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Batool S, Hansen EE, Sethi RKV, Rettig EM, Goguen LA, Annino DJ, Uppaluri R, Edwards HA, Faden DL, Schnipper JL, Dohan D, Reich AJ, Bergmark RW. Perspectives on Referral Pathways for Timely Head and Neck Cancer Care. JAMA Otolaryngol Head Neck Surg 2024:2818527. [PMID: 38753343 PMCID: PMC11099838 DOI: 10.1001/jamaoto.2024.0917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/22/2024] [Indexed: 05/19/2024]
Abstract
Importance Timely diagnosis and treatment are of paramount importance for patients with head and neck cancer (HNC) because delays are associated with reduced survival rates and increased recurrence risk. Prompt referral to HNC specialists is crucial for the timeliness of care, yet the factors that affect the referral and triage pathway remain relatively unexplored. Therefore, to identify barriers and facilitators of timely care, it is important to understand the complex journey that patients undertake from the onset of HNC symptoms to referral for diagnosis and treatment. Objective To investigate the referral and triage process for patients with HNC and identify barriers to and facilitators of care from the perspectives of patients and health care workers. Design, Participants, and Setting This was a qualitative study using semistructured interviews of patients with HNC and health care workers who care for them. Participants were recruited from June 2022 to July 2023 from HNC clinics at 2 tertiary care academic medical centers in Boston, Massachusetts. Data were analyzed from July 2022 to December 2023. Main Outcomes and Measures Themes identified from the perspectives of both patients and health care workers on factors that hinder or facilitate the HNC referral and triage process. Results In total, 72 participants were interviewed including 42 patients with HNC (median [range] age, 60.5 [19.0-81.0] years; 27 [64%] females) and 30 health care workers (median [range] age, 38.5 [20.0-68.0] years; 23 [77%] females). Using thematic analysis, 4 major themes were identified: the HNC referral and triage pathway is fragmented; primary and dental care are critical for timely referrals; efficient interclinician coordination expedites care; and consistent patient-practitioner engagement alleviates patient fear. Conclusions and Relevance These findings describe the complex HNC referral and triage pathway, emphasizing the critical role of initial symptom recognition, primary and dental care, patient information flow, and interclinician and patient-practitioner communication, all of which facilitate prompt HNC referrals.
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Affiliation(s)
- Sana Batool
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elisabeth E. Hansen
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston
| | - Rosh K. V. Sethi
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eleni M. Rettig
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Laura A. Goguen
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donald J. Annino
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ravindra Uppaluri
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Heather A. Edwards
- Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Daniel L. Faden
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston
- Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Jeffrey L. Schnipper
- Hospital Medicine Unit and Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Daniel Dohan
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Amanda J. Reich
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Regan W. Bergmark
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Vladić MB, Andabak-Rogulj A, Gršić K, Brailo V, Brzak BL, Škrinjar I, Juras DV. Dentist Involvement in the Treatment of Radiation-Induced Oral Mucositis-A Pilot Cross-Sectional Study. Dent J (Basel) 2024; 12:134. [PMID: 38786532 PMCID: PMC11119246 DOI: 10.3390/dj12050134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives: Oral mucositis (OM) occurs in more than 95% of patients irradiated in the head and neck area. This paper aims to determine the occurrence and characteristics of OM in patients with head and neck cancer (HNC), as well as the involvement of dentists/oral medicine specialists in treating such patients. Methods: This study was conducted at the Department of Otorhinolaryngology and Department of Oral Medicine, University Hospital Center Zagreb, from April to August 2022, on patients irradiated in the head and neck area. A unique OM questionnaire was created on the incidence, characteristics, oral care, and involvement of dentists in the overall care. Results: Thirty patients filled out the questionnaire. Of the 22 patients who had developed OM, 14 had grade-three OM. Ten patients were treated for OM in line with the instructions of an oral medicine specialist, eight based on the instructions of a specialist responsible for monitoring of the underlying disease, and four were not treated at all. Sixteen patients had not been referred to a dentist before the start of RT. Conclusions: These results showed insufficient care and treatment of OM, as well as insufficient involvement of dentists in the oncology team.
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Affiliation(s)
- Monika Burja Vladić
- Department of Oral Medicine, University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia; (M.B.V.); (B.L.B.)
| | - Ana Andabak-Rogulj
- Department of Oral Medicine, University of Zagreb School of Dental Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.B.); (I.Š.); (D.V.J.)
| | - Krešimir Gršić
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia;
| | - Vlaho Brailo
- Department of Oral Medicine, University of Zagreb School of Dental Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.B.); (I.Š.); (D.V.J.)
| | - Božana Lončar Brzak
- Department of Oral Medicine, University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia; (M.B.V.); (B.L.B.)
| | - Ivana Škrinjar
- Department of Oral Medicine, University of Zagreb School of Dental Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.B.); (I.Š.); (D.V.J.)
| | - Danica Vidović Juras
- Department of Oral Medicine, University of Zagreb School of Dental Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia; (V.B.); (I.Š.); (D.V.J.)
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Davis RJ, Ayo-Ajibola O, Lin ME, Swanson MS, Chambers TN, Kwon DI, Kokot NC. Evaluation of Oropharyngeal Cancer Information from Revolutionary Artificial Intelligence Chatbot. Laryngoscope 2024; 134:2252-2257. [PMID: 37983846 DOI: 10.1002/lary.31191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/12/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE With burgeoning popularity of artificial intelligence-based chatbots, oropharyngeal cancer patients now have access to a novel source of medical information. Because chatbot information is not reviewed by experts, we sought to evaluate an artificial intelligence-based chatbot's oropharyngeal cancer-related information for accuracy. METHODS Fifteen oropharyngeal cancer-related questions were developed and input into ChatGPT version 3.5. Four physician-graders independently assessed accuracy, comprehensiveness, and similarity to a physician response using 5-point Likert scales. Responses graded lower than three were then critiqued by physician-graders. Critiques were analyzed using inductive thematic analysis. Readability of responses was assessed using Flesch Reading Ease (FRE) and Flesch-Kincaid Reading Grade Level (FKRGL) scales. RESULTS Average accuracy, comprehensiveness, and similarity to a physician response scores were 3.88 (SD = 0.99), 3.80 (SD = 1.14), and 3.67 (SD = 1.08), respectively. Posttreatment-related questions were most accurate, comprehensive, and similar to a physician response, followed by treatment-related, then diagnosis-related questions. Posttreatment-related questions scored significantly higher than diagnosis-related questions in all three domains (p < 0.01). Two themes of the physician critiques were identified: suboptimal education value and potential to misinform patients. The mean FRE and FKRGL scores both indicated greater than an 11th grade readability level-higher than the 6th grade level recommended for patients. CONCLUSION ChatGPT responses may not educate patients to an appropriate degree, could outright misinform them, and read at a more difficult grade level than is recommended for patient material. As oropharyngeal cancer patients represent a vulnerable population facing complex, life-altering diagnoses, and treatments, they should be cautious when consuming chatbot-generated medical information. LEVEL OF EVIDENCE NA Laryngoscope, 134:2252-2257, 2024.
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Affiliation(s)
- Ryan J Davis
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | | | - Matthew E Lin
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Mark S Swanson
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Tamara N Chambers
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Daniel I Kwon
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Niels C Kokot
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Potier AL, Leroy M, Mortuaire G, Rysman B, Morisse M, Mouawad F. Impact of the 2nd, 3rd and 4th waves of the COVID-19 pandemic on wait times in head and neck cancer: A retrospective study in a French expert center. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00052-8. [PMID: 38653655 DOI: 10.1016/j.anorl.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Treatment delay in head and neck cancer is a major problem, with impact on survival. The COVID-19 (coronavirus disease 2019) pandemic, evolving in waves around the world, caused diagnostic and therapeutic delays in certain cancers. The main objective of the present study was to analyze whether there was a change in wait times during three successive waves in our center. METHOD This was a single-center retrospective study of patients with a first diagnosis of head and neck cancer. Three groups, corresponding to waves 2, 3 and 4, were compared to a control group corresponding to a pre-pandemic period. Study data comprised median times between first consultation and tumor board meeting (C1-TB) and between tumor board meeting and treatment (TB-T). The significance threshold was set at P<0.005. RESULTS Ninety-six patients were included in the control group, and 154 in the "waves 2-3-4" group. There was no increase in C1-TB interval (respectively 35 and 26days, P=0.046) or TB-T interval (respectively 27 and 28days, P=0.723). CONCLUSION Intervals between first consultation and tumor board meeting and between tumor board meeting and treatment did not increase during the 2nd, 3rd and 4th waves of COVID-19 in our center.
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Affiliation(s)
- A-L Potier
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - M Leroy
- METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, ULR 2694, Université de Lille, CHU de Lille, 59000 Lille, France
| | - G Mortuaire
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - B Rysman
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - M Morisse
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - F Mouawad
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France; Cancer Heterogeneity, Plasticity and Resistance to Therapies (CANTHER), UMR9020, CNRS, U1277 Inserm, Université de Lille, CHU de Lille, COL, 59037 Lille cedex, France.
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Vasudev M, Martin E, Frank MI, Meller LLT, Haidar YM. Treatment Delay and HPV Status on OPSCC With Upfront Surgery: Analysis of National Cancer Database. Otolaryngol Head Neck Surg 2024. [PMID: 38532532 DOI: 10.1002/ohn.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/12/2024] [Accepted: 02/05/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE Evaluate the effect of treatment delay on survival in human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing primary surgical resection. STUDY DESIGN Retrospective cohort study using the 2010-2017 National Cancer Database. SETTING Multicenter database study. METHODS Patients >18 years old with OPSCC and known HPV status, treated surgically with or without postoperative radiation/chemotherapy were included. Two cohorts based on HPV status were grouped by time to treatment initiation (TD-TI, ≤30, 31-60, ≥61 days) and surgery to radiotherapy (TS-RT, ≤42, 43-66, ≥67 days). Univariate, Kaplan-Meier, and multivariate analyses assessed correlations between demographic and clinical factors with overall survival in treatment delay groups. RESULTS Included were 1643 HPV-positive OPSCC patients and 391 HPV-negative OPSCC patients. No associations between survival and gender, age, race, insurance, or radiotherapy length were observed. Regardless of HPV status, larger tumor size (>2 cm) and lymphovascular invasion predicted worse survival. HPV negative patients with >4 lymph nodes involved had 2.5× greater mortality risk (P = .039). Robotic surgery was associated with improved survival only in HPV positive patients (hazard ratio [HR]: 0.41, P < .001). In HPV positive patients, higher TD-TI related to lower mean survival, although this was not significant on multivariate analysis. HPV negative patients with >42 days of TS-RT had decreased survival (43-66 days, HR 1.63, P = .049; ≥67 days, HR 2.10, P = .032). CONCLUSION Longer TS-RT was associated with lower overall survival in HPV negative patients. Treatment delay was not associated with survival in HPV positive OPSCC according to multivariate analysis. These findings enhance knowledge about treatment delay effects in OPSCC, aiding providers in decisions and patient communication.
