Treatment Of Oral Cavity Cancer Research Articles

Dysphagia and Dysphonia After Head and Neck Cancer.

The purpose of this work is to synthesize the latest developments in diagnosis and management of acute and late dysphagia and dysphonia in oral cavity cancer. A literature search was conducted using PubMed, Web of Science, Embase and Google Scholar in May 2024 of articles published between 2021 and 2024. Keywords in the search terms included oral cavity cancer, dysphagia, dysphonia, deglutition, swallowing, voice, oral cavity cancer treatment, oral cavity radiation, chemotherapy, dysgeusia, xerostomia, swallow preservation. Twenty-seven pertinent studies fit the inclusion criteria. The most common dysphagic complaints following head and neck cancer are trismus, xerostomia, mucositis and dysphagia. Dysphonia, change in voice is reported by half of head and neck cancer survivors. Fibrosis and neuropathy following radiation therapy to the oral cavity, tongue, oropharynx and its surrounding structures is the most common etiology of post-treatment dysphonia. Oral cavity cancers cause speech and swallowing dysfunction due to both anatomic and post-treatment changes. These sequalae can be detrimental to the quality of life of the head and neck cancer survivor. For both dysphagia and dysphonia after head and neck cancer early speech and swallow therapy with a Speech Language Pathologist are essential to restoring and maintaining function.

Comparative Analysis of DysphagiaOptimized IMRT vs Standard IMRT in Oral Cavity Cancer Treatment: A Single - Center Study

Comparative Analysis of DysphagiaOptimized IMRT vs Standard IMRT in Oral Cavity Cancer Treatment: A Single - Center Study

Targeting of 3D oral cancer spheroids by αVβ6 integrin using near-infrared peptide-conjugated IRDye 680

BackgroundIn the treatment of oral cavity cancer, margin status is one of the most critical prognostic factors. Positive margins are associated with higher local recurrence and lower survival rates. Therefore, the universal goal of oral surgical oncology is to achieve microscopically clear margins. Near-infrared fluorescence guided surgery (FGS) could improve surgical resection using fluorescent probes. αVβ6 integrin has shown great potential for cancer targeting due to its overexpression in oral cancers. Red fluorescent contrast agent IRDye 680 coupled with anti-αVβ6 peptide (IRDye-A20) represents an asset to improve FGS of oral cancer. This study investigates the potential of IRDye-A20 as a selective imaging agent in 3D three-dimensional tongue cancer cells.MethodsαVβ6 integrin expression was evaluated by RT-qPCR and Western Blotting in 2D HSC-3 human tongue cancer cells and MRC-5 human fibroblasts. Targeting ability of IRDye-A20 was studied in both cell lines by flow cytometry technique. 3D tumor spheroid models, homotypic (HSC-3) and stroma-enriched heterotypic (HSC-3/MRC-5) spheroids were produced by liquid overlay procedure and further characterized using (immuno)histological and fluorescence-based techniques. IRDye-A20 selectivity was evaluated in each type of spheroids and each cell population.ResultsαVβ6 integrin was overexpressed in 2D HSC-3 cancer cells but not in MRC-5 fibroblasts and consistently, only HSC-3 were labelled with IRDye-A20. Round shaped spheroids with an average diameter of 400 μm were produced with a final ratio of 55%/45% between HSC-3 and MRC-5 cells, respectively. Immunofluorescence experiments demonstrated an uniform expression of αVβ6 integrin in homotypic spheroid, while its expression was restricted to cancer cells only in heterotypic spheroid. In stroma-enriched 3D model, Cytokeratin 19 and E-cadherin were expressed only by cancer cells while vimentin and fibronectin were expressed by fibroblasts. Using flow cytometry, we demonstrated that IRDye-A20 labeled the whole homotypic spheroid, while in the heterotypic model all cancer cells were highly fluorescent, with a negligible fluorescence in fibroblasts.ConclusionsThe present study demonstrated an efficient selective targeting of A20FMDV2-conjugated IRDye 680 in 3D tongue cancer cells stroma-enriched spheroids. Thus, IRDye-A20 could be a promising candidate for the future development of the fluorescence-guided surgery of oral cancers.Graphical

Indian clinical practice consensus guidelines for the management of oral cavity cancer: Update 2022

The treatment of oral cavity cancer primarily depends on the location, tumor size, and feasibility of organ preservation in patients with negative margins. A liquid biopsy is a minimally invasive approach for detecting blood-based signatures such as circulating tumor cells (CTCs) and circulatory tumor DNA (ctDNA). To assess the presence of occult metastatic disease, sentinel lymph node biopsy (SLNB) is recommended in early-stage oral cavity cancer (OCC). In India, surgery is the preferred choice of treatment for oral cancers. Selected patients, who are medically inoperable or refuse surgery, should be given definitive radiotherapy (RT) as an alternative to surgery. Concurrent chemoradiation (CCRT) may be considered an alternative option to definitive RT in patients with unresectable oral cancer.

