Neck Cancer Outcomes Research Articles

Urban and rural differences in outcomes of head and neck cancer.

To assess for potential urban and rural disparities in head and neck cancer (HNC) outcomes within a single-payer healthcare system. A large retrospective population-based cohort analysis of consecutive HNC patients treated in British Columbia, Canada between 2001 and 2010 was conducted. All patients diagnosed with HNC from 2001 to 2010 and referred to any one of five British Columbia Cancer Agency centers for management were reviewed. Based on census data, patients were classified into: 1) rural, 2) small urban, 3) moderate urban, and 4) large urban areas. Kaplan-Meier methods and Cox regression models were used to correlate site of residence with overall survival (OS), controlling for prognostic factors that included sociodemographic and other tumor and treatment-related characteristics. We identified 3,036 patients; the median age was 64 years, 26% were women, and 32% had Eastern Cooperative Oncology Group (ECOG) 0 or 1. The majority resided in large urban areas (55%) followed by rural (22%), moderate urban (13%), and small urban (10%). In regression analyses, smoking (hazard ratio [HR]: 2.10, 95% confidence interval [CI]: 1.28-3.45, P < .001), ECOG 2 + (HR: 3.44, 95% CI: 2.26-5.22, P < .001), oral cavity (HR: 1.54, 95% CI: 1.03-2.32, P = .04) and hypopharyngeal tumors (HR: 2.31, 95% CI: 1.42-3.77, P = .00), and large tumor size (HR: 1.69, 95% CI: 1.08-2.64, P = .02) were correlated with inferior OS, but site of residence was not. When stratified by type of treatment, OS remained similar irrespective of urban or rural residence. Urban-rural differences in HNC survival outcomes were not observed. 2c. Laryngoscope, 128:852-858, 2018.

Population assessment of head and neck cancer outcomes by race and HPV status in chance.

6045 Background: Growing literature suggests that racial disparities exist in patients with head and neck squamous cell carcinoma (HNSCC). Currently, there are many hospital-based cohorts assessing racial disparities, however only a limited number of population-based cohorts exist. This study aims to explore the association between clinical characteristics and patient demographics with overall survival by race and HPV status. Methods: Patients were identified from the Carolina Head and Neck Cancer Study (CHANCE), a population based case-control study with enrollment from 2001-2006 in North Carolina. Vital status was determined by linkage with the National Death Index. Survival was considered at 5 years after diagnosis or study enrollment. We used Kaplan-Meyer analyses and Cox proportional hazards regression modeling to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results: A total of 1361 HNSCC patients with no baseline metastasis and adequate survival time were identified. Of these, 1010 patients were white while 351 patients were black. Black patients were statistically more likely to be younger at age of diagnosis, have a history of tobacco or alcohol use, be uninsured, and not have completed high school (p-value &lt; 0.001). In an unadjusted cox regression analysis, blacks had 1.50 times (95% CI 1.01-1.57) decreased overall survival than whites. Adjusting for gender, stage of disease, age, treatment, and smoking status, this relationship remained (HR 1.30, CI 1.1-1.6). In a subset analysis of male patients by disease site, there was decreased overall survival in black patients in oral cavity cases (p &lt; 0.01). This relationship trended towards significant in pharynx cancer (p = 0.054) and was not found in laryngeal cancer. In pharyngeal cases only, there was decreased overall survival in black patients with HPV+ disease (p = 0.03) but not in HPV- cases (p = 0.33). Conclusions: This is the first population-based study that confirms racial disparities in HPV+ HNSCC. We also found worse overall survival prognosis for black patients with oral cavity cancer and a similar trend in pharynx cancer. Further studies are needed to evaluate if this difference is driven by either biological or socioeconomic factors.

Body mass index and prognosis in patients with head and neck cancer.

Body mass index (BMI) has been associated variably with head and neck cancer outcomes. We evaluated the association between BMI at either diagnosis or at early adulthood head and neck cancer outcomes. Patients with invasive head and neck squamous cell cancer at Princess Margaret Cancer Centre in Toronto, Canada, were surveyed on tobacco and alcohol exposure, performance status, comorbidities, and BMI at diagnosis. A subset also had data collected for BMI at early adulthood. With a median follow-up of 2.5 years, in 1279 analyzed patients, being overweight (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.4-0.8; p = .001) at diagnosis was associated with improved survival when compared with individuals with normal weight. In contrast, underweight patients at diagnosis were associated with a worse outcome (HR, 1.89; 95% CI, 1.2-3.1; p < .01). Being underweight at diagnosis was an independent, adverse prognostic factor, whereas being overweight conferred better prognosis. BMI in early adulthood was not associated strongly with head and neck cancer outcomes. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1226-1233, 2017.