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Affiliation(s)
- Milind Vasudev
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Elaine Martin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Madelyn I Frank
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Leo L T Meller
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
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Villarmé A, Pace-Loscos T, Schiappa R, Poissonnet G, Dassonville O, Chamorey E, Bozec A, Culié D. Impact of virtual surgical planning and three-dimensional modeling on time to surgery in mandibular reconstruction by free fibula flap. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108008. [PMID: 38359724 DOI: 10.1016/j.ejso.2024.108008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/14/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Mandible reconstruction using a free fibula flap (FFF) is preferably performed with virtual surgical planning (VSP) to potentially improve functional and aesthetic outcomes. However, VSP is time-consuming. This study aims to assess the impact of VSP on time to surgery (TS). MATERIALS AND METHODS All patients who underwent FFF for oral cavity cancer between 2007 and 2020 were included. Time to surgery (from the date of the first consultation to the surgery date) was compared between patients without VSP and with VSP. In our department, VSP and 3D modeling were performed by an external engineering laboratory. RESULTS One hundred sixty-five patients were included retrospectively. VSP was utilized for 90 patients (55%). The mean time to surgery was 31 ± 16 days for patients undergoing conventional surgery without VSP and 44 ± 19 days for patients with VSP (p < 0.001). No clinical or tumoral characteristic were associated with a TS extended, except for the utilization of VSP (p < 0.001). By constituting groups of 25 consecutive patients, there is no difference in TS between the groups. CONCLUSION The use of VSP significantly increased the time to surgery in our study, unrelated to clinical differences or year of surgery. This delay may have an impact on oncologic outcomes, so it should be considered in the care organization for each patient. Implementing new procedures to reduce this difference is warranted.
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Affiliation(s)
- A Villarmé
- Institut Universitaire de la Face et du Cou, Head and neck department, 31 avenue de Valombrose, Nice, France.
| | - Tanguy Pace-Loscos
- Epidemiology and Biostatistic Unit, Centre Antoine Lacassagne, Nice, France
| | - Renaud Schiappa
- Epidemiology and Biostatistic Unit, Centre Antoine Lacassagne, Nice, France
| | - Gilles Poissonnet
- Institut Universitaire de la Face et du Cou, Head and neck department, 31 avenue de Valombrose, Nice, France
| | - Olivier Dassonville
- Institut Universitaire de la Face et du Cou, Head and neck department, 31 avenue de Valombrose, Nice, France
| | - Emmanuel Chamorey
- Epidemiology and Biostatistic Unit, Centre Antoine Lacassagne, Nice, France
| | - Alexandre Bozec
- Institut Universitaire de la Face et du Cou, Head and neck department, 31 avenue de Valombrose, Nice, France
| | - Dorian Culié
- Institut Universitaire de la Face et du Cou, Head and neck department, 31 avenue de Valombrose, Nice, France
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Matsumoto K, Tanaka F, Kumai Y. Questionnaire Survey to Identify the Medical Departments That Patients With Possible Head and Neck Cancer (HNC) Symptoms Tend to Choose. Cureus 2024; 16:e55715. [PMID: 38586627 PMCID: PMC10998474 DOI: 10.7759/cureus.55715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
In the treatment of head and neck cancer (HNC), any delay in omit initiation worsens the overall prognosis. Thus, the early start of HNC treatment is crucial. Unfortunately, treatment delays persist in clinical practice. There are several possible reasons for this. One reason is that patients with HNC do not visit an ear, nose, and throat (ENT) doctor. This is because non-ENT doctors (e.g., general practitioners {GPs}) lack expertise in HNC and therefore may unrecognize it. Therefore, guiding patients with suspected HNC symptoms to an otorhinolaryngologist, an HNC specialist, is necessary. To determine the departments that patients with potential HNC symptoms tend to select, we administered a questionnaire survey to 140 participants. Fewer than 60% of respondents indicated they would consult an otorhinolaryngologist even when recognizing symptoms suggestive of HNC. Notably, a significantly low percentage of respondents mentioned they would consult an otorhinolaryngologist for neck masses. Public awareness of HNC symptoms, especially the association between a neck mass and HNC, is limited. The lack of understanding by the general public regarding the relationship between neck masses and HNC is a challenge to prompt initiation of treatment.
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Affiliation(s)
- Kohei Matsumoto
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Fujinobu Tanaka
- Department of Otolaryngology-Head and Neck Surgery, National Hospital Organization (NHO) Nagasaki Medical Center, Omura, JPN
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Medicine, Nagasaki, JPN
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Koyama S, Morishima T, Saito MK, Ma C, Nishimura N, Aoki K, Nishio M, Otsuka T, Tabuchi T, Ishibashi M, Miyashiro I. Faster surgery initiation in oral cancer patients during the COVID-19 pandemic in Osaka, Japan. Oral Dis 2024; 30:307-312. [PMID: 36691715 DOI: 10.1111/odi.14518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND We investigated the impact of the COVID-19 pandemic on oral cancer (OC), comparing diagnosis and number of pre-operative days in the diagnosis of OC in 2019 (pre-COVID-19) and that in 2020 (during the COVID-19 pandemic). METHODS Using data from a cancer registry-based study on the impact of COVID-19 on cancer care in Osaka (CanReCO), we collected details of sex, age, residential area, cancer site, date of diagnosis, clinical stage at first treatment and number of pre-operative days in OC patients. RESULTS A total of 1470 OC cases were registered. Incidence of OC before and during COVID-19 was 814 and 656 cases, respectively. During the first wave of the pandemic (March to May 2020), incidence was about half that in the same period in 2019 (2019; n = 271, 2020; n = 145). Number of pre-operative days (median number of days between the first hospital visit and surgery date) was significantly shorter during the COVID-19 year (24.5 days) than in the pre-COVID-19 year (28 days, p = 0.0015). CONCLUSIONS Incidence of OC during the COVID-19 pandemic was lower than in pre-COVID-19. Despite disruption in the healthcare system, the number of pre-operative days for OC cases was shorter during the pandemic.
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Affiliation(s)
- Shihoko Koyama
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | | | - Chaochen Ma
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Nao Nishimura
- Department of Dentistry, Osaka International Cancer Institute, Osaka, Japan
| | - Kengo Aoki
- Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Minako Nishio
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tomoyuki Otsuka
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Miki Ishibashi
- Department of Dentistry, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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Frank MH, van Dijk BAC, Schoonbeek RC, Zindler J, Devriese LA, van Es RJJ, Merkx MAW, de Bree R. Differences in the association of time to treatment initiation and survival according to various head and neck cancer sites in a nationwide cohort. Radiother Oncol 2024; 192:110107. [PMID: 38262531 DOI: 10.1016/j.radonc.2024.110107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To assess whether there are differences in the effects of time to treatment interval (TTI) on patient survival for head and neck cancer (HNC) sites in order to provide evidence that can support decision-making regarding prioritizing treatment. MATERIALS AND METHODS Patients in the Netherlands with a first primary HNC without distant metastasis between 2010 and 2014 were included for analysis (N = 10,486). TTI was defined as the time from pathologic diagnosis to the start of initial treatment. Overall survival (OS), cox regression analyses and cubic spline hazard models were calculated and visualized. RESULTS Overall, the hazard of dying was higher (HR = 1.003; 95 % CI 1.001-1.005) with each additional day until treatment initiation. The pattern, as visualized in cubic spline graphs, differed by site the hazard increased more steeply with increasing TTI for oral cavity cancer. For oropharyngeal and laryngeal cancer, a slight increase commenced after a longer TTI than for oral cavity cancer, while there was hardly an increase in hazard with increasing TTI for hypopharyngeal cancer. CONCLUSION The relationship between longer TTI and decreased survival was confirmed, but slight variations in the pattern of the hazard of dying by TTI by tumour site were observed. These findings could support decisions on prioritizing treatment. However, other aspects such as extent of treatment and quality of life should be investigated further so this can also be included.
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Affiliation(s)
- Michaël H Frank
- University of Utrecht, Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery, Haaglanden Medical Center, The Hague, the Netherlands.
| | - Boukje A C van Dijk
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Rosanne C Schoonbeek
- University of Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Jaap Zindler
- Department of Radiation Oncology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Lot A Devriese
- University of Utrecht, Department of Medical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert J J van Es
- University of Utrecht, Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Matthias A W Merkx
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands; Radboud University Nijmegen, IQ Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Remco de Bree
- University of Utrecht, Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
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Korsström C, Lilja M, Hammarstedt-Nordenvall L, Mäkitie A, Haapaniemi A. Endoscopic management of sinonasal tumours in the Nordic university hospitals: a survey. Eur Arch Otorhinolaryngol 2024; 281:785-794. [PMID: 37733092 PMCID: PMC10796644 DOI: 10.1007/s00405-023-08229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE The Nordic countries (27 M) all have comparable, publicly funded healthcare systems, and the management of sinonasal tumours is centralised to the 21 university hospitals. We sought to assess and compare the treatment practice of sinonasal tumours across the Nordic countries. METHODS A web-based questionnaire was sent to all university hospital departments of otorhinolaryngology-head and neck surgery in the Nordic countries. RESULTS Answers were obtained from all 21 Nordic university hospitals. The endoscopic approach was widely utilised by all, with most (62%) centres reporting 3-4 surgeons performing endoscopic sinonasal tumour surgery. Finland reported the lowest rates of centralisation among university hospitals despite having the highest number of 0.1-1 M catchment population hospitals. Most centres (88%) opted for the endoscopic approach in a patient case warranting medial maxillectomy. In a case of a Kadish C esthesioneuroblastoma, most (52%) of the centres preferred an endoscopic approach. Most centres (62%) reported favouring the endoscopic approach in a case describing a juvenile angiofibroma. Regarding a case describing a sinonasal undifferentiated carcinoma, consensus was tied (38% vs. 38%) between endoscopic resection followed by postoperative (chemo)radiotherapy (RT/CRT) and induction chemotherapy followed by RT/CRT or surgery followed by RT/CRT. CONCLUSION Endoscopic approach was widely utilised in the Nordic countries. The case-based replies showed differences in treatment practice, both internationally and nationally. The rate of centralisation among university hospitals remains relatively low, despite the rarity of these tumours.