Surgical Excision and Reconstruction in Oral Cavity Cancer

The primary treatment of oral cavity cancer is still surgery. By discussing the surgical treatment of oral cavity cancer, the basic concept of head and neck surgery could be thoroughly reviewed. The oral cavity is defined as the hard palate and the anterior 2/3 of the tongue. With appropriate reconstruction, most defects can be repaired without a significant change in quality of life, unlike in the oropharynx or hypopharynx, where aspiration problems frequently occur. The selection of a surgical approach that can provide an appropriate field of view to obtain a resection margin of 5 mm or more has become the core of head and neck surgery. The role of prophylactic neck dissection is also well established in oral cavity cancer patients. Mandibulotomy for access to the oral cavity or mandibulectomy due to cancer invasion requires bony surgical techniques, and reconstruction also requires bone tissue reconstruction techniques as well as soft tissue. Therefore, oral cancer surgery is the most important primary area where all techniques of head and neck surgery are mobilized.

Marginal versus Segmental Mandibulectomy in the Treatment of Oral Cavity Cancer: A Systematic Review and Meta-analysis.

Introduction Oral cavity squamous cell carcinoma (OCSCC) is the most common malignancy in the oral cavity. Two types of mandibular resections have been described: the segmental mandibulectomy and the marginal mandibulectomy. Both may have a different impact over the quality of life, oncological prognosis, and functional or aesthetic result. Objectives The aim of this study was to systematically explore the literature to determine the survival outcomes and disease control rates in patients who underwent segmental or marginal mandibulectomy for OCSCC with histological evidence of cortical and medullary bone invasion. Data Synthesis This review involved a systematic search of the electronic databases MEDLINE/PUBMED, Google Scholar, Ovid Medline, Embase, and Scopus including articles from 1985 to 2019. Fifteen articles were included for qualitative analysis and 11 articles were considered for meta-analysis calculations. All of them correspond to retrospective cohort studies. Conclusion This systematic review reveals the low-level evidence regarding the impact over local control or survival according to the type of mandibulectomy. Our results need to be considered with precaution according to the limited evidence available. We just found difference regarding the 5-year disease-free survival, and a tendency in favor of segmental mandibulectomy was confirmed when medullary invasion was evident.

Photodynamic therapy treatment of oral cavity cancer in patients with comorbidities

We report the experience of radical treatment by photodynamic therapy of patients with squamous cell carcinoma of oral cavity with serious side diseases. Completed treatment of two patients with serious side diseases (HIV infection with associated pulmonary hypertension of high degree and cardiac pathology) suffered from cancer of oral cavity. Extensive surgical treatment and/or aggressive course of chemoradiation therapy were not indicated to them due to concomitant pathology. Both patients were diagnosed with squamous cell carcinoma of oral cavity, with appropriate stage Ist. сT1N0M0. Patients received treatment by photodynamic therapy with chorine photosensitizer in dose 1 mg/kg. Options of photodynamic were: output power – 1.5W, power density – 0.31 W/cm2, light dose – 300 J/cm2. After one time session of photodynamic therapy, in both cases full response was diagnosed (according to RECIST 1.1). In one case the second session of photodynamic therapy was performed due to concomitant disease of oral cavity – multiply lesions of leukoplakia and after was diagnosed full remission of all lesions. Major adverse event was pain during the first 5-7 days after treatment, curable by painkillers. Follow-up (IQR) was 12 and 18 month respectively with no evidence of progression. It is available to avoid extensive surgical treatment and aggressive course of chemoradiation therapy (as an alternative) with the use of photodynamic therapy. Photodynamic therapy is minimally invasive method of radical treatment of localized squamous cell carcinoma of oral cavity with minimal adverse events, and could be especially relevant in patients with serious concomitant diseases.

Advances in Image-Guided Radiotherapy in the Treatment of Oral Cavity Cancer.