Abstract B78: The interplay between smoking at diagnosis, marital status, and head and neck cancer survivorship

Abstract BACKGROUND There are currently almost 300,000 head and neck cancer survivors in the United States, and that number is increasing due to a nationwide decrease in smoking incidence. Reports on whether smoking at time of diagnosis is associated with adverse head and neck cancer outcomes are inconsistent. There is also a paucity of information on whether marital status of head and neck cancer patients affects tobacco use. In the era of personalized cancer care, it is important to examine whether smoking status at diagnosis negatively affects survival of head and neck cancer patients to develop interventions that improve survivorship. It is also important to examine how marital status is associated with smoking, since spousal support is known to improve survival outcomes among head and neck cancer patients. PURPOSE Examine the association between smoking status at diagnosis and survival among head and neck cancer patients, as well as the association between marital status and smoking in these patients. METHODS This retrospective cohort study included 463 patients aged 20 to 87 (59.31 ± 11.42) with a diagnosis of head and neck squamous cell carcinoma (HNSCC) who attended an academic medical center between 1997 and 2012. For the first aim, the outcome was overall mortality. Main predictor variable was smoking at diagnosis (dichotomized as yes/no) and covariates included age, gender, race, marital status, insurance, alcohol use, stage of cancer, and treatment type received. Descriptive statistics and Cox proportional hazards regression analysis were used to evaluate predictors of survival based on smoking status at diagnosis and covariates. For the second aim, the outcome was smoking status at diagnosis, and the main predictor variable was marital status using the same covariates in the first aim. Multivariate logistic regression models were used to assess whether marital status was a predictor of smoking at diagnosis. RESULTS Approximately 56% of patients were smokers at diagnosis, and 50% were married. We found a statistically significant difference in median survival time between smokers vs. nonsmokers (50 months vs. 80 months, p &amp;lt; .05). In the adjusted Cox proportional hazards model, smoking status at diagnosis was an independent predictor of survival. Patients who were smokers at diagnosis were almost twice as likely to die earlier compared to nonsmokers (HR = 1.98; 95% CI: 1.42, 2.77). Other predictors of survival included stage of presentation (early stage HR=0.61; 95% CI: 0.42, 0.88), marital status (married HR=0.54; 95% CI: 0.40, 0.73), and age (20-49 years HR=0.42; 95% CI: 0.26, 0.67). In the multivariate logistic regression analysis, marital status was a significant predictor of tobacco use. Patients who were unmarried were 76% more likely to use tobacco compared to married patients (aOR=1.76; 95% CI: 1.08, 2.84). Patients who used tobacco were almost 3 times more likely to use alcohol vs. non-users (aOR=2.90; 95% CI: 1.82, 4.60). Other significant predictors of tobacco use included age and insurance status. CONCLUSIONS Smoking status at diagnosis independently predicts survival of head and neck cancer patients, and those who were smokers were almost twice as likely to die earlier than those who did not smoke. We also found that those who were married were less likely to be smokers at diagnosis. Our study suggests that individualized cancer care should incorporate social support in managing cancer risk behaviors. Both smoking and marital status predicted survival outcomes; thus, our findings highlight the need for providers to discuss and encourage spousal involvement in tobacco cessation efforts to mitigate risky behaviors that negatively affect head and neck cancer survival. Citation Format: Nosayaba Osazuwa-Peters, Eric Adjei Boakye, Betelihem B. Tobo, Kara M. Christopher, Betty Y. Chen, Carl E. Freter, Mark A. Varvares. The interplay between smoking at diagnosis, marital status, and head and neck cancer survivorship. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B78.

Racial disparities in oropharyngeal cancer survival

BackgroundOropharyngeal cancer is an important cause of mortality and morbidity. Several studies have revealed racial disparities in head and neck cancer outcomes. The goal of our study was to evaluate the impact of race on survival in patients with oropharyngeal cancer, using a large population-based cancer database. Materials and methodsThis was a retrospective cohort study. Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 18 Database of the National Cancer Institute. The study cohort included patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012. The outcomes of interest were overall survival (OS) and disease-specific survival (DSS). ResultsAfter adjusting for age, sex, marital status, tumor site, and year of diagnosis, black race was associated with worse OS (HR 1.67, p<0.0001) and DSS (HR 1.67, p<0.0001). ConclusionBlack race is associated with worse survival in patients with oropharyngeal cancer. Further research is needed to elucidate the mechanism by which race impacts survival in oropharyngeal cancer. This may reveal potential areas of opportunity for public health interventions aimed at addressing disparities in cancer outcomes.

