Longitudinal Oncology Registry Of Head And Neck Carcinoma Research Articles

Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN): Analysis of African American patients.

5533 Background: Previous retrospective analyses show poor outcomes for African American (AA) patients with head and neck carcinoma (HNC). Such racial disparities are not well understood, but patient (pt) demographics, comorbidities, tumor site, and human papillomavirus (HPV) status are suggested to play a role. Methods: The LORHAN registry was used to identify pts ≥18 yrs of age with de novo, non-metastatic HNC, and a record of survival time. This study evaluated pt and treatment characteristics by race, and conducted adjusted Cox regression analyses of overall survival (OS) and progression-free survival (PFS) to identify prognostic factors and interactions, and estimate hazard ratios (HRs) of AA vs. non-Hispanic white (NHW). Results: Baseline pt characteristics (see table below). The median OS/3-yr rate was 41.7 mo/51% in AA vs. 52.9 mo/70% in NHW, (age-adjusted HR: 1.73 [95% CI: 1.45, 2.08]). The median PFS/3-yr rate was 29.6 mo/43% in AA and 49.9 mo/62% in NHW, (age-adjusted HR: 1.64 [95%CI: 1.40, 1.93]). Multivariate analysis of OS and PFS showed that AA race, stage III and IV, PS 2, and smoking were significantly associated with a worse HR, while OP demonstrated a favorable HR over other sites. Significant interaction tests led to subgroup analyses for OS showing an elevated risk in AA with OP (HR: 2.62 [95%CI: 1.95, 3.52]) and similar risk elevations in male AA as well as in AA with PS 0-1 when compared to NHW in the corresponding subgroups. Conclusions: Controlling for other factors like PS and smoking, a worse prognosis was seen in AA males with OP localized SCCHN. Further investigation to improve the outcomes in this population is warranted. [Table: see text]

Head and neck carcinoma in the United States

Detailed information about how patients with head and neck carcinoma (HNC) are treated across practice settings does not exist. The authors conducted a prospective, observational study to examine the patterns of care for a series of patients with newly diagnosed HNC in the United States and to test 2 hypotheses: 1) There is no difference in the pattern of care between community and academic settings; and 2) the results of major randomized clinical trials will change the pattern of care in both practice settings within 1 year of publication in peer-reviewed journals. Patients aged ≥ 18 years were enrolled in the Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN) after providing written informed consent if they had a confirmed diagnosis of new HNC and were scheduled to receive treatment other than surgery alone. Between 2005 and 2010, 100 centers enrolled 4243 patients, including 2612 patients (62%) from academic investigators and 1631 patients (38%) from community centers. Initial treatments were radiation with concurrent chemotherapy (30%) or cetuximab (9%), adjuvant radiotherapy (21%), induction chemotherapy (16%), and other (24%). Intensity modulated radiation therapy was the dominant radiation technique (84%). Single-agent cisplatin was prescribed in nearly half of patients and more often in academic centers (53% vs 43% of patients; P < .0001). Single-agent cetuximab was the next most common drug used (19%) and was prescribed more frequently in community settings (24% vs 17%; P = .0001). The data rejected the 2 prospective hypotheses. LORHAN documented differences in patient characteristics and treatments between community and academic settings for a large series of patients in the United States.

United States Patterns of Radiation Oncology Practice in the Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN) Study

United States Patterns of Radiation Oncology Practice in the Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN) Study

Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN): Analysis of disparities in care.