Simple SummaryImage-guided radiotherapy (IGRT) overcomes geographic changeduring treatment and avoids underdose of the target, which provides better treatment outcomes for patients with oral cavity cancer (OCC) than intensity-modulated radiotherapy (IMRT). Additionally, IGRT also produces less radiation dose exposure to normal tissues that can cause fewer acute and late complications. All these potential benefits of IGRT can provide OCC patients with a better quality of life.Image-guided radiotherapy (IGRT) is an advanced auxiliary radiotherapy technique. During cancer treatment, patients with oral cavity cancer (OCC) experience not only disease but also adverse effects due to RT. IGRT provides the relevant advantages of RT by precisely delivering tumoricidal doses via real-time knowledge of the target volume location and achieves maximal tumor control with minimal complications as recommended for cancer treatment. Additionally, studies have shown that IGRT can improve clinical outcomes in terms of not only treatment side effects but also survival benefits for cancer patients. IGRT can be performed alongside various imaging methods, including computed tomography and magnetic resonance imaging, and at different times during the radiotherapy regimen. This article reviews the literature to discuss the effects and importance of IGRT for patients with OCC, examines the rationale underlying the advantages of IGRT, discusses the limitations of IGRT with respect to different techniques, and summarizes the strategies and future prospects of IGRT in the treatment of OCC.

Neoadjuvant QUAD shot for downstaging or temporizing locally advanced oral cavity cancer prior to definitive surgery

ObjectivesThe mainstay of oral cavity cancer treatment is surgery, often with adjuvant therapies. However, patients often present with locally advanced disease and downstaging would render surgery more feasible. We evaluated hypofractionated radiation therapy (QUAD Shot) prior to definitive surgery for head and neck cancers, with a goal of downstaging. Materials and MethodsEighteen patients with primary head and neck malignancy, predominantly locally advanced oral cavity cancers, received QUAD Shot radiation therapy from June 2016 to July 2021. External beam radiation therapy was delivered to the primary lesion in four fractions over two days, two fractions/day at least six hours apart with total dose ranging from 1400 cGy to 1500 cGy. Twelve patients proceeded to definitive surgery. ResultsOf the twelve patients receiving surgery, one had complete response to radiation therapy with no pathological disease seen at surgery. Four patients had a partial response, defined as downstaging on final pathology. Five patients showed no response, and two had progressive disease defined as upstaging on final pathology. Seven patients had radiographic primary tumor shrinkage ≥ 0.5 cm following Quad Shot. The Quad Shot was tolerated well with no reported adverse effects. ConclusionDiscrepancies between clinical- and pathological-staging are common and expected. However, ∼40 % of our patients experienced downstaging following QUAD Shot. Thus, neoadjuvant radiation therapy may be viable for temporizing tumor growth while awaiting surgery, or for downstaging and thus facilitating more technically feasible and less morbid surgery for locally advanced head and neck cancers.

Abstract 6234: Development of a patient-derived organoid platform for predicting responses to standard treatments in oral cavity cancer

Abstract Oral cancer is a rare cancer that occurs in the oral cavity, in areas such as the tongue, roof of mouth, floor of mouth, gum, and inside cheek. Oral cancer has frequent local recurrence and lymph node metastasis even after curative surgery with radiation to prevent recurrence. However, more than 50% of patients show a relapse pattern, and it is difficult to improve treatment due to the lack of experimental models that reflects the heterogeneity of the tumors as well as markers to predict treatment response. Although the patient-derived organoid (PDO) system is a good preclinical model that reflects the characteristics and heterogeneity of the original tumor, there are only small numbers of patients with oral cancer, so it has been relatively difficult to secure clinical samples. Therefore, oral cancer organoid development has so far been insufficient. Here, we have established a normal organoid library as well as cancer using primary tissue from many oral cancer patients. Seventy patients were enrolled in this study between Jan 2021 and Sep 2021. Fifty tumor organoids and fifty-five normal organoids were generated and sustained. Among them, 29 tumor organoids and 28 normal organoids were successfully cultured over 4 passages and cryopreserved. Moreover, 15 pairs of normal-tumor organoids were established. The success rate of organoids has no significant relationship with clinical information such as TNM stages, disease status and differentiation. These organoids recapitulated genomic features and histopathological characteristics of the patient tissue was examined through copy number variation (CNV) and IHC with TP53, P16, CK8, and so on, respectively. Normal organoids derived from tissue adjacent to the tumor of each patient showed typical morphology such as multilayer epithelium. Moreover, we set the assay system to evaluate the responses to radiation and the drug treatment using AUC value. Each organoid including normal and tumor showed different sensitivity to radiation. This oral cancer organoids platform is the largest repository in the field so far, apart from head and neck cancers. It provides a valuable platform for personalized treatment. It may also contribute to the discovery of factors associated with resistance or sensitivity to radiotherapy and chemotherapy in oral cavity cancer treatment. Citation Format: Sumin Kang, Mi Rim Lee, Sun-Young Kong, Jong-Ho Lee, Dohyun Kwon, Ikjae Kwon, Soung-Min Kim, Hye Won Shon, Yu-Sun Lee, Hyun-jin Kim, Joo Yong Park, Sung Weon Choi, Yun-Hee Kim. Development of a patient-derived organoid platform for predicting responses to standard treatments in oral cavity cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6234.

