in establishing the diagnosis were recorded per clinician’s documentation, and categorized as COVID-related or non-COVID-related. ResultsA total of 157 consecutive HPV + OPC patients were identified (Pre-Pandemic: 92; Pandemic: 65). Compared to the Pre-Pandemic cohort, Pandemic cohort patients had a higher proportion of N2-N3 (32 % vs 15 %, p = 0.019) and stage III (38 % vs 23 %, p = 0.034) disease at presentation. The differences in proportions with > 6 months delay from symptom onset to establishing the diagnosis (29 % vs 20 %, p = 0.16) or to first treatment (49 % vs 38 %, p = 0.22) were not statistically different. 47 % of diagnostic delays in the Pandemic cohort were potentially attributable to COVID-19. ConclusionWe observed a collateral impact of the COVID-19 pandemic on HPV + OPC care through more advanced stage at presentation and a non-significant but numerically longer interval to diagnosis. This could adversely impact patient outcomes and future resource allocation. Both COVID-19-related and unrelated factors contribute to diagnostic delays. Tailored interventions to reduce delays are warranted.

Oropharyngeal cancer diagnosis and treatment in actual clinical practice in the Republic of Bashkortostan: analysis for 2020

Introduction. Th e growing incidence of oropharyngeal cancer is driven by an increase in frequency of HPV-associated oropharyngeal cancer. Th e morbidity pattern of oropharyngeal cancer is area-specific.Aim. To analyze the oropharyngeal cancer diagnosis and treatment in the Republic of Bashkortostan for 2020.Materials and methods. Th e authors carried out a 2020 retrospective analysis of the diagnosis and treatment results of patients with oropharyngeal cancer. 79 patients were identified with this diagnosis. 84.8% (67/79) among them were males and 15.2% females (12/79). Th e mean age of the patients was 59.1 years. Th e site of primary tumor was on the oropharynx lateral wall in 37.8% cases (30/79), in the tongue root area — 24.1% (19/79), in the tonsils area — 17.7% (14/79), on the soft palate — 16.5% (13/79), on the oropharynx posterior wall — 3.8% (3/79).Results. Examination of tumor morphological types revealed squamous cell carcinoma (SCC) with various degrees of differentiation in 92.4% cases (73/79), adenocarcinoma of minor salivary gland — in 6.3% (5/79) and sarcoma in 1.2% (1/79). 57.5% of 73 patients with SCC (42/73) underwent protein (p16) immunohistochemistry, while 42.5% of the patients (31/73) did not. According to a surrogate marker for HPV, the following results were obtained for 42 patients: p16-positive in 23.8% cases (10/42), p16-negative in 76.2% (32/42). Stage distribution according to TNM-7: stage I — 11.4% (9/79), stage II — 17.7% (14/79), stage III — 36.7% (29/79), stage IV — 46.8% (37/79). Stage distribution according to TNM-8 (patients who underwent p16 immunohistochemistry): stage I — 11.9% (5/42), stage II — 23.8% (10/42), stage III — 19% (8/42), stage IV — 45.2% (19/42). In 2020, 72% of patients (57/79) received definitive treatment, 10.1% (8/79) — palliative care, 15.2% (12/79) — supportive care, and 2.5% (2/79) refused medical treatment.Discussion. Th e various types of radiation therapy were used as the main defi nitive treatment for patients with oropharyngeal cancer in 69.2% cases (45/65). Only 18.5% of patients (12/65) underwent surgery, 58.3% of which (7/12) received post-surgery radiation therapy.Conclusion. 57.5% of patients (42/73) were detected with HPV status, 23.8% (10/42) revealed surrogate markers for HPV association. 69.2% of patients (45/65) received radiation therapy as the definitive treatment. 18.5% of patients (12/65) underwent surgery, 58.3% of which (7/12) received postsurgery radiation therapy.

Human Papillomavirus (HPV)-Associated Cancers Among Hispanic Males in the United States: Late-Stage Diagnosis by Country of Origin.