5533 Background: We sought to examine differences in treatment by various populations in LORHAN, a national registry of head and neck carcinoma (HNC) patients (pts). Methods: Pts included in the analysis had de novo, stage III/IV, non-metastatic HNC, received radiotherapy (RT) and/or drug therapy, were ≥18 years of age and had provided written informed consent. Univariate analyses (UA) and multivariable logistic regression (LR) were used to assess relationship of pre-specified independent variables to selected treatment related dichotomous measures. Results: UA results are in table below. LR showed the following factors were significantly associated with use of RT alone: community setting (odds ratio [OR] 0.45; 95% CI, 0.30-0.67); age (OR 1.03; 95% CI, 1.01 - 1.05); black race (OR 1.9; 95% CI 1.1-3.0); Hispanic ethnicity (OR 3.5; 95% CI, 1.5-7.6). Factors significantly associated with use of surgery were: community setting (OR 0.54; 95% CI, 0.42-0.69) and age (OR 0.9877; 95% CI, 0.9766 - 0.9989). Conclusions: This analysis suggests setting, age and race may influence treatment received for HNC. Further investigation required to confirm findings here. Treatment comparison: Primary RT versus concurrent chemoradiation (CRT). Variable Intergroup comparisons All N=1,359 Primary CRT n=1,194 Primary RT n=165 P value No. % No. % No. % Setting Academic 864 64 738 62 126 76 0.0003 Community 495 36 456 38 39 24 Age (years) Mean 58 58 61 0.007 Ethnicity White (non-Hispanic origin) 1,108 82 986 83 122 74 0.009 Black (non-Hispanic origin) 163 12 133 11 30 18 Hispanic 39 3 30 3 9 6 Asian 22 2 19 2 3 2 Other 27 2 26 2 1 <1 Insurance status Does not have insurance 72 5 70 6 2 1 0.003 Has insurance 648 48 580 49 68 41 Unknown 639 47 544 46 95 58 Type of insurance Private 401 30 361 30 40 24 0.02 Medicaid 75 6 68 6 7 4 Medicare 141 10 125 11 16 10 Military/VA 29 2 24 2 5 3 No insurance 72 5 70 6 2 1 Unknown 641 47 546 46 95 58 Household income NS Highest education level NS Treatment comparison: Surgery vs. no surgery before RT or CRT. Variable Intergroup comparisons All N=1,826 No surgery n=1,359 surgery n=467 P value No. % No. % No. % Setting Academic 1,220 67 864 64 356 76 <0.0001 Community 606 33 495 36 111 24 Age (years) Mean 58 58 57 0.006 Other variables (as noted above) NS Abbreviation: NS, not significant.

Longitudinal oncology registry of head and neck carcinoma (LORHAN)

A study was undertaken to examine the patterns of systemic therapy use in conjunction with radiation therapy for patients with locally advanced head and neck squamous cell cancer. Between December 1, 2005 and May 11, 2009, 2874 patients with newly diagnosed head and neck squamous cell cancer who were scheduled to receive radiotherapy and/or drug therapy were registered in a prospective national database. The database was specifically analyzed to examine patients who received chemotherapy in conjunction with definitive radiotherapy. A total of 1144 patients received systemic therapy in conjunction with radiotherapy; 645 (56%) patients received agents concurrent with radiation therapy, 49 (4%) patients received chemotherapy before radiotherapy (induction), 224 (20%) patients received chemotherapy before and during radiotherapy (sequential), and 226 (20%) patients received chemoradiation after surgery. Single-agent cisplatin, single-agent cetuximab, and carboplatin plus paclitaxel were, in order, the 3 most commonly prescribed concurrent regimens. Concurrent cisplatin was more frequently used in the academic setting compared with the community setting (P = .0015). Postoperative chemoradiation, rather than radiation alone, was more commonly used in academic centers compared with community practice centers (P = <.0001). The LORHAN (Longitudinal Oncology Registry of Head and Neck Carcinoma) database is a useful barometer of current US practice patterns and can be applied to analyze future trends in the combined modality management of head and neck cancer. Sequential chemotherapy is used frequently, but cisplatin-based concurrent chemoradiation remains the most commonly used regimen for locally advanced head and neck cancer.

Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN): Findings related to the oropharynx.

5585 Background: We present the first report of findings focused on the oropharynx (OP) from LORHAN, a prospective, observational national registry of head and neck carcinoma (HNC) patients (pts). The Registry is now sufficiently large to perform site-specific analyses. Methods: Pts with newly diagnosed HNC, scheduled to receive radiotherapy (RT) or chemotherapy (CT), ≥18 years of age and who have provided written informed consent are eligible for enrollment. Electronic records are locked once they have been reviewed and signed off by the investigator. Results: As of Jan. 3, 2010, 3525 pts have been enrolled in LORHAN. Nearly 100 community (Comm) and academic (Acad) sites from 35 states have enrolled pts in the registry. Of principal investigators participating in LORHAN, 22% designated their setting as Acad, 78% as Comm. Acad centers accrued 65% of pts. Of pts enrolled, there are 941 locked baseline and treatment records for pts with the primary diagnosis of OP cancer, representing 44% of locked records ...