Neoadjuvant QUAD Shot as Temporizing Measure Prior to Definitive Surgery for Locally Advanced Oral Cavity Cancer

<h3>Purpose/Objective(s)</h3> The mainstay of treatment for oral cavity cancer is surgery, often with adjuvant therapies if necessary. However, given issues involving prolonged workup or scheduling of surgery, treatment delays are inevitable. We aim to evaluate the utilization of a temporizing hypofractionated course of radiation therapy in the form of a Quad Shot prior to planned surgery for head and neck cancers. <h3>Materials/Methods</h3> Eighteen patients with a primary head and neck malignancy, predominantly locally advanced oral cavity cancers, received radiation therapy in the form of a Quad Shot from June 2016 to July 2021. External beam radiation therapy was delivered to the site of primary disease over 2 days, with 2 fractions per day given at least 6 hours apart. Total dose delivered ranged from 1400cGy to 1500cGy. Out of the 18 patients, 12 (66.7%) went on to receive surgery. The remaining patients either passed away prior to planned surgery or went on to receive definitive chemoradiation or palliation. American Joint Committee on Cancer (AJCC) clinical and pathological stage groups were recorded for each patient. <h3>Results</h3> Out of the 12 patients who received surgery, 1 patient (5.6%) had complete response to the dose of temporizing radiation with no pathological disease seen at surgery. Four patients (22.2%) had a partial response as defined as downstaging on final pathology. No response was seen in 11 patients (61.1%), and 2 patients (11.1%) had progression of disease as defined as upstaging on final pathology. The Quad Shot was overall well tolerated with no recorded adverse effects. Eight patients (44.4%) received adjuvant radiation +/- chemotherapy following surgery. <h3>Conclusion</h3> Discrepancies between clinical staging and pathological staging are common and expected. However, a quarter of our patients experienced downstaging following a temporizing Quad Shot. This raises the question of whether neoadjuvant radiation therapy is a viable option to temporize tumor growth while awaiting a surgery for head and neck cancers.

Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy.