The epidemiology of human papillomavirus (HPV)-associated cancers has changed since the development of the multivalent vaccine. This is evidenced by the decline in incidence of cervical cancers in the post-vaccine era. By contrast, studies have reported the rise in incidence of these cancers in males. Though little is known regarding HPV-associated cancers in males, Hispanic males have been largely excluded from research on these cancers. The purpose of this study was to examine the differences in late-stage diagnosis of HPV-associated cancers (oropharyngeal, anorectal, or penile) among subgroups of Hispanic males in the U.S. We performed a population-based retrospective cohort study using the 2005-2016 North American Association of Central Cancer Registries Cancer in North America Deluxe data file (n = 9242). Multivariable logistic regression modeling was used in studying late-stage diagnosis. There were no differences in late-stage diagnosis of oropharyngeal cancer between Hispanic subgroups. Higher odds of late-stage penile cancers were observed among Mexican and Puerto Rican males relative to European Spanish males. Lower odds of late-stage anorectal cancers were observed among Central or South American and Puerto Rican males. Having Medicaid or no insurance were associated with late-stage diagnosis for all cancers. Certain subgroups of Hispanic males have higher odds of late-stage HPV-associated cancer diagnosis based on country of origin and insurance status. These findings call for improved efforts to increase HPV vaccination, particularly among these subgroups of Hispanic males. Efforts to improve health care access and early detection from health care providers are also needed.

Patient's perceptions of oral and oropharyngeal cancer diagnosis disclosure: communication aspects based on SPIKES protocol

Breaking bad medical news is a complex task of clinical practice. The manner in which this is done has a significant impact on patients. This study aimed to assess patient's perceptions regarding oral and oropharyngeal cancer diagnosis disclosure according to the "SPIKES" protocol. This cross-sectional study used a questionnaire with 21 SPIKES-based items. The questionnaire was administered to 100 patients with recently diagnosed oral and oropharyngeal squamous cell carcinoma who evaluated each item according to their preference and experience. Nineteen items showed a significant difference between patient's preference and recalled experience. Eighteen of these items showed lower experience scores primarily related to the amount of information desired by patients, presence of a companion, time to express feelings, and summary of information. Most patients preferred receiving as much information as possible about the diagnosis. However, only 35% reported that they had obtained sufficient information. Patients who were aware of cancer diagnostic suspicion had better communication experiences. Protocols may be useful to guide health professionals to support patient-centered strategies to disclose oral cancer diagnoses.

The impact of Human Papilloma Virus status on the prediction of head and neck cancer chemoradiotherapy outcomes using the pre-treatment apparent diffusion coefficient.

Objective:To determine the impact of Human Papilloma Virus (HPV) oropharyngeal cancer (OPC) status on the prediction of head and neck squamous cell cancer (HNSCC) chemoradiotherapy (CRT) outcomes with pre-treatment quantitative diffusion-weighted magnetic resonance imaging (DW-MRI).Methods:Following ethical approval, 65 participants (53 male, age 59.9 ± 7.86) underwent pre-treatment DW-MRI in this prospective cohort observational study. There were 46 HPV OPC and 19 other HNSCC cases with Stage III/IV HNSCC. Regions of interest (ROIs) (volume, largest area, core) at the primary tumour (n = 57) and largest pathological node (n = 59) were placed to analyse ADCmean and ADCmin. Unpaired t-test or Mann–Whitney test evaluated the impact of HPV OPC status and clinical parameters on their prediction of post-CRT 2 year locoregional and disease-free survival (LRFS and DFS). Multivariate logistic regression compared significant variables with 2 year outcomes.Results:On univariate analysis of all participants, the primary tumour area ADCmean was predictive of 2 year LRFS (p = 0.04). However, only the HPV OPC diagnosis (LFRS p = 0.03; DFS p = 0.02) predicted outcomes on multivariate analysis. None of the pre-treatment ADC values were predictive of 2 year DFS in the HPV OPC subgroup (p = 0.21–0.68). Amongst participants without 2 year disease-free survival, HPV-OPC was found to have much lower primary tumour ADCmean values than other HNSCC.Conclusion:Knowledge of HPV OPC status is required in order to determine the impact of the pre-treatment ADC values on post-CRT outcomes in HNSCC.Advances in knowledge:Pre-treatment ADCmean and ADCmin values acquired using different ROI methods are not predictive of 2 year survival outcomes in HPV OPC.