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Affiliation(s)
- Carl Korsström
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland.
| | - Markus Lilja
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland
| | - Lalle Hammarstedt-Nordenvall
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Head-, Neck-, Lung- and Skin Cancer, Theme Cancer, Karolinska University Hospital, 17164, Stockholm, Sweden
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Aaro Haapaniemi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland
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11
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Arch RS, Fei-Zhang DJ, Patel U, Rastatter JC. Influence of Medicaid Expansion on Head and Neck Squamous Cell Carcinoma Presentation and Survival. Otolaryngol Head Neck Surg 2024; 170:431-437. [PMID: 37811691 DOI: 10.1002/ohn.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 08/24/2023] [Accepted: 09/02/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To compare head and neck squamous cell carcinoma stage at presentation and survival in Medicaid-expanded states versus nonexpanded states. STUDY DESIGN Retrospective cohort. SETTING Northwestern University Feinberg School of Medicine. METHODS The Head and Neck with human papillomavirus Status Database within the Surveillance, Epidemiology, and End Results (SEER) Program was queried for cases of head and neck squamous cell carcinoma (HNSCC) diagnosed in the years 2010 to 2016. Cases were grouped according to their respective state Medicaid expansion status. Multivariable logistic regressions and multivariable Cox proportional hazards models were used to evaluate associations with stage IV disease and survival. RESULTS Compared to nonexpanded states, Medicaid-expanded states had a significantly larger proportion of Medicaid patients (20.3% vs 16.7%, P = .0009) and a significantly smaller proportion of uninsured patients (1.7% vs 10.1%, P < .0001). The case selection process resulted in 2215 patients meeting inclusion criteria. In multivariable analysis, cases under Medicaid expansion were 31% less likely to present with stage IV disease compared to cases in nonexpanded states (odds ratio: 0.69, 95% confidence interval [CI]: 0.51-0.93). In the multivariable Cox proportional hazards model, cases under Medicaid expansion had significantly better mortality outcomes and were 32% less likely to die compared to cases in nonexpanded states (hazard ratio: 0.68, 95% CI: 0.55-0.84). CONCLUSION Medicaid expansion is associated with fewer stage IV cases and improved survival of HNSCC cases. These findings support continued efforts to expand Medicaid coverage.
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Affiliation(s)
- Rebecca Sinard Arch
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David J Fei-Zhang
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Urjeet Patel
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey C Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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12
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Batool S, Hansen EE, Sethi RKV, Rettig EM, Goguen LA, Annino D, Uppaluri R, Edwards HA, Faden DL, Dohan D, Dhand A, Reich AJ, Bergmark RW. Personal Social Networks and Care-Seeking for Head and Neck Cancer: A Qualitative Study. Otolaryngol Head Neck Surg 2024; 170:457-467. [PMID: 38079157 DOI: 10.1002/ohn.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES To investigate the role of patients' personal social networks (SNs) in accessing head and neck cancer (HNC) care through patients' and health care workers' (HCWs) perspectives. STUDY DESIGN Qualitative study. SETTING Tertiary HNC centers at 2 academic medical centers, including 1 safety net hospital. METHODS Patients with newly diagnosed HNC, and HCWs caring for HNC patients, aged ≥18 years were recruited between June 2022 and July 2023. Semistructured interviews were conducted with both patients and HCWs. Inductive and deductive thematic analysis was performed with 2 coders (κ = 0.82) to analyze the data. RESULTS The study included 72 participants: 42 patients (mean age 57 years, 64% female, 81% white), and 30 HCWs (mean age 42 years, 77% female, 83% white). Four themes emerged: (1) Patients' SNs facilitate care through various forms of support, (2) patients may hesitate to seek help from their networks, (3) obligations toward SNs may act as barriers to seeking care, and (4) the SN composition and dedication influence care-seeking. CONCLUSION Personal SNs play a vital role in prompting early care-seeking among HNC patients. SN-based interventions could enhance care and improve outcomes for HNC patients.
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Affiliation(s)
- Sana Batool
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elisabeth E Hansen
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Rosh K V Sethi
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Eleni M Rettig
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Laura A Goguen
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Donald Annino
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ravindra Uppaluri
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Heather A Edwards
- Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Daniel L Faden
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Boston Medical Center, Boston, United States
| | - Daniel Dohan
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - Amar Dhand
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Network Science Institute, Northeastern University, Boston, Massachusetts, USA
| | - Amanda J Reich
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Regan W Bergmark
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
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13
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Clementine M, Camille C, Swann A, Alavi Z, Remi M, Jean-Christophe L. COVID-19 impact on the management of head and neck cancer: a French single-centre experience. Eur Arch Otorhinolaryngol 2024; 281:873-882. [PMID: 37845381 DOI: 10.1007/s00405-023-08245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has caused unprecedented pressure on medical care resources and access. The aim of this study was to evaluate the time between the cancer symptoms' onset and the first ENT specialist consultation for patients with head and neck (HNC) and salivary glands cancers during the pandemic. METHODS The outcome measures evaluated were time to diagnosis, and time to treatment onset, as well as the COVID-19 impact on the proportion of both cancer patient groups: asymptomatic and advanced stages. This is single-centre retrospective cross-sectional study, including 473 patients who were treated in our University Hospital for HNC and salivary gland cancers, 171 in the COVID-19 pandemic group (C +), and 302 patients in the pre-pandemic group (C-). RESULTS There were no significant between-group differences in the delays between cancer symptoms' onset and ENT consultation, diagnostic workup and initial treatment onset, respectively. There was a suggestive reduction in the number of diagnostic panendoscopy performed in the C + group (62%) compared to the C- group (73%) as well as a suggestive increase in the delay to adjuvant radiotherapy onset. CONCLUSION The median delay between cancer symptoms' onset and ENT specialist consultation was not affected by the COVID-19 pandemic in our centre. Our results suggest an 11% decrease in diagnostic procedures performed independently, a decrease in the delay between the ENT consultation and surgical treatment onset and a 10-day increase in the delay to adjuvant radiotherapy onset.
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Affiliation(s)
| | | | | | - Zarrin Alavi
- INSERM, CIC 1412, Brest University Hospital, Brest, France
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14
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Wei X, Yu S, Wang J, Xiang Z, Liu L, Min Y. Association between time from diagnosis to treatment and survival of patients with nasopharyngeal carcinoma: A population-based cohort study. Curr Probl Cancer 2024; 48:101060. [PMID: 38211418 DOI: 10.1016/j.currproblcancer.2024.101060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/06/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Treatment delays have frequently been observed in cancer patients. Whether the treatment delays would impair the survival of patients with nasopharyngeal carcinoma (NPC) is still unclear. METHODS The data were derived from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. Patients were divided into groups of timely treatment (<1 month), intermediate delay (1 and 2 months), and long delay (3-6 months). The influence of different treatment delay intervals on long-term survival was evaluated by multivariate Cox regression analysis. RESULTS In total, 2,048 patients with NPC were included in our study. There were 551 patients in the early stage (I, II stage: 26.9 %) and 1,497 patients in the advanced stage (III, IV stage: 73.1 %). No significant difference in overall survival (OS) or cancer-specific survival (CSS) was observed among the groups with various treatment delay intervals (p = 0.48 in OS and p = 0.43 in CSS, respectively). However, upon adjusting for covariates, a significantly improved OS probability emerged in patients with intermediate treatment delays compared to those who received timely interventions in both the entire study population (adjustedHazard Ratio (aHR)=0.86, 95 % CI: 0.74-0.99, p = 0.043) and the subgroup with advanced stage (aHR=0.85, 95 % CI: 0.72-1.00, p = 0.049). Regarding the CSS probability, similar associations were also observed in the entire study population (aHR=0.84, 95 % CI: 0.71-0.98, p = 0.030) as well as the advanced-stage patients (aHR=0.83, 95 % CI: 0.70-0.99, p = 0.038). CONCLUSIONS Our results revealed that treatment delays are not associated with worse survival of NPC patients. Tumor-specific characteristics and subsequent treatment modalities play more pivotal roles in the prognosis of NPC.
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Affiliation(s)
- Xiaoyuan Wei
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Siting Yu
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Jun Wang
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Zhongzheng Xiang
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Lei Liu
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China.
| | - Yu Min
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, PR China
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15
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Galletti C, De Marco L, Ciodaro F, Freni F, Saraniti C, Galletti F, Galletti B. Impact of the Sars-COVID-19 Pandemic on the "Early Diagnosis" of Laryngeal Tumors: Data From Monocentric Tertiary Care Hospital of South Italy. J Voice 2024:S0892-1997(23)00404-6. [PMID: 38290926 DOI: 10.1016/j.jvoice.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The aim of this retrospective case-control study is to investigate how the Sars-COVID-19 pandemic has influenced the delay in the early diagnosis of laryngeal cancer in patients who visited the University Hospital "G. Martino" in the last 3 years of the pandemic. It is also proposed to compare the diagnosis, surgical staging, and therapeutic approach offered to patients affected by laryngeal cancer in the years affected by the COVID-19 pandemic compared to cases treated during the 3 years preceding the pandemic METHODOLOGY/PRINCIPAL: A single-center retrospective study was carried out to analyze the effects of the COVID-19 pandemic on the diagnosis and treatment of patients with squamous cell carcinoma of the larynx at our Otorhinolaryngology Division of the "Gaetano Martino" University hospital. The research period, 6 years, was divided into two sub-periods of equal months for which we divided the patients into two groups "Before COVID-19" and "During COVID-19", defined, respectively, from February 2017 to March 2020 and from April 2020 to May 2023. Patients aged 18 years and older with a diagnosis of squamous cell carcinoma, seen and surgically treated at the Otorhinolaryngology division of the "Gaetano Martino" University Hospital and patients referred from other hospitals were included in the study population. Patients affected by malignancies in other sites with secondary laryngeal involvement, patients not amenable to surgical therapy, treated only with radio-chemotherapy therapy, and patients not amenable to surgical therapy were excluded from the study. RESULTS A total of 141 patients were recruited, divided into 76 patients in the "Before COVID-19" arm and 65 patients in the "During COVID-19" arm, with a male prevalence of 119 patients (84.4%). The mean age of our study population stands at a median of 69 years (percentile 25th 60.00 and percentile 75th 77.00). Smoking and alcohol are two predominant variables in our study population with a prevalence of 89.4% and 79.4%, respectively. A higher number of TNM stage IV cases was detected, 29.2% in the group "During COVID-19" compared to 5.3 detected in the group "Before COVID-19" (P = 0.005). In the "During COVID-19" group, we find an overall percentage of 61.5% for stages II-III-IV versus 36.9% present in the "Before COVID-19" group of patients. An adjuvant radiotherapy treatment was actuated in 30.26% of patients in the "Before COVID-19" versus 41.54% in "During COVID-19". CONCLUSIONS The most important result of our research was the statistically significant difference in tumor staging at the time of diagnosis between the "Before COVID-19" and "During COVID-19" groups, with a higher mean value in the latter. The current data confirm the previously exposed hypothesis according to which the COVID-19 pandemic has led to a delay in early diagnosis, negatively influencing the staging at the time of the first ENT visit and the subsequent therapeutic approach to be offered to the patient.