Oral cavity and oropharyngeal cancers are the most common cancers arising in the head and neck. Treatment of oral cavity cancer is generally surgery followed by radiotherapy, whereas oropharyngeal cancers, which are more likely to be advanced at the time of diagnosis, are managed with radiotherapy or chemoradiation. Surgery for oral cancers can be disfiguring and both surgery and radiotherapy have significant functional side effects. The development of new chemotherapy agents, new combinations of agents and changes in the relative timing of surgery, radiotherapy, and chemotherapy treatments may potentially bring about increases in both survival and quality of life for this group of patients. This review updates one last published in 2011. To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal squamous cell carcinoma results in improved overall survival, improved disease-free survival and/or improved locoregional control, when incorporated as either induction therapy given prior to locoregional treatment (i.e. radiotherapy or surgery), concurrent with radiotherapy or in the adjuvant (i.e. after locoregional treatment with radiotherapy or surgery) setting. An information specialist searched 4 bibliographic databases up to 15 September 2021 and used additional search methods to identify published, unpublished and ongoing studies. We included randomised controlled trials (RCTs) where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and that evaluated the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration. For this update, we assessed the new included trials for their risk of bias and at least two authors extracted data from them. Our primary outcome was overall survival (time to death from any cause). Secondary outcomes were disease-free survival (time to disease recurrence or death from any cause) and locoregional control (response to primary treatment). We contacted trial authors for additional information or clarification when necessary. We included 100 studies with 18,813 participants. None of the included trials were at low risk of bias. For induction chemotherapy, we reported the results for contemporary regimens that will be of interest to clinicians and people being treated for oral cavity and oropharyngeal cancers. Overall, there is insufficient evidence to clearly demonstrate a survival benefit from induction chemotherapy with platinum plus 5-fluorouracil prior to radiotherapy (hazard ratio (HR) for death 0.85, 95% confidence interval (CI) 0.70 to 1.04, P = 0.11; 7427 participants, 5 studies;moderate-certainty evidence), prior to surgery (HR for death 1.06, 95% CI 0.71 to 1.60, P = 0.77; 198 participants, 1 study; low-certainty evidence) or prior to concurrent chemoradiation (CRT) with cisplatin (HR for death 0.71, 95% CI 0.37 to 1.35, P = 0.30; 389 participants, 2 studies; low-certainty evidence). There is insufficient evidence to support the use of an induction chemotherapy regimen with cisplatin plus 5-fluorouracil plus docetaxel prior to CRT with cisplatin (HR for death 1.08, 95% CI 0.80 to 1.44, P = 0.63; 760 participants, 3 studies; low-certainty evidence). There is insufficient evidence to support the use of adjuvant chemotherapy over observation only following surgery (HR for death 0.95, 95% CI 0.73 to 1.22, P = 0.67; 353 participants, 5 studies; moderate-certainty evidence). Among studies that compared post-surgical adjuvant CRT, as compared to post-surgical RT, adjuvant CRT showed a survival benefit (HR 0.84, 95% CI 0.72 to 0.98, P = 0.03; 1097 participants, 4 studies; moderate-certainty evidence). Primary treatment with CRT, as compared to radiotherapy alone, was associated with a reduction in the risk of death (HR for death 0.74, 95% CI 0.67 to 0.83, P < 0.00001; 2852 participants, 24 studies; moderate-certainty evidence). AUTHORS' CONCLUSIONS: The results of this review demonstrate that chemotherapy in the curative-intent treatment of oral cavity and oropharyngeal cancers only seems to be of benefit when used in specific circumstances together with locoregional treatment. The evidence does not show a clear survival benefit from the use of induction chemotherapy prior to radiotherapy, surgery or CRT. Adjuvant CRT reduces the risk of death by 16%, as compared to radiotherapy alone. Concurrent chemoradiation as compared to radiation alone is associated with a greater than 20% improvement in overall survival; however, additional research is required to informhow the specific chemotherapy regimen may influence this benefit.

Possibilities of photodynamic therapy in the treatment of malignant tumors of the oral cavity

Oral mucosa cancer is a common disease with relatively low survival rates. The standard for the treatment of malignant neoplasms (MNO) of the oral mucosa is the surgical method, chemotherapy and / or radiation therapy. With the introduction of modern protocols and the improvement of current treatment methods, the increase in survival is insignificant due to the development of local and distant relapses, the appearance of simultaneous tumors of the oral cavity. Cosmetic and functional results in patients who have undergone complex treatment for oral cancer are often unsatisfactory. There is an obvious need to develop new approaches to treating patients with cancer of the oral mucosa. Photodynamic therapy (PDT) has similar properties. With the development of endoscopic and fiber-optic equipment, the fields of PDT application have significantly expanded. Foci in the oral cavity and oropharynx became available for PDT. The early stages of oral mucosal cancer are optimal for PDT because large surface defects can be treated with minimal complications. Preservation of subepithelial and collagen structures, which is typical for PDT, promotes healing without the formation of scar processes, thereby achieving an ideal cosmetic and functional effect. The use of PDT in the treatment of oral cavity cancer is not limited only to the initial stages in an independent version. It is possible to use PDT in combination with surgical and radiation treatment. In case of massive tumor processes, PDT is used for palliative purposes. The influence of the adaptive immune response under the influence of PDT is being studied.

A Promising, Novel Radiosensitizer Nanodrug Complex for Oral Cavity Cancer: Cetuximab and Cisplatin-Conjugated Gold Nanoparticles.