Rapid and noninvasive diagnosis of oral and oropharyngeal cancer based on micro-Raman and FT-IR spectra of saliva

Fast, sensitive, and noninvasive techniques are needed for better health care management, particularly when traditional biopsies could be replaced with appropriate analyses of body fluids, such as saliva. Here is presented a proof-of-concept study, which aims to test a recently developed saliva samples preparation method, for oral and oropharyngeal cancer diagnosis, using micro-Raman and Fourier transform infrared (FT-IR) spectroscopic techniques. The detected biomarker bands and the cancer classification rates are compared and discussed. Saliva samples were collected from healthy donors and pathologically confirmed oral and oropharyngeal cancer patients. Principal components analysis (PCA) and principal components analysis-linear discriminant analysis (PCA-LDA) chemometric methods were applied to build discrimination models for the test and control groups. Based on the differences between salivary spectra of healthy and cancer patients, several biomarker bands were identified. Noteworthy, a significant vibrational biomarker band at 2064 cm−1, assigned to thiocyanate, was observed in both the FT-IR and Raman data-set. Other cancer characteristic Raman bands were 754 cm−1 (tryptophan), 530 and 927 cm−1 (lysozyme), 1001 cm−1 (phenylalanine), while the FT-IR biomarker band was located at 1075 cm−1 (phosphodiester bonds stretching in DNA, RNA). The oral and oropharyngeal cancer was classified with an accuracy of 90% based on the micro-Raman data and 82% based on the FT-IR data set, respectively. The study showed that oral and oropharyngeal cancer can be differentiated from control saliva samples based on their respective micro-Raman and FT-IR spectral signatures, due to the biomolecular modifications induced by the disease.

Change in Age at Diagnosis of Oropharyngeal Cancer in the United States, 1975-2016.

Simple SummaryWhile previous studies have suggested that HPV-associated head and neck cancer (HNC) is mostly in the younger population, we found that in the last 40 years, the mean age at diagnosis of oropharyngeal cancer has been 60.3 years. We found that after an initially decrease leading up to the early 2000s, there has been a steady increase in age at diagnosis of oropharyngeal cancer since 2002. For non-oropharyngeal HNC, mean age at diagnosis has steadily increased throughout the last four decades. Finally, we found that age at diagnosis of HNC is higher among females in general, and lowest among blacks.The emergence of the human papillomavirus (HPV) as the primary etiology of oropharyngeal cancer has changed head and neck cancer (HNC) epidemiology. This study described change in the age at diagnosis of oropharyngeal and non-oropharyngeal HNC in the United States in the last four decades. Using a retrospective cohort analysis, the Surveillance, Epidemiology, and End Results dataset from 1975 to 2016 was queried for eligible adult cases of HNC, grouped as oropharyngeal (n = 31,702) versus non-oropharyngeal (n = 87,108). Age at diagnosis was compared by gender (female, male) using independent t-test, and by race/ethnicity (Hispanic, non-Hispanic black, non-Hispanic white, non-Hispanic other) using analysis of variance. Joinpoint regression estimated yearly increases/decreases in age of diagnosis by sex and race/ethnicity through annual percent changes (APC), which were summarized with average annual percent changes (AAPC). Mean age at diagnosis for oropharyngeal cancer was 60.3 years. While there was initially a decrease in age at diagnosis, a 0.37% annual increase occurred from 2002 to 2016 (APC = 0.37, 95% confidence interval (CI) 0.28, 0.45). For non-oropharyngeal cancer, mean age at diagnosis was 63.2 years, with a continuous increase in age at diagnosis throughout the study period (1975–2016 AAPC = 0.08, 95% CI 0.04, 0.12). Females had higher average age at diagnosis than males for both sites, while blacks (57.4 years for oropharyngeal cancer; 59.0 years for non-oropharyngeal) had the lowest age at diagnosis of all races/ethnicity. Age at diagnosis of oropharyngeal cancer has increased significantly since 2002, while non-oropharyngeal HNC has increased significantly in the last four decades.