Weight loss after head and neck cancer: A dynamic relationship with depressive symptoms.

Weight loss and depressive symptoms are critical head and neck cancer outcomes, yet their relation over the illness course is unclear. Associations between self-reported depressive symptoms and objective weight loss across the year after head and neck cancer diagnosis were examined using growth curve modeling techniques (n = 564). A reciprocal covariation pattern emerged-changes in depressive symptoms over time were associated with same-month changes in weight loss (t [1148] = 2.05; p = .041), and changes in weight loss were associated with same-month changes in depressive symptoms (t [556] = 2.43; p = .015). To the extent that depressive symptoms increased, patients lost incrementally more weight than was lost due to the passage of time and vice versa. Results also suggested that pain and eating-related quality of life might explain the reciprocal association between depressive symptoms and weight loss. In head and neck cancer, a transactional interplay between depressive symptoms and weight loss unfolds over time. © 2016 Wiley Periodicals, Inc. Head Neck 39: 370-379, 2017.

Abstract 3472: Does being married independently predict survival in patients with head and neck cancer? Results from a single institution

Abstract Purpose/Objectives An important factor in cancer survivorship is social support, often coming from a spouse. There is an emerging literature on the role of spousal support in head and neck cancer (HNC) outcomes; however most are based on results from national databases. While more generalizable, these studies may not always capture the unique variation in different patient populations. This single institution study aimed to describe the association between marital status and outcomes of HNC; and to determine if marital status independently predicts survival in a local patient population. Materials/Methods We identified 460 patients aged 20 to 91 (59.31 ± 11.42) years diagnosed with squamous cell carcinoma of the head and neck at an academic tertiary referral center between 1997 and 2012 in this retrospective cohort study. Cox proportional hazards model assessed the effect of marital status on survival. Results are based on the final model constructed after accounting for covariates in the data. Results Our study population was made up of 73% males, and 82.2% Whites. We found an association between marital status and HNC survival. Unmarried HNC patients had a 66% increase in the hazard of death compared to married HNC patients (HR = 1.66, 95% CI = 1.23 - 2.23). This was after controlling for covariates, which included sociodemographic variables (age, race, sex, and health insurance status), social habits (tobacco and alcohol), primary anatomical subsite (oral cavity, oropharyngeal, laryngeal, and others), stage at presentation (early vs. late stage), and treatment modality (surgery, surgery with adjuvant therapies, other single modality therapy, and palliative care). Other factors found to be associated with an increased hazard of death were age (≥ 50 years), current tobacco use, late stage of presentation, palliative care, and laryngeal subsite. Conclusion Marital status is associated with head and neck cancer outcomes, and being married is an independent predictor of survival among patients. This result, found in previous national studies, held true in our local patient population. This underscores the need for the multidisciplinary HNC team to recognize this aspect of survivorship and to emphasize the need for social support among unmarried HNC patients. It could be that it is necessary to add social support to the clinical practical guidelines for managing head and neck cancer beyond palliative care. Citation Format: Nosayaba Osazuwa-Peters, Kara M. Christopher, Sean T. Massa, Lauren Cass, Ronald J. Walker, Mark A. Varvares. Does being married independently predict survival in patients with head and neck cancer? Results from a single institution. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3472.