Background: Nanomedicine has provided promising tools for the imaging, diagnosis, and treatment of cancer. Gold nanoparticles (GNPs) may be useful in enhancing the efficacy of radiotherapy, such as radiosensitization, in cancer therapy.Aims: To develop a nanodrug complex containing cetuximab (C225, CTX) and cisplatin (CDDP) conjugated with GNPs and to investigate its cytotoxic effects on oral cavity cancer cells when combined with radiotherapy.Study Design: In vitro cell culture study.Methods: The GNPs were synthesized and successfully conjugated with cetuximab and cisplatin. Cell viability was monitored by the xCELLigence real-time cell analysis (RTCA) single-plate (SP) system in GNP-treated UPCI-SCC-131 cells for 48 hours. Cells with/without GNPs were irradiated with 6 MV X-rays, and colony formation was assayed to investigate the long-term effects of GNPs and the nanodrug complex after irradiation on radiotherapy-resistant oral cavity cancer cells.Results: The GNPs entered the tumor cells, and GNP–CDDP (P < .0001) and GNP–CDDP–CTX (P < .0001) were shown to cause a decrease in cell viability. GNP and GNP–CTX combined with radiotherapy led to greater reduction on UPCI-SCC-131 colony numbers, than radiation alone (P = .0369) and radiation with free CTX, with sensitizing enhancement ratios of 1 : 2 and 1 : 9, respectively.Conclusion: The cetuximab and cisplatin-conjugated gold nanodrug complex has a great potential to increase cytotoxicity and overcome resistance to radiotherapy, in the treatment of oral cavity cancer.

Strategies for treatment of oral cavity cancer

Strategies for treatment of oral cavity cancer

Update of the German S3 guideline “Diagnosis and treatment of oral cavity cancer”: what’s new?

Update of the German S3 guideline “Diagnosis and treatment of oral cavity cancer”: what’s new?

To what extent has the last two decades seen significant progress in the management of older patients with head and neck cancer?

IntroductionLife expectancy is rising and consequently also the number of older patients with head and neck cancer. Different treatment regimens are often applied for older patients. The aim of this study is to investigate how treatment patterns and survival rates have changed over the past 20 years in older patients with head and neck squamous cell carcinoma (HNSCC). MaterialsPatient and tumour characteristics, treatment and 5-year survival data from the Netherlands Cancer Registry of patients aged ≥60 years diagnosed with HNSCC in 1990–1995 and 2010–2015 were compared using chi-square test and relative survival analysis. ResultsData of 14,114 patients were analyzed. Oral cavity cancer treatment did not change over time, while survival improved from 54% to 58% (p = 0.03). Oropharyngeal and hypopharyngeal cancer treatment shifted towards non-surgical, with survival improving from 31% to 51% (p < 0.01) and 26% to 34% (p < 0.01), respectively. Laryngeal cancer treatment changed towards surgery in stage I and non-surgical treatment in stage III and IV disease. Survival in laryngeal cancer stage I remained stable and favorable at a relative survival rate of around 90%. Survival non-significantly changed from 54% to 49% for stage III disease and from 37% to 33% for disease. ConclusionRelative survival increased for all head and neck cancer sites in older patients, except for laryngeal cancer. For oropharyngeal, hypopharyngeal and advanced laryngeal cancer, a shift towards non-surgical treatment modalities was observed.

The Role of Hospital Safety-Net Burden in the Treatment of Oral Cavity Cancers: Evaluating its Impact on Survival Outcomes