Aspirin use predicts prolonged survival in patients with oropharyngeal cancer: Nationwide Veterans Affairs database study.

Single-institution studies suggest that aspirin reduces the risk of death in head and neck cancer. The aim of this study was to investigate the effect of aspirin use on overall survival (OS) in veterans with oropharyngeal cancer (OPC). A total of 23 083 veterans with OPC were identified between 2005 and 2018 from the Veterans Health Administration Corporate Data Warehouse. Records were queried for clinical-demographic data, aspirin prescriptions, and outcomes. Three-year OS was estimated. A Cox model was used to estimate hazard ratios (HR) for aspirin use. Among the 23 083 identified veterans, 17 206 veterans met inclusion criteria. 21.8% used aspirin. Three-year OS was prolonged for aspirin users (66%) compared to nonaspirin users (54%; P < .001). Adjusted HR for death for nonaspirin users was 1.75 (95% confidence interval (CI) [1.60-1.91]). The average treatment effect of aspirin on survival using inverse probability weighting was 10% (95% CI [0.08-0.11]). Aspirin use following OPC diagnosis was independently associated with improved 3-year OS among veterans nationwide.

Burden of comorbidities is higher among elderly survivors of oropharyngeal cancer compared with controls.

The prevalence of survivors of oropharyngeal cancer (OPC) is increasing due to improved survival for individuals with human papillomavirus (HPV)-related disease. Although elderly survivors of OPC are known to have a high burden of comorbidities, to the authors' knowledge it is unknown how this compares with a similar cohort without a history of cancer. The current retrospective, cross-sectional study included individuals with a first incident primary diagnosis of OPC from 2004 through 2011 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked databases and matched controls. The baseline prevalence and subsequent incidence of comorbid conditions were identified. The association between comorbidity and overall survival was evaluated. A total of 2497 eligible patients with OPC were matched to 4994 noncancer controls. Baseline comorbidity was higher in cases (Charlson Comorbidity Index >0 for 48.5% of cases vs 35.8% of controls). At 5years, cases were more likely than controls to develop comorbidities. Survivors of OPC were at high risk (≥20% cumulative prevalence by 5years) of developing severalcomorbidities, including cardiovascular diseases, cerebrovascular disease, chronic obstructive pulmonary disease, and tobacco abuse, and were at moderately high risk (10%-19% cumulative prevalence) of developing otherconditions including carotid artery occlusive stroke, alcohol abuse, depression, and anxiety. In both cases and controls, the presence of the majority of comorbidities either at the time of diagnosis or during the follow-up period was associated with worse survival. Patients with OPC have a higher comorbidity burden compared with matched controls, both at baseline and during survivorship, the majority of which are associated with decreased survival. Oncologic surveillance of survivors of OPC should include screening for highly prevalent conditions.

Strategies for communicating oral and oropharyngeal cancer diagnosis: why talk about it?

This review aimed to explore the paradigms of disclosing a cancer diagnosis with a focus on oral and oropharyngeal cancer and patient-related considerations. A search of MEDLINE, Embase, and Scopus was conducted using the following keywords: oral cancer; mouth lesions; oncology; breaking bad news; truth disclosure; and communication skills training. English and Spanish language studies published through October 2019 were included. The way bad news is conveyed to patients with cancer may affect their comprehension of information, emotional distress, treatment adherence, and health outcomes. Models of communication that are focused on patients' preferences may result in better treatment outcomes. Available protocols, such as SPIKES and ABCDE, have useful recommendations for health care professionals communicating an oral cancer diagnosis. However, it is important to be attentive to the particular information needs of patients. When communicating a cancer diagnosis, providers should employ validated methods of information delivery and support for oncology patients. Further studies are needed to evaluate the experiences and preferences of patients with oral cancer during these communications.