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Affiliation(s)
- Cosimo Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Laura De Marco
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Francesco Ciodaro
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Francesco Freni
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Carmelo Saraniti
- Division of Otorhinolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy.
| | - Francesco Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Bruno Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
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16
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Rich BJ, Samuels SE, Azzam GA, Kubicek G, Freedman L. Oral Cavity Squamous Cell Carcinoma: Review of Pathology, Diagnosis, and Management. Crit Rev Oncog 2024; 29:5-24. [PMID: 38683151 DOI: 10.1615/critrevoncog.2023050055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Squamous cell carcinoma of the oral cavity presents a significant global health burden, primarily due to risk factors such as tobacco smoking, smokeless tobacco use, heavy alcohol consumption, and betel quid chewing. Common clinical manifestations of oral cavity cancer include visible lesions and sores, often accompanied by pain in advanced stages. Diagnosis relies on a comprehensive assessment involving detailed history, physical examination, and biopsy. Ancillary imaging studies and functional evaluations aid in accurate staging and facilitate treatment planning. Prognostic information is obtained from histopathological factors, such as tumor grade, depth of invasion, lymphovascular invasion, and perineural invasion. Notably, lymph node metastasis, found in approximately half of the patients, carries significant prognostic implications. Effective management necessitates a multidisciplinary approach to optimize patient outcomes. Surgical resection is the backbone of treatment, aimed at complete tumor removal while preserving functional outcomes. Adjuvant therapies, including radiation and chemotherapy, are tailored according to pathological factors. Further work in risk stratification and treatment is necessary to optimize outcomes in squamous cell carcinoma of the oral cavity.
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Affiliation(s)
| | | | - Gregory A Azzam
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
| | - Gregory Kubicek
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
| | - Laura Freedman
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
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17
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Machado B, Barroso T, Godinho J. Impact of Diagnostic and Treatment Delays on Survival and Treatment-Related Toxicities in Portuguese Patients With Head and Neck Cancer. Cureus 2024; 16:e53039. [PMID: 38410318 PMCID: PMC10895551 DOI: 10.7759/cureus.53039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
INTRODUCTION Delays in diagnosis and initiation of treatment have a negative impact on the prognosis and survival of head and neck cancer (HNC) patients. These delays also involve more intensive treatments with greater toxicity, dysfunction, and morbidity. METHODS This was a retrospective observational study with patients diagnosed with HNC between January 1, 2018, and December 31, 2021. The main objective was to estimate whether the time to diagnosis (TD) and time until treatment initiation (TIT) translated into changes in the patient's overall survival (OS). Multivariate data analysis was performed with the Cox regression model. Significance was considered for p<0.05. RESULTS A total of 139 patients were included in this study. Median TD was 126 days and median TIT was 43 days. No association between TD, TIT, treatment toxicity, and OS was found. Being a smoker was associated with a longer TD (p=0.05, hazard ratios {HR}=1.01). TIT was significantly shorter in higher grades (p=0.03, HR=0.57) and during coronavirus disease 2019 (COVID-19) (p=0.04, HR=0.57), but higher in larger disease (tumor {T}) (p=0.04, HR=1.39). A higher T (p=0.01, HR=2.67) and lymph node metastasis (nodes {N}) (p=0.02, HR=2.24) were identified as risk factors with a negative impact on OS, whereas grade was positively correlated (p=0.05, HR=0.32). CONCLUSIONS Even though there was no correlation between TD and TIT, and OS, action still needs to be taken to shorten these times. T and N remain negative predictive prognostic markers of HNC.
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Affiliation(s)
- Bárbara Machado
- Medical Oncology, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
| | - Tiago Barroso
- Medical Oncology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, PRT
| | - Joana Godinho
- Medical Oncology, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT
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18
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Dayan G, Bahig H, Fortin B, Filion É, Nguyen-Tan PF, O'Sullivan B, Charpentier D, Soulières D, Gologan O, Nelson K, Létourneau L, Schmittbuhl M, Ayad T, Bissada E, Guertin L, Tabet P, Christopoulos A. Predictors of prolonged treatment time intervals in oral cavity cancer. Oral Oncol 2023; 147:106622. [PMID: 37948896 DOI: 10.1016/j.oraloncology.2023.106622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Delays in treatment time intervals have been associated with overall survival in oral cavity squamous cell carcinoma (OCSCC). The aim of this study was to identify bottlenecks leading to prolonged treatment intervals. MATERIAL AND METHODS A retrospective analysis was conducted using a cohort of OCSCC patients who underwent surgery and adjuvant radiation therapy. The endpoints of interest were prolonged treatment intervals. Multivariable logistic regression was used to adjust for patient and tumour characteristics. RESULTS Median diagnosis-to-treatment interval (DTI) and surgery to initiation of postoperative radiation therapy interval (S-PORT) were 39 days (IQR 30-54) and 64 days (IQR 54-66), respectively. Prolonged DTI was associated with older age, worse Charlson Comorbidity index scores and worse T stages. Patients with prolonged DTI had longer times to preoperative imaging reports (25 vs 9 days; P < 0.01). Time to preoperative pathology did not differ. Prolonged S-PORT was associated with longer times to pathology report (28 vs 18 days; P < 0.01), to maxillofacial consult (38 vs 15 days; P < 0.01) and to maxillofacial approval of radiation (50 vs 28 days; P < 0.01). In patients requiring medical oncology consults, those with prolonged S-PORT had longer waiting times until consultation (58 vs 38 days; P = 0.02). Multivariate analysis showed independent predictors of prolonged DTI: time to preoperative imaging; and prolonged S-PORT: time to pathology report, time to maxillofacial consult, and time to medical oncology consult. CONCLUSIONS Strategies targeting these organizational bottlenecks may be effective for shortening treatment time intervals, hence representing potential opportunities for improving oncological outcomes in OCSCC patients.
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Affiliation(s)
- Gabriel Dayan
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Houda Bahig
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Bernard Fortin
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Hopital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Édith Filion
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Phuc-Felix Nguyen-Tan
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Brian O'Sullivan
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Danielle Charpentier
- Department of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Denis Soulières
- Department of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Olga Gologan
- Department of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Kristoff Nelson
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Létourneau
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Matthieu Schmittbuhl
- Department of Stomatology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Tareck Ayad
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Eric Bissada
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Louis Guertin
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Paul Tabet
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Apostolos Christopoulos
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada.
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19
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Nguyen J, Patel R, Eloy JA, Baredes S, Park RCW. Assessing the Association Between Time to Surgery and Survival in Sinonasal Squamous Cell Carcinoma. Laryngoscope 2023; 133:3389-3395. [PMID: 37194665 DOI: 10.1002/lary.30738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION To assess the association between time to surgery (TTS) and survival in sinonasal squamous cell carcinoma patients (SSCC). METHODS We queried the 2004-2016 National Cancer Database for all cases of adult SSCC undergoing primary surgical treatment. Patients with missing TTS information were excluded. We conducted a multivariate analysis of patient demographic and clinicopathological characteristics' effect on overall survival (OS) using a Cox proportional hazards model enhanced with cubic spline non-linear approximation. Bootstrapping methods were utilized to detect the aggregate risk of TTS delay on patient OS. RESULTS A total of 2,881 patients met the inclusion criteria. The majority of patients were male (63.5%), White (86.3%), and over the age of 60 (58.4%). Parametric cubic spline approximation Cox hazard model detected a non-linear association between patient OS and TTS below 30 days with the lowest risk occurring at 18 days and steadily increasing subsequently. To analyze the aggregate risk and identify the optimal TTS cut-off after 30 days of surgical delay, the cohort sample was bootstrapped and dichotomized. The largest increase in aggregated risk was identified at 59 days (Hazards Ratio [HR] = 1.006 [0.839-1.084], p = 0.003). 60 days were used as the optimal TTS cut-off for analyzing the survival rate using the Cox proportional hazard model. Undergoing surgery within 60 days translated to a 14.6% decreased chance of death (HR: 0.854 [0.83-0.96]). CONCLUSIONS Increasing TTS is associated with worse overall survival in patients with SSCC. Our study suggests that surgery should be done within 60 days to achieve optimal survival results. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3389-3395, 2023.
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Affiliation(s)
- Julia Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rushi Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJ Barnabas Health, Livingston, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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20
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Dayan GS, Bahig H, Johnson-Obaseki S, Eskander A, Hong X, Chandarana S, de Almeida JR, Nichols AC, Hier M, Belzile M, Gaudet M, Dort J, Matthews TW, Hart R, Goldstein DP, Yao CMKL, Hosni A, MacNeil D, Fowler J, Higgins K, Khalil C, Khoury M, Mlynarek AM, Morand G, Sultanem K, Maniakas A, Ayad T, Christopoulos A. Oncologic Significance of Therapeutic Delays in Patients With Oral Cavity Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:961-969. [PMID: 37422839 PMCID: PMC10331621 DOI: 10.1001/jamaoto.2023.1936] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Importance Oral cavity cancer often requires multidisciplinary management, subjecting patients to complex therapeutic trajectories. Prolonged treatment intervals in oral cavity cancer have been associated with poor oncological outcomes, but there has yet to be a study investigating treatment times in Canada. Objective To report treatment delays for patients with oral cavity cancer in Canada and evaluate the outcomes of treatment delays on overall survival. Design, Setting, and Participants This multicenter cohort study was performed at 8 Canadian academic centers from 2005 to 2019. Participants were patients with oral cavity cancer who underwent surgery and adjuvant radiation therapy. Analysis was performed in January 2023. Main Outcomes and Measures Treatment intervals evaluated were surgery to initiation of postoperative radiation therapy interval (S-PORT) and radiation therapy interval (RTI). The exposure variables were prolonged intervals, respectively defined as index S-PORT greater than 42 days and RTI greater than 46 days. Patient demographics, Charlson Comorbidity Index, smoking status, alcohol status, and cancer staging were also considered. Univariate (log rank and Kaplan-Meier) and multivariate (Cox regression) analyses were performed to determine associations with overall survival (OS). Results Overall, 1368 patients were included; median (IQR) age at diagnosis was 61 (54-70) years, and 896 (65%) were men. Median (IQR) S-PORT was 56 (46-68) days, with 1093 (80%) patients waiting greater than 42 days, and median (IQR) RTI was 43 (41-47) days, with 353 (26%) patients having treatment time interval greater than 46 days. There were variations in treatment time intervals between institutions for S-PORT (institution with longest vs shortest median S-PORT, 64 days vs 48 days; η2 = 0.023) and RTI (institution with longest vs shortest median RTI, 44 days vs 40 days; η2 = 0.022). Median follow-up was 34 months. The 3-year OS was 68%. In univariate analysis, patients with prolonged S-PORT had worse survival at 3 years (66% vs 77%; odds ratio 1.75; 95% CI, 1.27-2.42), whereas prolonged RTI (67% vs 69%; odds ratio 1.06; 95% CI, 0.81-1.38) was not associated with OS. Other factors associated with OS were age, Charlson Comorbidity Index, alcohol status, T category, N category, and institution. In the multivariate model, prolonged S-PORT remained independently associated with OS (hazard ratio, 1.39; 95% CI, 1.07-1.80). Conclusions and Relevance In this multicenter cohort study of patients with oral cavity cancer requiring multimodal therapy, initiation of radiation therapy within 42 days from surgery was associated with improved survival. However, in Canada, only a minority completed S-PORT within the recommended time, whereas most had an appropriate RTI. An interinstitution variation existed in terms of treatment time intervals. Institutions should aim to identify reasons for delays in their respective centers, and efforts and resources should be directed toward achieving timely completion of S-PORT.