Health Insurance Affects Head and Neck Cancer Treatment Patterns and Outcomes

The purpose of this study is to examine the effect of insurance coverage on stage of presentation, treatment, and survival of head and neck cancer (HNC). A retrospective study was conducted using the Surveillance, Epidemiology, and End Results (SEER) program to identify patients diagnosed with HNC. The primary variable of interest was insurance analyzed as a dichotomous variable: Patients were considered uninsured if they were classified as "uninsured" by SEER, whereas patients were considered insured if they were defined by SEER as "any Medicaid," "insured," or "insured/no specifics." The outcomes of interest were cancer stage at presentation (M0 vs M1), receipt of definitive treatment, and HNC-specific mortality (HNCSM). Multivariable logistic regression modeled the association between insurance status and stage at presentation, as well as between insurance status and receipt of definitive treatment, whereas HNCSM was modeled using Fine and Gray competing risks. Sensitivity logistic regression analysis was used to determine whether observed interactions remained significant by insurance type (privately insured, Medicaid, and uninsured). Patients without medical insurance were more likely to present with metastatic cancer (adjusted odds ratio, 1.60; P < .001), were more likely to not receive definitive treatment (adjusted odds ratio, 1.64; P < .001), and had a higher risk of HNCSM (adjusted hazard ratio, 1.20; P= .002). Sensitivity analyses showed that when results were stratified by insurance type, significant interactions remained for uninsured patients and patients with Medicaid. Uninsured patients and patients with Medicaid are more likely to present with metastatic disease, are more likely to not be treated definitively, and are at a higher risk of HNCSM. The treatment gap between Medicaid and private insurance observed in this study should serve as an immediate policy target for health care reform.

Quality Measures in Early Stage Oral Cavity Squamous Cell Carcinoma

Background/Aims: Head and neck cancer treatment practices and outcomes vary from institution to institution. Other than survival data, there has been no established method to evaluate an institution’s quality of cancer care. To address this issue, the American Head and Neck Society (AHNS) developed quality guidelines for head and neck cancer care based on systematic literature review and expert opinion. These guidelines represent critical aspects of accepted standards of oral cancer care, and the presence or absence of these measures is most likely to affect the overall outcome regardless of patient comorbidity. The purpose of this study is to evaluate the quality of oral tongue cancer care at our institution and validate these established quality measures.

Elderly patients with squamous cell carcinoma of the head and neck and the benefit of multimodality therapy.

Limited data are available regarding outcomes in elderly head and neck cancer patients. This retrospective study was designed to characterize head and neck cancer in geriatric patients. This study included all patients in a large university-based tumor registry who were diagnosed with head and neck cancer from January 1, 1990, to December 31, 2005. Patients aged ≥70 years at the time of diagnosis were defined as older. Overall survival and progression-free survival were censored at 60 months. Survival differences were compared using the log-rank test. Hazard ratios were estimated using a Cox proportional hazards model, adjusting for potential confounders. Of 1,598 patients identified, 1,166 patients were aged <70 years (i.e., younger) and 281 patients were aged ≥70 years (older). When controlling for possible confounders, older patients were nearly twice as likely to die within 5 years as their younger counterparts (hazard ratio: 1.92). The median life expectancy for older patients was nearly 5 years for stage I-II disease and <2 years for stage III-IV disease. Older patients with stage III-IV disease who received multimodality therapy had 5-year survival similar to that younger patients with stage III-IV disease who were treated similarly (33.2% vs. 44.0%). Older patients with stage III-IV disease who received single-modality therapy had extremely poor survival compared with all other patients (hazard ratio for progression-free survival: 1.5). This study highlights the need for better understanding of the factors affecting head and neck cancer outcomes in elderly patients. Information about life expectancy in elderly head and neck cancer patients may help guide treatment decisions.

EDGE Task Force on Head and Neck Cancer Outcomes: A Systematic Review of Outcome Measures for Temporomandibular-related Dysfunction

Background: Patients with head and neck cancer (HNC) often experience significant postoperative limitations in temporomandibular joint (TMJ) function, facial pain, reduced nutritional intake, speech impairments, and compromised activities of daily living due to side effects of cancer treatment. Physical therapists treating these individuals must use valid and reliable patientreported outcome measures to quantify change related to physical therapy intervention for the TMJ. Purpose: As part of the activities of the Oncology Section EDGE Task Force on Head and Neck Cancer Outcomes, we report evidence-based recommendations for patient-reported outcome measures for individuals with HNC-related temporomandibular dysfunction (TMD). Methods: A systematic literature review of TMD-related patient-reported outcome measures that are clinically feasible and relevant to the HNC patient population was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model. Recommendations are based on the quality of psychometric properties, clinical utility, and previous use in HNC-related research. Twenty-two outcome measures were selected for review; 4 received a rating of 3, “recommended” for use in the HNC population. Conclusions: A variety of outcome measures have been reported in the literature for individuals with HNC-related TMD. Four measures, the Graded Chronic Pain Scale, 8 and 20-item Jaw Functional Limitation Scale and TMD Pain Screener, are recommended for clinical use by the researchers on this task force although it is important to note psychometric properties specific to the HNC population are lacking. Systematic Review Registration Number: PROSPERO CRD42013004898

EDGE Task Force on Head and Neck Cancer Outcomes A Systematic Review of Outcome Measures for Quantifying External Lymphedema

EDGE Task Force on Head and Neck Cancer Outcomes A Systematic Review of Outcome Measures for Quantifying External Lymphedema

Marital status and head and neck cancer outcomes.