Impact of oral and oropharyngeal cancer diagnosis on smoking cessation patients and cohabiting smokers.

INTRODUCTIONOur aim was to determine the influence of oral and oropharyngeal (OOP) cancer diagnosis on smoking cessation in patients and/or cohabiting smokers. We also aimed to determine whether OOP cancer patients received smoking-cessation advice and evaluated the factors that were influential in aiding them to quit or decrease smoking.METHODSThis study was conducted at King Fahad Medical City, Saudi Arabia from March 2015 to May 2017. A pre-validated self-administered questionnaire was administered to OOP cancer patients visiting the Dentistry and Head & Neck Oncology outpatient clinics. Sociodemographics and baseline information were obtained from electronic medical records. Data were collected from 203 patients; 88 were ever-smokers and 115 were never-smokers.RESULTSAmong patients who were smoking at the time of the OOP cancer diagnosis, 47.7% continued to smoke after the diagnosis. OOP cancer diagnosis was influential in smoking cessation in ever-smoker patients and their cohabiting smokers. The apparent influence of OOP cancer diagnosis was different between cohabiting smokers of ever-smoker patients (n=21/25; 84%) and those of never-smokers (n=10/21; 47.6%). Former-smokers (n=16/19; 84.2%) were less likely to remember receiving smoking-cessation advice than current-smokers (n=17/39; 43.6%). Pressure from family and friends, adverse impact on cancer prognosis, and adverse impact of cancer treatment were influential factors for smoking cessation. Among treatment modalities, combined chemoradiotherapy had the greatest impact (n=10/21; 47.6%) on smoking cessation among patients who stated that oncology treatment was influential in causing them to quit or decrease smoking.CONCLUSIONSA substantial number of patients continued to smoke after the OOP cancer diagnosis; however, diagnosis facilitated smoking cessation in many cases. Current smoking status should be reviewed throughout the OOP cancer patient’s disease course, and smoking-cessation assistance should be provided where necessary.

Societal cost of oropharyngeal cancer by human papillomavirus status, cancer stage, and subsite.

BackgroundThe incidence of oropharyngeal cancer (OPC) is increasing, particularly human papillomavirus (HPV)-associated OPC. The aim of this study was to specify the total societal cost of OPC by HPV status, cancer stage, and subsite using a bottom-up cost-of-illness approach.MethodsWe analyzed 121 consecutive patients with OPC from the Southern Health Care Region of Sweden. We estimated the direct medical costs and indirect costs (e.g., disease-related morbidity and premature death) from 1 month prior to OPC diagnosis until 3 years after treatment completion.ResultsThe mean total cost per patient was €103 386 for HPV-positive and €120 244 for HPV-negative OPC. Eighty-one percent of the patients analyzed were HPV-positive: Accordingly, HPV-positive OPC represented 79% of the total cost of OPC. The mean total cost of stage I, II, III, IVA, IVB, and IVC, regardless of HPV status, was €59 424, €57 000, €69 246, €115 770, €234 459, and €21 930, respectively, of which indirect costs were estimated at €22 493 (37.8%), €14 754 (25.9%), €28 681 (41.4%), €67 107 (58%), €166 280 (70.9%), and €0. Tonsillar cancer represented 64% of OPC, with a mean total cost of €117 512 per patient.ConclusionThe societal cost of OPC is substantial. HPV-associated OPC comprises 79% of the total cost of this disease. The data presented in this study may be used in analytical models to aid decision makers in determining the potential value of gender-neutral HPV vaccination.