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Affiliation(s)
- Gabriel S. Dayan
- Division of Otolaryngology–Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montéal, Montreal, Quebec, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | | | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Xinyuan Hong
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Shamir Chandarana
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John R. de Almeida
- Department of Otolaryngology–Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anthony C. Nichols
- Department of Otolaryngology–Head and Neck Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael Hier
- Department of Otolaryngology–Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Mathieu Belzile
- Department of Otolaryngology–Head and Neck Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marc Gaudet
- Department of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph Dort
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - T. Wayne Matthews
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert Hart
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David P. Goldstein
- Department of Otolaryngology–Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christopher M. K. L. Yao
- Department of Otolaryngology–Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology–Head and Neck Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - James Fowler
- Department of Otolaryngology–Head and Neck Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Khalil
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mark Khoury
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alex M. Mlynarek
- Department of Otolaryngology–Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Gregoire Morand
- Department of Otolaryngology–Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Anastasios Maniakas
- Department of Head and Neck Surgery, MD Anderson Cancer Center, University of Texas, Houston
| | - Tareck Ayad
- Division of Otolaryngology–Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montéal, Montreal, Quebec, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology–Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montéal, Montreal, Quebec, Canada
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21
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Tirelli G, Boscolo-Rizzo P, Pelloso L, Gardenal N, Giudici F, Marcuzzo AV, Tofanelli M. Impact of time-to-surgery on survival and quality of life in oral cancer. Am J Otolaryngol 2023; 44:103984. [PMID: 37437337 DOI: 10.1016/j.amjoto.2023.103984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE To investigate the association between time-to-surgery (TTS) and overall survival (OS), disease specific survival (DSS) and quality of life (QoL) in patients with oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS 116 patients with OSCC candidate to surgery were examined. TTS intervals starting from diagnosis (TTS-clinical-based) and from histological reports (TTS-biopsy-based) were calculated. The effects of TTS intervals and prognostic factors on 5-year OS and DSS were explored. RESULTS In our cohort advanced T-categories OSCCs with TTS < 30 days showed a trend to have higher DSS rate (p = 0.049). Patients with TTS-clinical-based < 30 days showed better postoperative QoL. Positive surgical margins, nodal involvement (pN+), DOI >10 mm, invasive surgery and extra-capsular extension in pN+ were found to be significantly associated with a poor OS and DSS. CONCLUSIONS TTS ≥ 30 days can adversely affect DSS, especially in the advanced T categories. Short TTS intervals resulted associated with a better postoperative QoL.
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Affiliation(s)
- Giancarlo Tirelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Ludovica Pelloso
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Nicoletta Gardenal
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Fabiola Giudici
- Department of Medicine, Surgery and Health Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Margherita Tofanelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy.
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22
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Tasoulas J, Schrank TP, Smith BD, Agala CB, Kim S, Sheth S, Shen C, Yarbrough WG, Hackman T, Sullivan CB. Time to treatment patterns of head and neck cancer patients before and during the Covid-19 pandemic. Oral Oncol 2023; 146:106535. [PMID: 37625360 DOI: 10.1016/j.oraloncology.2023.106535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES The delivery of healthcare has changed significantly over the past decades. This study analyzes the clinicodemographic factors and treatment patterns of head and neck squamous cell carcinoma (HNSCC) patients between 2004 and 2020. MATERIALS AND METHODS Retrospective cohort analysis of HNSCC patients from the National Cancer Data Base from 2004 to 2020. RESULTS A total of 164,290 patients were included. Increased times from diagnosis to definitive surgery (TTS) were seen across all facility types (academic centers, AC; non-academic centers, NAC) between 2004 and 2019, with NAC affected more. TTS < 15 days (RR = 1.05, 95%CI:1.05-1.09) and > 75 days (1.07, 95%CI:1.05-1.09) were associated with increased mortality risk. This association was more prominent among HPV + HNSCC (RR = 1.45; 95%CI:1.18-1.78). Treatment in AC was associated with a decreased mortality risk (RR = 0.94, 95%CI:0.93-0.95). Despite the universal increase in wait times from 2004 to 2019, short-term mortality was significantly decreased from 2016 to 2019, relative to 2004-2007 (3-month mortality: RR = 0.77, 95%CI:0.70-0.85; 12-month mortality: RR = 0.80, 95%CI:0.77-0.84). Wait times decreased in 2020. CONCLUSIONS TTS increased between 2004 and 2019, with NAC affected more. However, despite longer wait times, short-term survival increased significantly. Very short (<15 days) and very long (>75 days) TTS were associated with increased mortality risk. Patients with HPV + HNSCC have the highest increase among those treated > 75 days from diagnosis. Treatment at AC was associated with improved survival, which could be explained by the presence of multidisciplinary teams and subspecialists that may be less available at NAC. The 2021 NCDB data are required for a comprehensive analysis of wait times in 2020.
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Affiliation(s)
- Jason Tasoulas
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Travis P Schrank
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Blaine D Smith
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chris B Agala
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sulgi Kim
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siddharth Sheth
- Division of Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colette Shen
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wendell G Yarbrough
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pathology and Laboratory Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Trevor Hackman
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher Blake Sullivan
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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23
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Reerds STH, Honings J, van Engen ACH, Marres HAM, Takes RP, van den Hoogen FJA. Prioritizing parotid gland surgery: A call for the implementation of the MSRSGC classification. Cancer Cytopathol 2023; 131:701-707. [PMID: 37519238 DOI: 10.1002/cncy.22747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/29/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is developed to aid diagnosis and management of salivary gland tumors. This study evaluates the time-to-treatment initiation (TTI) for parotid gland tumors in the Netherlands and relates these to the MSRSGC classification. Subsequently, the use of the MSRSGC in the Netherlands is evaluated. METHODS Data regarding fine-needle aspiration cytology (FNAC) and histopathological resections of the parotid were gathered from the Dutch nationwide pathology data bank (PALGA). The TTI was calculated for each MSRSGC category and type of treating center. FNACs performed from 2018 to 2021 were gathered from PALGA to estimate how frequently the MSRSGC classification was applied. RESULTS Median TTI in days were 86 for nondiagnostic (MSRSGC I), 75 for nonneoplastic (MSRSGC II), 65 for atypia of unknown significance (AUS) (MSRSGC III), 89 for benign (MSRSGC IVa), 52 for salivary gland neoplasm of unknown malignant potential (SUMP) (MSRSGC IVb), 31 for suspected malignant (MSRSGC V), and 30 for malignant (MSRSGC VI) categories. Significant variation in the TTI between the types of treating centers was found for the nondiagnostic, nonneoplastic, AUS, SUMP, and suspected malignant categories. In the first 3 years after the introduction of the MSRSGC, the pathologist stated the MSRSGC classification in 6.4% of all reports. CONCLUSIONS The median TTI for most categories is long, and there is significant interhospital variation in TTI. Preoperative risk stratification and treatment prioritization in parotid gland surgery in the Netherlands should be improved. The MSRSGC could contribute to this. Until 2021, the MSRSGS classification was implemented on a limited scale in the Netherlands.
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Affiliation(s)
- Sam T H Reerds
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | | | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
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24
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Day AT, Prestwood CA, Emmett TR, Eary RL, Salley JR, Cerda V, Mayfield Arnold E, Lee SC, Tiro JA. Unmet Needs and Receipt of Supportive Care Services in Head and Neck Cancer Patients Prior to Oncologic Treatment: A Prospective, Cross-Sectional Pilot Study. Ann Otol Rhinol Laryngol 2023; 132:1361-1372. [PMID: 36890749 DOI: 10.1177/00034894231154182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To characterize the supportive care (SC) needs and receipt of SC services among head and neck cancer (HNC) patients prior to oncologic treatment and to explore the influence of social determinants of health on these outcomes. MATERIALS AND METHODS Newly diagnosed HNC patients were surveyed via telephone prior to oncologic treatment between 10/2019 and 1/2021 using a prospective, cross-sectional, bi-institutional, pilot study design. The primary study outcome was unmet SC needs (Supportive Care Needs Survey-Short Form34 [SCNS-SF34]). Hospital type (university- vs county safety-net) was explored as an exposure. Descriptive statistics were performed using STATA16 (College Station, TX). RESULTS Among 158 potentially eligible patients, 129 were successfully contacted, 78 met the study criteria, and 50 completed the survey. The mean age was 61, 58% exhibited clinical stage III-IV disease, and 68% and 32% were treated at the university and county safety-net hospital, respectively. Patients were surveyed a median of 20 days after their first oncology visit and 17 days prior to initiation of oncology treatment. They had a median of 24 total needs (11 were met and 13 were unmet) and preferred to see a median of 4 SC services but received care from none. County safety-net patients had comparatively more unmet needs than university patients (14.5 vs 11.5, P = .04). CONCLUSION Pretreatment HNC patients at a bi-institutional academic medical center report a high number of unmet SC needs with corollary poor receipt of available SC services. Novel interventions to address this significant gap in care are needed.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Courtney A Prestwood
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas R Emmett
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rebecca L Eary
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jordan R Salley
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Vanessa Cerda
- Department of Population and Data Sciences; UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Simon Craddock Lee
- Department of Population and Data Sciences; UT Southwestern Medical Center, Dallas, TX, USA
| | - Jasmin A Tiro
- Department of Population and Data Sciences; UT Southwestern Medical Center, Dallas, TX, USA
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25
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Balchander D, Shorbaji K, Cabrera CI, Hoying D, Clancy K, Fowler N, Thuener JE, Lavertu P, Pan Q, Teknos TN, Rezaee RP, Li S, Tamaki A. Prognostic significance of time trends in treatment of head and neck squamous cell carcinoma. Am J Otolaryngol 2023; 44:103966. [PMID: 37481899 DOI: 10.1016/j.amjoto.2023.103966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/19/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE To analyze the impact of demographic, clinical, and management variables on time to treatment initiation (TTI) and overall survival (OS). STUDY DESIGN Retrospective chart review. MATERIALS AND METHODS Medical records of patients diagnosed with head and neck cancer from 2018 to 2020 were reviewed. Univariate linear and Cox-regressions identified predictors of TTI and OS. Kaplan Meier (KM) curves assessed the difference in survival by diagnostic year and TTI. RESULTS 381 patients met eligibility criteria. Median TTI was 35.0 days (IQR: 25.0-49.0). Only 10.8 % of all patients reported any treatment delay, with TTI exceeding 90 days found in 3.7 % of patients. TTI increased with African American race (p = 0.02), ED referrals (p = 0.02), and direct admission status (p = 0.01). When compared to treatment with surgery alone, TTI was shorter in patients undergoing surgery with adjuvant radiation (p = 0.02), adjuvant chemoradiation (p = 0.04), and salvage surgery (p = 0.04). Univariate Cox-regressions found smoking (p = 0.01), direct admission status (p = 0.02), increased duration of symptoms (p = 0.02), placement of PEG tubes (p < 0.01) and tracheostomies (p < 0.01), combination treatment (p < 0.01), and surgery with adjuvant chemoradiation treatment (p = 0.01) to increase mortality risk. Disease characteristics, including tumor size (p < 0.01), presence of nodal disease (p = 0.02), and late-stage disease (p < 0.01), increased mortality risk. TTI and diagnostic year did not impact survival. CONCLUSIONS Our analysis determined several demographic, referral, and treatment factors impacted TTI. However, increased TTI did not impact survival. Characteristics consistent with advanced disease worsened OS. Despite the pandemic burden, patients diagnosed in 2020 showed no difference in short-term survival compared to prior years.