The objective of this study was to examine the effects of marital status on stage at presentation, receipt of treatment, and survival in patients with head and neck cancer (HNC). The Surveillance, Epidemiology, and End Results database was used to analyze 51,272 patients who were diagnosed with HNC from 2007 to 2010. The impact of marital status on cancer stage at presentation, receipt of definitive treatment, and HNC-specific mortality (HNCSM) was determined using multivariable logistic and Fine and Gray competing-risks regression models, as appropriate. Marriage had a protective effect against metastatic presentation of oral and laryngeal cancers (oral cancer: adjusted odds ratio [AOR], 0.72; 95% confidence interval [CI], 0.60-0.87; P < .001; laryngeal cancer: AOR, 0.53; 95% CI, 0.42-0.67; P < .001) but not against oropharyngeal, hypopharyngeal, or nasopharyngeal cancers. Among patients with nonmetastatic disease, married patients were more likely to receive definitive treatment (overall AOR, 1.77; 95% CI, 1.60-1.95; P < .001) and had a lower risk of HNCSM (overall adjusted hazard ratio, 0.72; 95% CI, 0.68-0.77; P < .001); these associations remained significant across all HNC sites. Among patients with oral and laryngeal cancers, those who are married are less likely to present with metastatic disease. In addition, married patients are more likely to receive definitive treatment and less likely to die from HNC across all HNC sites. This suggests that spousal support may have a role in the surveillance of visual and symptomatic HNC types and leads to higher rates of treatment and better survival across all HNC sites.

Abstract C93: Head and neck cancer trends in Trinidad and Tobago

Abstract Background: Head and neck squamous cell carcinoma (HNSCC) include tumors that arise in the oral cavity, pharynx and larynx. A steady decline in HNSCC incidence has been observed world-wide, and is likely attributed to declining prevalence of tobacco and alcohol consumption. Exceptions to this observation have been a steady increase in the incidence of cancers arising in the oropharnyx/tonsil which has been associated in the United States and Europe with an increasing incidence of HPV-positive tumors. Survival from head and neck cancer is poor, ∼50%; however HPV-related oropharyngeal cancer patients are known to have significant longer survival compared to non-oropharyngeal cancer patients. To date there are no data reported for the Caribbean Islands. Objective: To review head and neck cancer (HNSCC) incidence and outcomes in Trinidad and Tobago (TT) and compare trends to that of the United States. Methods: National cancer registry data from the Dr. Elizabeth Quamina National Cancer Registry of Trinidad and Tobago was obtained for 742 HNSCC cases diagnosed between 1995-2007. Squamous cell cancers of the oral cavity, pharynx, and larynx were analyzed. Data from the US SEER database were obtained for age adjusted incidence comparison. Kaplan-Meier survival analyses was performed on the two groups. Results: The majority (323, 43.5%) of TT patients had larynx cancer, were of African ancestry (296, 39.9%), with East Indians representing a significant minority (230, 31.0%). The male:female cancer ratio was 4.5:1. Female patients were more likely to have oral cancer (OR 3.7, CI 2.5-5.4), and less likely larynx cancers (OR 0.3, CI 0.2-0.5). The majority of African ancestry patients were diagnosed with larynx cancer (44%), while the majority of Indians were diagnosed with oral cavity tumors (38.1%). Age-adjusted incidence trends in TT and the US SEER database showed a decrease in larynx cancers until 2001 when a rise in TT larynx cancers was identified. While a rise in oropharynx prevalence was seen in the SEER data from 1995-2006, oropharynx cancer remained on the steady decline in TT. Survival in this series was poor with 16.9% 5y localized disease specific survival (DSS), and 6.3% and 8.7% regional and distant metastasis 5y DSS. No survival advantage was seen in TT oropharynx cases versus non-oropharynx cases. Conclusions: Most HNSCC in TT are diagnosed in African ancestry males with larynx cancer. Indian patients and females were more likely to have oral cancer. No increase in oropharynx cancers were seen the TT registry in recent years, a clear difference from US SEER data over the same period. HNSCC survival is uniformly poor. Citation Format: Camille Ragin, Jeffrey Liu, Elizabeth Blackman, Veronica Roach, Karthik Devarajan, Kimlin Tam Ashing, Samuel Gathere, Emanuela Taioli. Head and neck cancer trends in Trinidad and Tobago. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C93. doi:10.1158/1538-7755.DISP13-C93