Abstract 5047: Change in age of diagnosis of oropharyngeal cancer in the United States, 1975-2015

Abstract Introduction: Human papillomavirus (HPV) is the most common etiology of oropharyngeal squamous cell carcinoma (OPSCC), causing 70-90% of cases, and has continued to increase in incidence. While HPV-associated OPSCC has been associated with younger age at diagnosis compared to other head and neck cancers, research studies suggest that age of diagnosis might have increased in the last decade. There is currently no long-term, population-based estimate of age of diagnosis of oropharyngeal cancer, or differences in age of diagnosis based on race and gender. This study aimed to describe the change if any in the age of diagnosis of OPSCC in the last four decades. Methods: The mean age at diagnosis of OPSCC patients from the Surveillance, Epidemiology, and End Results (SEER) 9 database diagnosed from 1975-2015 was computed for each year (n = 30,320). An independent samples t-test compared mean age at diagnosis by sex (female, male), and analysis of variance compared mean age at diagnosis by race/ethnicity (Hispanic, non-Hispanic (NH) white, NH black, NH other). Joinpoint regression estimated yearly increases/decreases in mean age of diagnosis by sex and race/ethnicity through annual percent changes (APC), which were summarized with average annual percent changes (AAPC). Results: OPSCC patients were predominantly NH white (80.0%) and male (76.8%) with a mean age at diagnosis of 60.3 years (standard deviation = 10.9 years). Females had a significantly higher mean age at diagnosis than males (62.4 versus 59.7, p &amp;lt; 0.01). Hispanic (mean = 59.2) and NH black patients (mean = 57.3) had a significantly lower mean age at diagnosis than NH white patients (mean = 60.8). Overall, mean age at diagnosis remained stable from 1975-1996 (APC = 0.00, p &amp;gt; 0.05), significantly decreased from 1996-2002 (APC=-0.86, p &amp;lt; 0.01), and significantly increased from 2002-2015 (APC = 0.35, p &amp;lt; 0.01). However, the overall AAPC showed a stable trend in age of diagnosis from 1975-2015 (AAPC = -0.02, p &amp;gt; 0.05). The AAPCs in age of diagnosis for gender (males and females) and race/ethnicity also both remained stable from 1975-2015 (p &amp;gt; 0.05), except for NH blacks, with an estimated 0.13% yearly increase in age of diagnosis from 1975-2015 (AAPC = 0.13, p &amp;lt; 0.01). Conclusions: The overall age at diagnosis for OPSCC has remained stable in the United States between 1975 and 2015. The younger age at diagnosis among NH blacks and Hispanics is important in prevention, early detection, and surveillance of OPSCC in the United States Citation Format: Brittany J. Cline, Matthew C. Simpson, Aleksandr R. Bukatko, Eric Adjei Boakye, Kahee A. Mohammed, Nosayaba Osazuwa-Peters. Change in age of diagnosis of oropharyngeal cancer in the United States, 1975-2015 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5047.

Abstract 1202: Spatial analysis of late-stage oropharyngeal cancer diagnosis in Florida: Hierarchical models and geographically-weighted regression

Abstract Literature on spatial variation of cancer outcomes in the US remains scarce. Studies have not assessed how late-stage OPC diagnosis varies across geography nor the effect of spatially different socioeconomic factors. Identifying risk factors that have higher impact on certain localities can help inform clinicians and policy-makers. Our study aimed to evaluate spatial differences in stage of diagnosis of oropharyngeal cancer (OPC) in Florida using hierarchical and geographically-weighted regression (GWR) models. We used the Florida Cancer Data System to derive a cohort of 57,082 patients diagnosed with OPC during 1990-2010. The individual-level covariates that informed our models consisted of age at diagnosis, gender, race, married status, health insurance payer, history of cigarette smoking, and year of diagnosis. Patients' addresses were geocoded to obtain a point feature used to map the spatial distribution of individuals using ArcGIS. A hot-spot analysis (Getis-or-Gi) revealed areas of high clustering of patients with late-stage diagnosis. To evaluate spatially-relevant factors for such variation, we fitted a mixed logistic regression model using PROC GLIMMIX in SAS with the individual-level variables in addition to county and census tract-level covariates. We used US Census data to extract records on the percent of residents unemployed, living in poverty, and foreign-born. Variables for the county level extracted from the Area Health Resource File and the Behavioral Risk Factor Data included the percent of residents engaging in heavy drinking, who couldn't visit a dentist due to cost, and who were smokers, a flag for Health Professional Shortage Areas for primary care doctors and dentists, presence of a hospital with oncology services, and a flag for rural designation. The model showed significant higher odds for late-stage OPC diagnosis for non-White patients (OR 1.63, 95%CI 1.48-1.79 for Black and 1.29, 95%CI 1.03-1.62 for other-race), current smoker status (OR 1.45, 95%CI 1.36-1.54), former smoker status (OR 1.36, 95%CI 1.27-1.45), patients without health insurance (OR 1.60, 95%CI 1.41-1.82), patients covered by Medicaid (OR 1.73, 95%CI 1.5-1.97), patients diagnosed with cancer in pharyngeal sites (OR 4.74, 95%CI 4.53-4.95), and higher percentage of residents in census tract living in poverty (OR 1.01, 95%CI 1.00-1.011). The GWR conducted at the county-level revealed areas where coefficients associated with various risk-factors contributed to a higher proportion of late-stage OPC diagnosis. For easier communication of findings, we created density maps that will be presented. Our study empirically showed variation of late-stage OPC diagnosis across Florida and differential effects of spatial socioeconomic factors. Future public health initiatives can use a targeted approach to focus resources in these specific areas more likely to be impacted. Citation Format: Juan M. Hincapie-Castillo, Yi Guo, Natalie L. Silver, Hong Xiao. Spatial analysis of late-stage oropharyngeal cancer diagnosis in Florida: Hierarchical models and geographically-weighted regression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1202.