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Affiliation(s)
| | - Khaled Shorbaji
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Hoying
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kate Clancy
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicole Fowler
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jason E Thuener
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pierre Lavertu
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Quintin Pan
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Theodoros N Teknos
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rod P Rezaee
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Shawn Li
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Sun Y, Sun Q, Tian J, He X. Effect of Waiting Time for Radioactive Iodine Therapy on Outcome in N1 Stage Papillary Thyroid Cancer. J Clin Endocrinol Metab 2023; 108:e1413-e1423. [PMID: 37167097 DOI: 10.1210/clinem/dgad264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
CONTEXT The waiting time for radioactive iodine therapy (WRAIT) after total thyroidectomy (TT) in patients with papillary thyroid cancer (PTC) and lymph node metastases (N1) has not been sufficiently investigated for risk of adverse outcomes. OBJECTIVE This work aimed to estimate the effect of WRAIT on the outcomes of disease persistence and recurrence among patients with N1 PTC and investigate factors predictive of delayed radioactive iodine therapy (RAIT). METHODS This retrospective cohort study was conducted in a university hospital. A total of 909 patients with N1 PTC were referred for RAIT between 2014 and 2018. WRAIT is the duration between TT and initial RAIT. The optimal WRAIT threshold determined using recursive partitioning analysis was used to define early and delayed RAIT. The primary end point was tumor persistence/recurrence. We compared the outcomes of patients with early and delayed RAIT using inverse probability weighting based on the propensity score. RESULTS The WRAIT threshold that optimally differentiated worse long-term remission/excellent response outcomes was greater than 88 days (51% of our cohort; n = 464). WRAIT exceeding 88 days was associated with an augmented risk of disease persistence/recurrence (odds ratio, 2.47; 95% CI, 1.60-3.82) after adjustment. Predictors of delayed RAIT included residence in lower-income areas, reoperation before the initial RAIT, TT at a nonuniversity-affiliated hospital, multifocality, extrathyroidal extension, N1b disease, and pre-RAIT-stimulated thyroglobulin level less than 1 ng/mL. CONCLUSION Delayed RAIT beyond 88 days after TT in patients with N1 PTC independently increased the risk of disease persistence/recurrence. Evaluation of the predictive determinants of prolonged WRAIT may help target at-risk patients and facilitate interventions.
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Affiliation(s)
- Yungang Sun
- Department of Nuclear Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Qiaoling Sun
- Department of Nuclear Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Jinyu Tian
- Department of Nuclear Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
| | - Xiaochuan He
- Department of Nuclear Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
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Viani GA, Moraes FY, Marta GN, Kowalski LP, Gouveia AG. Real-world evidence for oncological outcomes after radiotherapy or surgery for T1a-T1b glottic squamous cell carcinoma: A population-based cohort study. Head Neck 2023; 45:2505-2514. [PMID: 37555376 DOI: 10.1002/hed.27470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Compare outcomes after surgery (S) or radiotherapy (RT) for T1a-T1b glottic squamous cell carcinoma (T1GSCC) in a population-based cohort study. METHODS Patients diagnosed with T1GSCC from 1999 to 2020 were identified from a public database. Clinical, demographic, and social data were extracted. Treatment and patient groups and subgroups were compared with log-rank test, Cox proportional test, and propensity-score matched (PSM). RESULTS Eight hundred and eighty-eight patients with T1GSCC were included in the study, with a median follow-up of 61 months. The 5- and 10-year overall survival (OS) S versus RT were 76% versus 71% and 60% versus 52% (p = 0.02), respectively. In the subgroup analysis, S was associated with better OS for T1b, male, and public service patients (p < 0.05). In the PSM cohort of S versus RT with 110 patients each, there was no significant difference in the OS, CSS, and LC. CONCLUSIONS T1GSCC has favorable outcomes with S or RT.
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Affiliation(s)
- Gustavo Arruda Viani
- Department of Medical Imagings, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Fabio Ynoe Moraes
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Gustavo Nader Marta
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Radiation Oncology, Hospital Sirio Libanês, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center (ACCCC), Sao Paulo, Brazil
- Department of Head and Neck Surgery, São Paulo State Cancer Institute (ICESP), School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Andre Guimaraes Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Radiation Oncology, Americas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
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Bekkers S, Stewart L, Panizza BJ. Time is function and survival. ANZ J Surg 2023; 93:2281-2282. [PMID: 37849061 DOI: 10.1111/ans.18680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Stijn Bekkers
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Otolaryngology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Linda Stewart
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Benedict J Panizza
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Heckel S, Bohr C, Meier J, Maurer J, Kuenzel J, Mueller K, Koelbl O, Reichert T, Vielsmeier V, Gruber I. Head and neck oncology management in the time of COVID-19: results of a head and neck cancer center. J Cancer Res Clin Oncol 2023; 149:12081-12087. [PMID: 37421460 PMCID: PMC10465623 DOI: 10.1007/s00432-023-05122-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/04/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Given the concerns about the effects of the COVID-19 pandemic on cancer care, we analyzed the treatment quality of the head and neck cancer center Regensburg before and throughout 2 years of the pandemic. We included data of 3 years to reflect the extended pandemic period as new developments continued to influence its course. METHODS This retrospective review included all patients diagnosed with head and neck cancer in 2019, 2020, and 2021 who had not started treatment elsewhere prior to being referred to the head and neck cancer center. We compared tumor characteristics and times to therapy of patients diagnosed before COVID-19 in 2019 (n = 253), during COVID-19 in 2020 (n = 206), and in a phase of partial normalization in a persistent pandemic situation in 2021 (n = 247). RESULTS Our data revealed no decrease in diagnoses or drift in stages toward more advanced stages. There was an increased percentage of diagnoses confirmed at the head and neck cancer center from 2019 (57.3%) to 2020 (68.0%) and to 2021 (65.6%) compared to confirmation at other institutions (2019, 42.7%; 2020, 32.0%; 2021, 34.4%; P = 0.041). Surgery and radiotherapy were performed with the same frequency. The median days between diagnosis and surgery were decreased in 2020 (19.5 days; P = 0.049) and 2021 (20.0 days; P = 0.026) in comparison to 2019 (23 days). The days to radiotherapy were not affected. CONCLUSION The data indicate a consistent oncological performance for head and neck cancer patients in all waves of the pandemic and thereafter without a decrease in diagnoses or shift in stages.
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Affiliation(s)
- Silvia Heckel
- University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany
| | - Christopher Bohr
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Johannes Meier
- Department of Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Julia Maurer
- University Cancer Center Regensburg, Franz-Josef-Strauss Allee 11, Regensburg, Germany
| | - Julian Kuenzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Karolina Mueller
- Center for Clinical Studies, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Oliver Koelbl
- Department of Radiation Oncology, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Torsten Reichert
- Department of Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Veronika Vielsmeier
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Isabella Gruber
- Department of Radiation Oncology, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
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Sundaresan PD, Kruger E, Geachie JM, Tennant M. Special needs dentistry in multidisciplinary head and neck cancer management - characterizing scope and complexity of patient care. SPECIAL CARE IN DENTISTRY 2023; 43:579-587. [PMID: 36396444 DOI: 10.1111/scd.12801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022]
Abstract
AIMS To describe the involvement and need for specialists in special needs dentistry (SND) in the multidisciplinary management of patients and to characterize the complexity of patients with special health care needs. METHODS Referrals for SND review from the Fiona Stanley Hospital head and neck cancer (HNC) multidisciplinary team between January 1 and December 31, 2019 were screened. Data recorded included demographic information, medical history, dental status, and dental treatment provided prior to HNC management. RESULTS In total 127 patients were referred to the SND clinic in 2019 of which 89.0% were males and 74.8% were aged 50-79. The mean waiting time for SND review was 19.6 days. On average patients had a decayed, missing, filled tooth (DMFT) score of 20.3. During the study period 407 extractions and 30 restorations were completed. Seventeen patients (13.4%) had all their teeth removed prior to HNC management. The majority of patients (79.6%) were categorized as either moderate or severe complexity. Increasing complexity was seen in older age groups. CONCLUSIONS Significant oral disease is seen in patients with HNC often requiring extensive dental treatment. Complexity is seen in patients requiring multidisciplinary care however characteristics that constitute complexity are varied given the spectrum encompassing 'special needs'.
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Affiliation(s)
- Pritam Daniel Sundaresan
- School of Human Sciences, The University of Western Australia, Perth, Australia
- Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, Australia
- Specialist Dental Unit, Waikato Hospital, Hamilton, New Zealand
| | - Estie Kruger
- School of Human Sciences, The University of Western Australia, Perth, Australia
| | - John Mc Geachie
- School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Marc Tennant
- School of Human Sciences, The University of Western Australia, Perth, Australia
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Schmidt IG, Korsholm M, Johansen J, Sørensen JA, Godballe C, Bjørndal K. Missed cancer in the Danish head and neck cancer fast-track program: results from a tertiary cancer center. Acta Oncol 2023; 62:836-841. [PMID: 37493617 DOI: 10.1080/0284186x.2023.2238552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/02/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The Danish head and neck cancer fast-track program is a national standardized pathway aiming to reduce waiting time and improve survival for patients suspected of cancer in the head and neck (HNC). Until now, the frequency of missed cancer in the fast-track program has not been addressed. A missed cancer leads to treatment delay and may cause disease progression and worsening of prognosis. The study objective was to estimate the frequency of patients with missed cancers in the Danish HNC fast-track program and to evaluate the accuracy of the program. MATERIALS AND METHODS Patients who were rejected from the HNC fast-track program because cancer was not found between 1 July 2012 and 31 December 2018 at Odense University Hospital, Denmark were included and followed for three years. Patients were categorized into groups depending on the diagnostic evaluation. Group 1 included patients evaluated with standard clinical work-up without imaging and biopsy. Group 2 included patients evaluated with imaging and/or biopsy in addition to the standard clinical work-up. The local cancer database and electronic patient records were reviewed to determine if a missed cancer had occurred within the follow-up period. RESULTS A total of 8345 HNC fast-track courses were initiated during the study period. 1499 were patients suspected of recurrent cancer and were excluded leaving 6846 patients to be assessed for eligibility. Of these, 3752 patients were rejected because cancer was not found. Ten patients were subsequently diagnosed with cancer within the follow-up period resulting in an overall frequency of 0.15%. For group 1 and 2, the frequency was 0.04% and 0.10%, respectively. The sensitivity of the fast-track program was 99.67% and the negative predictive value was 99.73%. CONCLUSION The frequency of missed cancer in a tertiary HNC center following the Danish fast track program is low.