Abstract 4144: Genetic and epidemiology characterization of head and neck cancers by targeted sequencing

Abstract Oral and pharyngeal cancer, grouped together, is the sixth most common cancer in the world. The annual estimated incidence is around 275,000 for oral and 130,300 for pharyngeal cancers excluding nasopharynx, two-thirds of these cases occurring in developing countries. The principal objective of this work was to investigate the somatic genetic changes that influence the risk of head and neck cancer occurrence and outcome, and how they interact with environmental and host factors: HPV infection, alcohol and Smoking. We selected 205 paired samples diagnosed as head and neck SCC included in two multicenter studies in Europe and Brazil: ARCAGE, a multi center case- control study, conducted between 2002-2005 involving 10 countries across Europe and the Gencapo case- control study in the state of Sao Paulo from 2001 to 2010. Targeted sequencing was performed independently on both germline DNA and the tumor material using the PGM™ System at an average depth of 250X.Sequencing included the entire coding region of 5 of the most frequently mutated genes in Head and Neck cancer: TP53, NOTCH1, CDKN2A, CASP8, and PTEN. HPV status was achieved by capsid protein serology and DNA genotyping. Statistical tests were carried out in the R statistical programming environment or using STATA statistic software. Kaplan-Meier analysis was used to determine overall survival. Statistically significant differences in exposure status were found between both series of patients with more prevalent cases of former and current both smokers and alcohol drinkers in Brazil(p=0.001). 76% and 63% of the patients in each series had at least 1 mutation and there were no significant differences in the percentage of mutations found. Most of the mutations were found in TP53 (60%) and NOTCH1 (18%). Smoking status was significantly associated to TP53 mutations (p=0.015). Positive serology for HPV16 E6 oncoprotein was associated to Oropharyngeal tumors all of which lack TP53 mutations. When comparing the survival of patients according to the mutational profile we found a reduction in overall survival for those patients carrying mutations in TP53 (p=0.002) and CDKN2A (p=0.001). Combined molecular profiling and exposure data can be a resource to assess the role of lifestyle habits on prognosis, and will help to identify early markers of survival for head and neck cancer patients. Citation Format: Sandra Perdomo, Luciana Reis, Devasena Anantharaman, James Mckay, Paul Brennan. Genetic and epidemiology characterization of head and neck cancers by targeted sequencing. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4144. doi:10.1158/1538-7445.AM2014-4144

Racial and Ethnic Disparities in Salivary Gland Cancer Survival.

Several recent US studies have documented racial disparities in head and neck cancer outcomes, but few have investigated racial and ethnic differences in salivary gland cancer (SGCA) survival. To determine whether patient race or ethnicity affects SGCA survival. Retrospective survival analysis of all patients with SGCA from 1988 through 2010 in the Surveillance, Epidemiology, and End Results database. Disease-specific survival according to race and ethnicity. End points assessed included age at diagnosis, sex, tumor grade, tumor size at diagnosis, extension at diagnosis, lymph node involvement at diagnosis, and treatment. Results were further analyzed by histologic subtype of SGCA. Of 11,007 patients with SGCA, 1073 (9.7%) were black, and 1068 (9.7%), Hispanic. Whites' mean age at diagnosis was 63 years vs 53 and 52 years for blacks and Hispanics, respectively (P < .001). Twenty-year disease-specific survival rates for all SGCA histologic subtypes combined for whites, blacks, and Hispanics were 78%, 79%, and 81%, respectively. Unadjusted survival curves showed no significant difference between blacks and whites and an apparent advantage for Hispanics. However, multivariable Cox regression models controlling for patient, tumor, and treatment characteristics showed poorer disease-specific survival vs whites for blacks (hazard ratio [HR], 1.22 [95% CI, 1.03-1.46]; P = .03) but not for Hispanics (HR, 0.97 [0.79-1.19]; P = .77). The overall disease-specific survival disparity was due to poorer disease-specific survival for blacks vs whites with mucoepidermoid (P = .03) and squamous cell carcinomas (P = .05). Less surgical treatment for blacks than whites (57.26% vs 76.94%; P < .001) was a source of the survival disparity for squamous cell but not mucoepidermoid SGCA. Black race is a risk factor for poorer disease-specific survival for patients with mucoepidermoid or squamous cell carcinoma, whereas Hispanic ethnicity has no effect. Differing treatment between black and white patients affects survival in squamous cell but not mucoepidermoid SGCA. Differences in chemotherapy treatment, comorbidities, socioeconomic status, tumor genetic factors, and environmental exposures are potential but unproven additional sources of the racial survival disparities for mucoepidermoid and squamous cell SGCA.