To investigate the relationships between hospital safety-net burden, clinicopathologic characteristics, and overall survival in oral cavity cancer (OCC) patients From the National Cancer Database, we identified 48,176 OCC patients diagnosed with oral cavity cancer between the years 2004 to 2015. Facilities treating 0-30th, >30-75th, and >75-100th percentiles of uninsured/Medicaid patients were defined as no safety-net burden hospitals (NBH), low safety-net burden hospitals (LBH), and high safety-net burden hospitals (HBH), respectively. Social demographic and clinicopathologic variables assessed were age, distance to treatment facility, time to first treatment, gender, race, Hispanic origin, insurance status, median household income, year of diagnosis, Charlson-Deyo score, location of primary site, AJCC stage, facility type and volume, and treatment modality. Safety-net burden of treatment facilities was used as the primary independent predictor in this analysis, and the primary outcome of interest was overall survival. Crude and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) were computed using Cox regression modelling, where clustering of patients within facilities was accounted for using robust sandwich covariance matrix estimates. There were 380 NBH (29.9%), 573 LBH (45.2%), and 316 HBH (24.9%) identified among the 1,269 treatment facilities evaluated for their respective safety-net burden and survival outcomes in oral cavity cancer patients. The median percentage of uninsured/Medicaid patients treated was 23.5% (range 18.6-100%) at HBH, 11.6% (range 1.2-18.5%) at LBH, and 0% (range 0-0%) at NBH. Median follow-up in all surviving patients was 49.0 months. A total of 22,466 deaths were reported, and the overall 5-year survival rate was 53.5% (median survival = 69.7 months). Median survival for NBH, LBH and HBH was 68.6, 74.8 and 55.0 months, respectively (p<0.0001). Compared to NBH and LBH, HBH facilities treated more patients of advanced cancers, lower socioeconomic status, and racial and ethnic minorities. After adjusting for the aforementioned social demographic and clinicopathologic variables, no significant survival difference was noted in LBH (aHR 0.97 95% CI 0.91-1.04, p = 0.405) or HBH (aHR 1.05 95% CI 0.98-1.13, p = 0.175) when compared to patients treated at NBH facilities. High safety-net burden hospitals treated disproportionately more patients of late-staged cancers, lower socioeconomic status, and racial and ethnic minorities. Thus, while lower actuarial survival rates were observed in HBH compared to LBH and NBH, these findings may be driven by socioeconomic and clinicopathologic characteristics, rather than hospital safety-net burden. Therefore, high burden safety-net hospitals may play a more critical role in caring for vulnerable populations with oral cavity cancer than it is attributed for at first glance.

Acquiring guideline-enabled data driven clinical knowledge model using formally verified refined knowledge acquisition method

Background and Objective: Validation and verification are the critical requirements for the knowledge acquisition method of the clinical decision support system (CDSS). After acquiring the medical knowledge from diverse sources, the rigorous validation and formal verification process are required before creating the final knowledge model. Previously, we have proposed a hybrid knowledge acquisition method with the support of a rigorous validation process for acquiring medical knowledge from clinical practice guidelines (CPGs) and patient data for the treatment of oral cavity cancer. However, due to lack of formal verification process, it involves various inconsistencies in knowledge relevant to the formalism of knowledge, conformance to CPGs, quality of knowledge, and complexities of knowledge acquisition artifacts.Methods: This paper presents the refined knowledge acquisition (ReKA) method, which uses the Z formal verification process. The ReKA method adopts the verification method and explores the mechanism of theorem proving using the Z notation. It enhances a hybrid knowledge acquisition method to thwart the inconsistencies using formal verification.Results: ReKA adds a set of nine additional criteria to be used to have a final valid refined clinical knowledge model. These criteria ensure the validity of the final knowledge model concerning formalism of knowledge, conformance to GPGs, quality of the knowledge, usage of stringent conditions and treatment plans, and inconsistencies possibly resulting from the complexities. Evaluation, using four medical knowledge acquisition scenarios, shows that newly added knowledge in CDSS due to the additional criteria by the ReKA method always produces a valid knowledge model. The final knowledge model was also evaluated with 1229 oral cavity patient cases, which outperformed with an accuracy of 72.57% compared to a similar approach with an accuracy of 69.7%. Furthermore, the ReKA method identified a set of decision paths (about 47.8%) in the existing approach, which results in a final knowledge model with low quality, non-conformed from standard CPGs.Conclusion: ReKA refined the hybrid knowledge acquisition method by discovering the missing steps in the current validation process at the acquisition stage. As a formally proven method, it always yields a valid knowledge model having high quality, supporting local practices, and influenced by standard CPGs. Furthermore, the final knowledge model obtained from ReKA also preserves the performance such as the accuracy of the individual source knowledge models.

Changes in head and neck oncologic practice during the COVID-19 pandemic.

IntroductionThe COVID‐19 pandemic has raised controversies regarding safe and effective care of patients with head and neck cancer. It is unknown how much the pandemic has changed surgeon practice.MethodsA questionnaire was distributed to head and neck surgeons assessing opinions related to treatment and concerns for the safety of patients, self, family, and staff.ResultsA total of 88 head and neck surgeons responded during the study period. Surgeons continued to recommend primary surgical treatment for oral cavity cancers. Respondents were more likely to consider nonsurgical therapy for patients with early glottic cancers and HPV‐mediated oropharynx cancer. Surgeons were least likely to be concerned for their own health and safety and had the greatest concern for their resident trainees.ConclusionsThis study highlights differences in the willingness of head and neck surgeons to delay surgery or alter plans during times when hospital resources are scarce and risk is high.