Longitudinal oncology registry of head and neck carcinoma (LORHAN): First report of outcomes

6071 Background: Registries can be invaluable for describing patterns of care and outcomes for a population of patients (pts). We report the initial survival findings from LORHAN, a prospective, longitudinal, observational national registry of head and neck carcinoma (HNC) pts. Methods: Pts are eligible for LORHAN if they have newly diagnosed HNC, are scheduled to receive radiotherapy (RT) or drug therapy, are ≥18 years of age and have provided written informed consent. Data are entered in the registry electronically and transferred via Secure HTTP protocols. Patient confidentiality is strictly maintained. Pts are followed from time of initial diagnosis and for a minimum of 2 and up to 10 years. When information is complete and has been verified and signed off by the investigator, a record is locked. Only locked records are summarized and reported. Results: 2,354 pts have been enrolled in LORHAN since Dec. 2005. Of these, 1,326 pts have completed initial cancer treatment and have locked records. 1- and 2-year follow-up data are available for 583 and 56 pts, respectively. Baseline characteristics were similar between settings, except that pts treated at academic centers were significantly younger (58 vs. 62 years of age), had poorer performance status (mean Zubrod: 0.9 vs. 0.7), had fewer laryngeal tumors (17% vs. 27% of pts) but more oropharyngeal tumors (42% vs. 37% of pts) and presented with more advanced disease (stage IV: 70% vs. 48% of pts) compared to pts treated in community. Treatment did not differ by setting. Treatment and survival data are shown below. Conclusions: LORHAN demonstrates it is feasible to collect more detailed information about patient and tumor features and treatment other than surgery. Changes in the pattern of care and survival findings are expected to emerge as newer regimens, including IC and targeted agents, are incorporated more broadly into clinical practice, and data in LORHAN matures. [Table: see text] [Table: see text]

Longitudinal oncology registry of head and neck carcinoma (LORHAN®): initial supportive care findings

We report the first analysis of demographic, socioeconomic, and toxicity data from the Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN). Eligible patients include newly diagnosed Head and Neck Cancer (HNC) patients, scheduled to receive radiotherapy or drug therapy, > or =18 years of age, and able to provide informed consent. Assessments are completed at baseline, at the completion of therapy, and yearly thereafter. Patient data are entered in the registry electronically and transferred via Secure HTTP protocols. Reported use of supportive care differed by treatment setting. When compared to community sites, patients at academic centers received more supportive interventions: feeding tube (59% vs. 48%; p = 0.001), tracheotomy tube (16% vs. 9%; p = 0.002), opioid analgesics (89% vs. 59%; p < 0.0001), anti-emetics (83% vs. 68%; p < 0.0001), and amifostine (17% vs. 12%; p = 0.02). Reported grades 3-4 mucositis/stomatitis was also higher in patients treated at academic centers (38% vs. 28%; p = 0.001). There was a marked decrease in the documented use of supportive care measures in the community setting. This may be due to (1) lower rates of toxicity requiring less supportive care, (2) less stringent documentation, or (3) less aggressive use of supportive care measures. The documented rate of mucositis was less than expected. This is likely due to inadequate assessment or documentation. Further exploration of these findings is warranted as they may indicate an under appreciation and undertreatment of clinically significant acute tumor and treatment-related toxicities.

Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN): Preliminary Report Regarding Radiation Patterns of Care