Head and neck cancer (HN) characteristics and outcomes in a human immunodeficiency virus infected (HIV+) patient cohort: A 12-year experience of the Louisiana State University Health Sciences Center (LSUHSC) and Charity Hospital in New Orleans.

6069 Background: HIV+ patients (pts) are typically excluded from enrollment on randomized clinical trials for head and neck cancer. Data regarding clinical characteristics and outcomes for HIV+ pts...

Outcomes Measurement in Patients with Head and Neck Cancer

Outcomes research is defined as clinical and population-based research that investigates the results of healthcare practices or interventions through the filter of the benefit to the patient and other stakeholders. Outcomes research is an increasingly important field or research, because of the pressing need for evidence-based information that can be used to make better informed health and healthcare decisions, and define desired health care practices in the current era of healthcare reform. This article will review the head and neck cancer (HNCA) outcomes literature published in the past year, with a focus on studies evaluating treatment and survival, short-term and long-term complications, and quality of life (QOL).

Association of polymorphism in cytochrome P450 2C9 with susceptibility to head and neck cancer and treatment outcome

The present case–control study involving 750 cases and equal number of healthy controls investigates the association of polymorphism in cytochrome P450 2C9 (CYP2C9) with head and neck squamous cell carcinoma (HNSCC) and response in patients receiving chemotherapy or combination of radio-chemotherapy. The frequency of heterozygous or homozygous genotypes of CYP2C9*2 &CYP2C9*3, which leads to the poor metabolizer (PM) genotype was significantly higher in HNSCC cases when compared to the healthy controls resulting in significantly increased risk in the cases. Tobacco use in the form of tobacco smoking or tobacco chewing was found to increase the risk several fold in cases when compared to the non-tobacco users. Likewise, alcohol intake in cases with variant genotypes of CYP2C9*2 or CYP2C9*3 also significantly increased the HNSCC risk in cases when compared to non-alcohol users. Further, majority of the cases carrying variant alleles of both CYP2C9*2 or CYP2C9*3 were found to respond poorly to the chemotherapy or combination of radio-chemotherapy. The data suggests a significant association of the CYP2C9 polymorphism with HNSCC and treatment outcome.

Pretreatment dietary patterns, weight status, and head and neck squamous cell carcinoma prognosis

Few studies have evaluated the association of diet and weight status with head and neck cancer outcomes. The purpose of this study was to determine whether pretreatment dietary patterns and weight status are associated with head and neck cancer prognosis. This was a longitudinal study of 542 patients with newly diagnosed head and neck cancer who completed food-frequency questionnaires and health surveys before treatment. Clinical data were abstracted from medical records and the Social Security Death Index. Dietary patterns were identified by using principal component analysis. Cox proportional hazard models were used to examine the association of derived dietary patterns (fit by quintiles of exposure) and weight status with time to recurrence and survival, with control for covariates. During the study period, there were 229 deaths and 184 recurrences. Two dietary patterns were identified: a whole-foods pattern (characterized by high intakes of vegetables, fruit, fish, poultry, and whole grains) and a Western pattern (characterized by high intakes of red and processed meats, refined grains, potatoes, and French fries). In multivariable analyses, significantly fewer deaths were observed in subjects most adherent to the whole-foods pattern (HR: 0.56; 95% CI: 0.34, 0.92; P-trend = 0.01). Subjects classified as overweight or obese had significantly fewer deaths (HR: 0.65; 95% CI: 0.49, 0.85; P = 0.001) and recurrences (HR: 0.70; 95% CI: 0.52, 0.95; P = 0.02) than did normal-weight or underweight subjects. Consumption of a diet rich in vegetables, fruit, fish, poultry, and whole grains and being overweight before diagnosis with head and neck cancer are associated with a better prognosis.