Impact of chronic hepatitis C virus infection on the survival of patients with oropharyngeal cancer.

Although an association between hepatitis C virus (HCV) infection and oropharyngeal cancers (OPCs) has been reported, to the authors' knowledge the clinical significance of this epidemiological finding remains unknown. Therefore, the authors analyzed the oncologic outcomes of HCV-infected patients with OPCs. In this retrospective cohort study, all patients with OPCs who were seen at The University of Texas MD Anderson Cancer Center between January 2004 and December 2015 were reviewed. HCV infection was defined as detectable HCV RNA in the serum. Five-year overall survival and progression-free survival rates were compared between patients infected with HCV and those not infected. A total of 161 patients were examined. The majority of the patients were white (141 patients; 88%) and male (132 patients; 82%) and had TNM stage III or IV disease (147 patients; 91%). The OPC involved the tonsils (83 patients; 52%), base of the tongue (67patients; 42%), or the soft palate (11 patients; 7%). The median follow-up after an OPC diagnosis was 3 years (range, 1-13 years). HCV-infected patients (25 patients) and HCV-uninfected patients (136 patients) were comparable with regard to smoking and alcohol status. In multivariate analysis, HCV was associated with increased cancer-specific mortality (hazard ratio, 2.15; 95% confidence interval, 1.08-6.85 [P = .02]) and risk of OPC progression (hazard ratio, 5.42; 95% confidence interval, 2.64-11.14 [P = .0008]) independent of age and cirrhosis status. Antivirals were administered after the diagnosis of OPC in 8 of the 25 HCV-infected patients (32%). HCV-infected patients who received antivirals were found to have better 5-year overall survival (70% vs 12%; P = .005) and progression-free survival (72% vs 19%; P = .005) compared with patients who did not. The early detection of HCV is important in patients with OPC because this infection may affect their oncologic outcomes. Cancer 2018;124:960-5. © 2017 American Cancer Society.