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Affiliation(s)
- Ida Grunske Schmidt
- Research Unit for ORL-Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Region of Southern Denmark
| | - Malene Korsholm
- Research Unit for ORL-Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Research Unit for ORL-Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Kristine Bjørndal
- Research Unit for ORL-Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Region of Southern Denmark
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Farber NI, Li Y, Solis RN, Chen J, Masheeb Z, Wilson M, Bewley AF, Abouyared M, Rao S, Rong Y, Birkeland AC. Tumor and Nodal Disease Growth Rates in Patients with Oropharyngeal Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:3865. [PMID: 37568681 PMCID: PMC10416867 DOI: 10.3390/cancers15153865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Though specific growth rate (SGR) has potential prognostic value for oropharyngeal squamous cell carcinoma (OPSCC), there is sparse literature defining these rates. Our aims were to establish the SGRs of primary tumors (PTs) and lymph nodes (LNs) in OPSCC and to correlate SGR with oncologic outcome. A pilot study was designed with a retrospective analysis examining 54 patients from the University of California, Davis with OPSCC (diagnosed 2012-2019). Radiation oncology software and pretreatment serial CT scans were used to measure PT and LN volumes to calculate SGR and doubling time (DT). The mean PT-SGR was 1.2 ± 2.2%/day and the mean LN-SGR was 1.6 ± 1.9%/day. There was no statistically significant difference between slow-growing and fast-growing cohorts in terms of age, gender, smoking status, tumor subsite, HPV status (as determined with p16 staining), initial volume, or overall stage. SGR had no impact on 2-year overall survival, disease-free survival, or disease-specific survival. We found the average daily growth rates for OPSCC to be 1.2%/day and 1.6%/day. Our findings suggest PT- and LN-SGR are independent factors, not heavily influenced by known biomarkers and patient characteristics, without a statistical impact on prognosis. This information has value in patient counseling regarding tumor growth and in providing patients worried about fast-growing tumors the appropriate reassurance.
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Affiliation(s)
- Nicole I. Farber
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Yimin Li
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 94720, USA (S.R.)
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361005, China
| | - Roberto N. Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Joy Chen
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Zahrah Masheeb
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Machelle Wilson
- Davis-School of Medicine, University of California, Sacramento, CA 94720, USA
| | - Arnaud F. Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Marianne Abouyared
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Shyam Rao
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 94720, USA (S.R.)
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 94720, USA (S.R.)
- Department of Radiation Oncology, Mayo Clinic, Pheonix, AZ 85054, USA
| | - Andrew C. Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
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Janapareddi S, Mansuri S, Khot SN, Jamwal SS, Kanta MK, Sarma SN. Evaluation of the Head and Neck Surgery During the Pandemic COVID-19: A Tertiary Care Center Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S122-S126. [PMID: 37654388 PMCID: PMC10466622 DOI: 10.4103/jpbs.jpbs_434_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 09/02/2023] Open
Abstract
Introduction There is a notable shift in the attitude of the admission, review, diagnostics, and follow-up of patients for all the medical sectors and of particular interest of cancer patients. The present study aimed to elaborate on the identification of patients with head and neck cancers (HNCs); the diagnostics, the triage, and the best treatment plan were all evaluated and at the same time compared with the years before the pandemic at a tertiary care center that caters to various other patients also. Materials and Methods A retrospective observational clinical study was conducted at the tertiary care center that catered to all the medical specialties. The demographics, the patient characteristics, the surgeries performed, complications, mortality, and readmissions were evaluated and compared with the pre-coronavirus disease (COVID) time. Results There was a significant difference in the complications for the pre-COVID time when the groups were compared for the matched pair. Conclusion The proper screening and triaging of the patients will help in the early intervention of the patients with the HNCs.
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Affiliation(s)
- Sreedevi Janapareddi
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Samir Mansuri
- Consultant Oral and Maxillofacial Surgeon, Ahmedabad, Gujarat, India
| | - Sunil N. Khot
- Department of ENT, Government Medical College, Miraj, Maharashtra, India
| | | | - Manoj K. Kanta
- Department of Maxillofacial Surgery, GSL Dental College and Hospital, Rajamahendravaram, Andhra Pradesh, India
| | - Sankar Narayana Sarma
- Department of Periodontics, Government Dental College and Hospital, Kadapa, Andhra Pradesh, India
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Costa AASD, Caldeira PC, Sousa AA, Tibúrcio JD, Belligoli LDQG, Santos VBD, Bretas PMC, Nunes LL, Prado Neto SCD, Silva GW, Soares JMA. Oral and oropharyngeal cancer: time from first symptoms to treatment initiation and associated factors. Braz Oral Res 2023; 37:e054. [PMID: 37255074 DOI: 10.1590/1807-3107bor-2023.vol37.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/19/2022] [Indexed: 06/01/2023] Open
Abstract
The aim of this study was to evaluate the time elapsed from first symptoms to the treatment of oral and oropharyngeal cancer (OOC) and to identify variables associated with treatment delay. This is an observational study with retrospective and prospective data collection. Patients with a diagnosis of OOC seen at the Head and Neck Surgery outpatient clinic of a Brazilian public hospital were included and followed up to treatment initiation. Participants answered a questionnaire for the collection of socioeconomic, demographic, cultural, and clinical information, as well as information about the time elapsed from first symptoms to the first appointment with a head and neck surgeon. Time to treatment was classified into four intervals: 1- first symptoms to first medical appointment; 2- first medical appointment to specialized medical care; 3- specialized medical care to preparation for treatment; and 4- preparation for treatment to treatment initiation. Bivariate statistics were computed. Out of 100 participants, nine died before treatment. Mean time to treatment was 217 days. Highest mean time was observed for interval 2 (94 days), followed by interval 1 (63 days), interval 4 (39 days), and interval 3 (21 days). At interval 1, a longer time was associated with severe alcohol consumption, severe smoking, and family history of cancer. At interval 2, the delay was associated with appointment with a general practitioner, clinical diagnosis of disease other than cancer, and antibiotic prescription. At interval 4, delay in treatment was associated with surgical treatment. Patients with OOC experience delays from symptom onset to treatment initiation. The longest interval was associated with professional delay, followed by patient delay in help-seeking.
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Affiliation(s)
- Adriana Aparecida Silva da Costa
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Pathology and Surgery, Belo Horizonte - MG, Brazil
| | - Patrícia Carlos Caldeira
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Pathology and Surgery, Belo Horizonte - MG, Brazil
| | - Alexandre Andrade Sousa
- Universidade Federal de Minas Gerais - UFMG, Hospital das Clínicas, Instituto Alfa de Gastroenterologia, Belo Horizonte - MG, Brazil
| | | | | | - Viviane Bigodeiro Dos Santos
- Universidade Federal de São João Del-Rey - UFSJ, School of Medicine, Department of Surgery, Divinópolis, MG, Brazil
| | | | - Louise Lanna Nunes
- Universidade Federal de São João Del-Rey - UFSJ, School of Medicine, Department of Surgery, Divinópolis, MG, Brazil
| | | | - Gustavo Waldolato Silva
- Universidade Federal de São João Del-Rey - UFSJ, School of Medicine, Department of Surgery, Divinópolis, MG, Brazil
| | - João Marcos Arantes Soares
- Universidade Federal de São João Del-Rey - UFSJ, School of Medicine, Department of Surgery, Divinópolis, MG, Brazil
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Nguyen J, Takesh T, Parsangi N, Song B, Liang R, Wilder-Smith P. Compliance with Specialist Referral for Increased Cancer Risk in Low-Resource Settings: In-Person vs. Telehealth Options. Cancers (Basel) 2023; 15:2775. [PMID: 37345112 DOI: 10.3390/cancers15102775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/13/2023] [Accepted: 05/13/2023] [Indexed: 06/23/2023] Open
Abstract
Efforts are underway to improve the accuracy of non-specialist screening for oral cancer (OC) risk, yet better screening will only translate into improved outcomes if at-risk individuals comply with specialist referral. Most individuals from low-resource, minority, and underserved (LRMU) populations fail to complete a specialist referral for OC risk. The goal was to evaluate the impact of a novel approach on specialist referral compliance in individuals with a positive OC risk screening outcome. A total of 60 LRMU subjects who had screened positive for increased OC risk were recruited and given the choice of referral for an in-person (20 subjects) or a telehealth (40 subjects) specialist visit. Referral compliance was tracked weekly over 6 months. Compliance was 30% in the in-person group, and 83% in the telehealth group. Approximately 83-85% of subjects from both groups who had complied with the first specialist referral complied with a second follow-up in-person specialist visit. Overall, 72.5% of subjects who had chosen a remote first specialist visit had entered into the continuum of care by the study end, vs. 25% of individuals in the in-person specialist group. A two-step approach that uses telehealth to overcome barriers may improve specialist referral compliance in LRMU individuals with increased OC risk.
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Affiliation(s)
- James Nguyen
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Thair Takesh
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Negah Parsangi
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Bofan Song
- College of Optical Sciences, University of Arizona, Tucson, AZ 85721, USA
| | - Rongguang Liang
- College of Optical Sciences, University of Arizona, Tucson, AZ 85721, USA
| | - Petra Wilder-Smith
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
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Derton A, Guevara M, Chen S, Moningi S, Kozono DE, Liu D, Miller TA, Savova GK, Mak RH, Bitterman DS. Natural Language Processing Methods to Empirically Explore Social Contexts and Needs in Cancer Patient Notes. JCO Clin Cancer Inform 2023; 7:e2200196. [PMID: 37235847 DOI: 10.1200/cci.22.00196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/22/2023] [Accepted: 03/23/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE There is an unmet need to empirically explore and understand drivers of cancer disparities, particularly social determinants of health. We explored natural language processing methods to automatically and empirically extract clinical documentation of social contexts and needs that may underlie disparities. METHODS This was a retrospective analysis of 230,325 clinical notes from 5,285 patients treated with radiotherapy from 2007 to 2019. We compared linguistic features among White versus non-White, low-income insurance versus other insurance, and male versus female patients' notes. Log odds ratios with an informative Dirichlet prior were calculated to compare words over-represented in each group. A variational autoencoder topic model was applied, and topic probability was compared between groups. The presence of machine-learnable bias was explored by developing statistical and neural demographic group classifiers. RESULTS Terms associated with varied social contexts and needs were identified for all demographic group comparisons. For example, notes of non-White and low-income insurance patients were over-represented with terms associated with housing and transportation, whereas notes of White and other insurance patients were over-represented with terms related to physical activity. Topic models identified a social history topic, and topic probability varied significantly between the demographic group comparisons. Classification models performed poorly at classifying notes of non-White and low-income insurance patients (F1 of 0.30 and 0.23, respectively). CONCLUSION Exploration of linguistic differences in clinical notes between patients of different race/ethnicity, insurance status, and sex identified social contexts and needs in patients with cancer and revealed high-level differences in notes. Future work is needed to validate whether these findings may play a role in cancer disparities.