We report initial patterns of care findings for LORHAN, a new, prospective, longitudinal, observational national registry of head and neck carcinoma (HNC) patients (pts). This report describes initial patient characteristics and therapies with a focus on radiation practice for pts who have completed therapy. Pts with newly diagnosed HNC, scheduled to receive radiotherapy (RT) or drug therapy, >/=18 years of age and providing written informed consent are being enrolled. Patient data are entered in the registry from initial diagnosis through follow-up for a minimum of 2 years and up to 10. Detailed information on initial treatment and re-treatment is collected. Both community and academic investigators are participating in LORHAN. LORHAN was launched in October 2005 and as of February 2008, 1447 pts have been enrolled; 1101 are evaluable for baseline assessment and 746 have completed initial treatment, of which 724 received RT. Baseline characteristics are similar between academic and community settings, except for age, performance status and staging. Pts treated in academic settings are significantly younger (61 vs. 57; p < 0.0001), have a poorer performance status (mean Zubrod: 1 vs. 0.7; p < 0.0001) and have more advanced disease (Stage IV: 71 vs. 47%; p < 0.0001) than pts treated in the community. The 3 most common tumor sites treated were oropharynx, 42%, larynx, 21% and oral cavity, 17%. Less than 20% of pts overall were enrolled in clinical trials. Sixty-six percent of pts received chemotherapy concurrently with RT and 33% received postoperative RT. The most common form of RT delivered in both settings was IMRT; however, IMRT was delivered more frequently to pts treated in academic settings (87 vs. 71% pts; p < 0.0001). The most common fractionation schedule used in 80% of pts was once daily, 5 fractions per week. Concomitant boost was delivered more frequently in academic vs. community settings (16 vs. 2% patients; p < 0.0001). The median dose was 69 Gy (interquartile range (IQR), 65 -70 Gy). The median number of fractions was 33 (IQR, 30 - 35) and the median number of treatment days was 47 (IQR, 43 - 53). Ninety-two percent of pts were noted as having completed the RT schedule intended. The most common drugs delivered concurrently with RT were cisplatin (59% of pts), followed by cetuximab (21% of pts). LORHAN is a new national initiative that intends to further the understanding of the pattern of care of HNC pts across practice settings. This initial report indicates that the majority of HNC pts are treated with concurrent chemoradiation regimens and that IMRT has been broadly adopted into both community and academic practice. The majority of pts are treated with once daily fractionation. Outcome data are maturing.

Longitudinal oncology registry of head and neck carcinoma (LORHAN): Initial treatment findings

6054 Background: Registries can be invaluable for describing patterns of care for a population of patients. Most cancer registries, however, do not possess sufficient breadth or depth to provide a ...

Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN), A New National Cancer Registry

LORHAN is a new national registry designed to examine contemporary patterns of care of head and neck carcinoma (HNC) patients. LORHAN extends current cancer registries by providing detailed data on radiation and/or cancer drugs delivered to HNC patients in all practice settings.

Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN), a new national cancer registry

5583 Background: Registries can be invaluable for describing patterns of care for a population of patients (pts). Most cancer registries, however, do not possess sufficient breadth or depth to provide a complete and reliable picture of clinical practice. We report the launch of LORHAN, a new national registry of head and neck carcinoma (HNC) pts. LORHAN is designed to extend current cancer registries by providing detailed data on radiation and/or cancer drugs delivered to HNC pts in all practice settings. Methods: This is a prospective, multi-center, longitudinal, observational registry. Pts with newly diagnosed HNC, scheduled to receive radiotherapy or drug therapy, ≥18 years of age and providing written informed consent are being enrolled. Patients participating in clinical trials are eligible for LORHAN. The primary objective of the registry is to describe, in detail, patterns of care for HNC pts. The secondary objectives are to document outcome by treatment regimen, determine the incidence and severity of major toxicities and to identify supportive care received for managing treatment-related complications. Pts are entered in the registry from the time of initial diagnosis and are followed for at least 2 years and up to 10 years. Detailed information on initial treatment and re-treatment is collected. Data entry is electronic and incorporates encrypted point-to-point data transfer via secure HTTP protocols. Physician and patient confidentiality are strictly maintained. Participating practitioners can review and compare their data on a real-time basis to the database. Registry pts may be linked to the NDI to minimize lost to follow-up. Analyses of data are primarily descriptive. Results: LORHAN was launched in Oct. 2005, and as of Dec., 7 sites have received IRB approval and 3 pts have been enrolled. Of the 7 sites, 1 is an academic site and the remaining are community-based practices. An additional 21 sites (17 academic, 4 community) are at various stages of participation. More than 100 medical oncologists and radiation oncologists are anticipated to participate and approximately 26,000 pts will be eligible each year. Accrual status will be updated. Conclusions: LORHAN is a new national initiative that may further the understanding of the care of HNC pts across practice settings. [Table: see text]