Pre-diagnostic dynamic HPV16 IgG seropositivity and risk of oropharyngeal cancer

ObjectiveThe aim of this study was to determine the association of HPV16 antibodies (Abs) and oropharyngeal cancer (OPC) risk in sera obtained prior to clinical diagnosis. MethodsWe identified 92 participants with incident OPC and 460 matched controls from the Janus Serum Bank Cohort in Norway. Archived tumor specimens were requested for a subset of the cases. Serum samples were collected from cases, on average, 9.3years before diagnosis (range, 0.1–14.9years). Ten cases had serum samples from multiple time points. IgG seropositivity to 8 HPV16 antigens was determined, and a logistic regression classifier of a panel of all early-antigen (EA) Abs for the predictive diagnosis of OPC was applied. ResultsHPV16 EA seropositivity was present in 25.0% of patients with OPC and 7.6% of controls (odds ratio (OR), 4.1; 95% CI, 2.3–7.2, p<0.0001). Abs to E2 were strongly associated with cases 0–2years pre- diagnosis (OR, 150.1; 95% CI, 27.4–1040.0, p<0.0001), and the probability of seropositivity was inversely associated with time to diagnosis (OR, 0.7 per additional year; 95% CI, 0.6–0.9, p=0.0002). Abs to E2 were also strongly associated with tumor HPV status (OR, 35.6; 95% CI, 8.7–200.0, p<0.0001). A positive score on the binary classifier was associated with an overall OR of 15.8 (95% CI, 5.6–53.4) compared with controls (p<0.05), and was strongly associated with tumor HPV status (OR, 27.4; 95% CI, 8.6–99.6, p<0.001). ConclusionsHPV16 Abs are detectable years prior to diagnosis of OPC, and the probability of seropositivity increases closer to diagnosis.

Medical Care Cost of Oropharyngeal Cancer among Texas Patients.

Background: The incidence of oropharyngeal cancer is rising rapidly, with the majority of cases being attributable to human papillomavirus (HPV). Despite the availability of a vaccine, rates of HPV vaccination among Texas youth are low. The healthcare cost of oropharyngeal cancer in Texas is unknown. The aims of this study were to estimate the first 2-year cost of treating new cases of oropharyngeal cancer and determine the predictors of oropharyngeal cancer treatment cost in Texas.Methods: This study included a retrospective cohort of 467 Texas patients with commercial insurance claims data with oropharyngeal cancer diagnosed from 2011 to 2014 and a control group of 467 noncancer patients obtained with propensity score matching. Total healthcare cost during the first 2 years after the index date was measured. A generalized linear model was used to identify predictors of monthly cost during the 2 years after the index date.Results: The mean differential adjusted healthcare cost for oropharyngeal cancer cases was $139,749 in the first 2 years. The mean adjusted monthly cost in the first 2 years was $6,693 for cases and $870 for controls. Age, comorbidity, mental health, prediagnostic healthcare cost, and time index were significant predictors of monthly cost.Conclusions: Medical care cost was about $140,000 in the first 2 years after diagnosis of oropharyngeal cancer among commercially insured patients in Texas.Impact: The cost estimates provide important parameters for development of decision-analytic models to inform decision makers about the potential value of initiatives for increasing the HPV immunization rate in the state. Cancer Epidemiol Biomarkers Prev; 26(9); 1443-9. ©2017 AACR.

27 Percutaneous endoscopic gastrostomy tubes; a retrospective analysis in patients with head and neck cancer over 5 years

Background Weight loss and malnutrition are common side effects of disease process and treatment of head and neck cancer. The use of PEG tubes to aid nutrition has been shown to be effective in previous studies and suggest patients benefit from PEGs. Aim 1) To determine the rate of insertion and use of PEGs 2) To determine complication rates Method This study assessed 175 patients who had PEG tubes inserted from 2012 to 2016. Data was collected and extracted from patient dietitian record and analysed using SPSS. Results 175 patients had PEGs placed from January 2012 t o December 2016. 39% of PEGs were inserted prophylactically. 67% of patients in the cohort had a diagnosis of oropharyngeal cancer. 27% of patients had laryngeal cancer. 3% had salivary gland cancer. Of all patients who received PEGs from 2012-2016, 25% gained weight and 6% of patients’ weight remained stable. 68% did not experience any complication (n=119). 5% experienced a major complication of PEG infection (n=9), while the remaining 11.5% had minor complications of PEG leakage 7.5% and granuloma formation (4%). Conclusions Weight loss is almost ubiquitous in head and neck cancers. This study demonstrated that PEGs are a useful aid for patients undergoing treatment for cancer allowing 31% of patients to gain and/or maintain weight. PEGs had relatively low rates of complications with only 5% of patients experiencing a serious complication. This study highlights that patients may benefit from PEG placement during treatment and benefits may outweigh risks.