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Affiliation(s)
- Abigail Derton
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
| | - Marco Guevara
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Shan Chen
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Shalini Moningi
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - David E Kozono
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Dianbo Liu
- Mila-Quebec AI Institute, Montreal, QC, Canada
| | - Timothy A Miller
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA
| | - Guergana K Savova
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA
| | - Raymond H Mak
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Danielle S Bitterman
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Wang SJ, Lin B, Shen SY, Lin JL, Zhang TW, Yang HY. Factors associated with follow-up attendance of patients with oral squamous cell carcinoma: A retrospective cohort study. Head Neck 2023; 45:963-971. [PMID: 36827077 DOI: 10.1002/hed.27327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/29/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND This study examined the postoperative follow-up attendance of oral squamous cell carcinoma (OSCC) patients, evaluated some of the factors associated with it, and assessed its relationship with early detection of postoperative disease progression. METHODS An exploratory retrospective cohort study of 430 OSCC patients was conducted. We examined associations of follow-up attendance within the first year after surgery with selected demographic and clinical factors, and with early detection of disease progression. RESULTS The mean number of follow-up visits within the first year after surgery was 3.9 out of the 12 recommended at our center; few patients were fully adherent. Age ≥70 years, unmarried status, high education level, and negative history of surgery for premalignant or malignant lesions from oral cavity or other sites were significantly associated with lower follow-up attendance. Greater follow-up attendance was significantly associated with early detection of disease progression during the first year after surgery (p = 0.025). CONCLUSIONS Adherence to follow-up visits was poor. Several sociodemographic and clinical factors were related to follow-up attendance, greater follow-up attendance was significantly associated with early detection of disease progression, and these should be further explored in future research.
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Affiliation(s)
- Shun-Ji Wang
- Department of Oral and Maxillofacial Surgery, Stomatological Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Guangdong Provincial High-Level Clinical Key Specialty, Shenzhen, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Guangdong Province Engineering Research Center of Oral Disease Diagnosis and Treatment, Shenzhen, Guangdong, China.,The Institute of Stomatology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, China
| | - Bo Lin
- Department of Oral and Maxillofacial Surgery, Stomatological Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Guangdong Provincial High-Level Clinical Key Specialty, Shenzhen, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Guangdong Province Engineering Research Center of Oral Disease Diagnosis and Treatment, Shenzhen, Guangdong, China.,The Institute of Stomatology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, China
| | - Shi-Yue Shen
- Department of Oral and Maxillofacial Surgery, Stomatological Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Guangdong Provincial High-Level Clinical Key Specialty, Shenzhen, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Guangdong Province Engineering Research Center of Oral Disease Diagnosis and Treatment, Shenzhen, Guangdong, China.,The Institute of Stomatology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, China
| | - Jian-Lin Lin
- Department of Oral and Maxillofacial Surgery, Stomatological Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Guangdong Provincial High-Level Clinical Key Specialty, Shenzhen, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Guangdong Province Engineering Research Center of Oral Disease Diagnosis and Treatment, Shenzhen, Guangdong, China.,The Institute of Stomatology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, China
| | - Tian-Wen Zhang
- Department of Oral and Maxillofacial Surgery, Stomatological Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Guangdong Provincial High-Level Clinical Key Specialty, Shenzhen, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Guangdong Province Engineering Research Center of Oral Disease Diagnosis and Treatment, Shenzhen, Guangdong, China.,The Institute of Stomatology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, China
| | - Hong-Yu Yang
- Department of Oral and Maxillofacial Surgery, Stomatological Center, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Guangdong Provincial High-Level Clinical Key Specialty, Shenzhen, Guangdong, China.,Department of Oral and Maxillofacial Surgery, Guangdong Province Engineering Research Center of Oral Disease Diagnosis and Treatment, Shenzhen, Guangdong, China.,The Institute of Stomatology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, China
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Tsutsumi K, Ahmed KH, Goshtasbi K, Torabi SJ, Mohyeldin A, Hsu FPK, Kuan EC. Impact of esthesioneuroblastoma treatment delays on overall patient survival. Laryngoscope 2023; 133:764-772. [PMID: 35460271 DOI: 10.1002/lary.30136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/13/2022] [Accepted: 04/01/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To characterize clinical factors associated with esthesioneuroblastoma treatment delays and determine the impact of these delays on overall survival. STUDY DESIGN Retrospective database analysis. METHODS The 2004-2016 National Cancer Database was queried for patients with esthesioneuroblastoma managed by primary surgery and adjuvant radiation. Durations of diagnosis-to-treatment initiation (DTI), diagnosis-to-treatment end (DTE), surgery-to-RT initiation (SRT), radiotherapy treatment (RTD), and total treatment package (TTP) were analyzed. The cohort was split into two groups for each delay interval using the median time as the threshold. RESULTS A total of 814 patients (39.6% female, 88.5% white) with mean ± SD age of 52.6 ± 15.1 years who underwent both esthesioneuroblastoma surgery and adjuvant radiotherapy were queried. Median DTI, DTE, SRT, RTD, and TTP were 34, 140, 55, 45, and 101 days, respectively. A significant association was identified between increased regional radiation dose above 66 Gy and decreased DTI (OR = 0.54, 95% CI 0.35-0.83, p = 0.01) and increased RTD (OR = 3.94, 95% CI 2.36-6.58, p < 0.001) durations. Chemotherapy administration was linked with decreased SRT (OR = 0.64, 95% CI 0.47-0.89, p = 0.01) and TTP (OR = 0.59, 95% CI 0.43-0.82, p = 0.001) durations. Cox proportional-hazards analysis revealed that increased RTD was associated with decreased survival (HR = 1.80, 95% CI 1.26-2.57, p < 0.005), independent of age, sex, race, regional radiation dose, facility volume, facility type, insurance status, modified Kadish stage, chemotherapy status, Charlson-Deyo comorbidity index, and surgical margins. CONCLUSIONS Delays during, and prolongation of radiotherapy for esthesioneuroblastoma appears to be associated with decreased survival. LEVEL OF EVIDENCE 4 Laryngoscope, 133:764-772, 2023.
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Affiliation(s)
- Kotaro Tsutsumi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Khwaja H Ahmed
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Ahmed Mohyeldin
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA.,Department of Neurological Surgery, University of California, Irvine, California, USA
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Sivaranjini K, Oak A, Cheulkar S, Maheshwari A, Mahantshetty U, Dikshit R. Role of education and income on disparities of time-to-treatment initiation and its impact on cervical cancer survival. Indian J Public Health 2023; 67:235-239. [PMID: 37459018 DOI: 10.4103/ijph.ijph_1299_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Background In India, cervical cancer is the second-leading cause of cancer incidence among women. Socioeconomic factors play a vital role in cervical cancer survival. Objectives This study assessed the role of education and income on disparities in time-to-treatment initiation (TTI) and its impact on cervical cancer survival. Materials and Methods This was a retrospective facility-based record study conducted among newly treated cervical cancer patients registered in a tertiary medical care center in Mumbai between 2014 and 2016. Adjusted hazard ratio with a 95% confidence interval was reported. Results In total, 1947 cervical cancer patients with a mean age of 52.89 (±10.55) years were included. The average number of days for TTI among highly educated patients was 27 versus 35 days for patients with no formal education. An increasing trend in survival was observed as education levels shift from no formal to higher education category (75.54%, 77.30%, and 85.10%, P = 0.01). All cause mortality was lower in cervical cancer patients with secondary education and above than illiterates (hazard ratio [HR] = 0.63, P < 0.01), among those with higher income (HR = 0.78, P = 0.04) than lower income and among who started on treatment within 30 days (HR = 0.90, P = 0.29) than patients who started treated after 30 days. Conclusions Inferior survival is found for cervical cancer patients with lower education and income and who initiated treatment after 30 days. Hence, it is important to improve awareness and screening activities, especially among the lower socioeconomic groups, for early diagnosis and better treatment outcomes.
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Affiliation(s)
- K Sivaranjini
- Medical Officer-D, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Maharashtra, India
| | - Amey Oak
- Medical Officer-D, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Maharashtra, India
| | - Sandhya Cheulkar
- Scientific Assistant - E, Division of HBCR and POCSS, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Maharashtra, India
| | - Amita Maheshwari
- Professor and Head, Division of Gynaec Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Maharashtra, India
| | - Umesh Mahantshetty
- Director, Professor, Division of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Visakhapatnam, Andhra Pradesh, India
| | - Rajesh Dikshit
- Director, Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, Maharashtra, India
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40
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Ryu JH, Rahman J, Deo S, Flint M. Effects of time to treatment initiation on outcomes for soft tissue sarcomas. J Surg Oncol 2023; 127:1174-1186. [PMID: 36939055 DOI: 10.1002/jso.27237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Few studies have investigated the effects of time to treatment initiation (TTI) for soft tissue sarcomas (STS). Our objective was to investigate the risk factors for prolonged TTI and the effects of prolonged TTI on local recurrence free survival (LRFS), distant metastasis free survival (DMFS), and disease specific survival (DSS). METHOD Patients diagnosed with high-grade STS of the extremities and trunk from 2011 to 2020 were included. TTI was grouped into two groups (treatment provided in less than vs. more than or equal to 30 days). Two-year and 5-year survival probabilities were calculated for LRFS, DMFS, and DSS. Cox regression and Kruskal-Wallis tests in univariate analysis were conducted to find risk factors affecting TTI and the survival outcomes. RESULTS In the univariate analysis, diagnosis in the later 5-year period of the study, tumor size, and treatment modality were associated with prolonged TTI. TTI ≥30 days was associated with higher DMFS but no association was found with LRFS or DSS. Tumor size, surgical margins, and provision of surgery were associated with DSS. CONCLUSION Despite the delay in treatment for STS patients caused by the COVID-19 pandemic, our study showed TTI of more than 30 days does not negatively impact patients.
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Affiliation(s)
- Jae Hong Ryu
- Department of Orthopaedic Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Juma Rahman
- Research and Evaluation Office, Counties Manukau Health, Auckland, New Zealand
| | - Shaneel Deo
- Department of Orthopaedic Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Michael Flint
- Department of Orthopaedic Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
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Atula M, Aro K, Irjala H, Halme E, Jouppila-Mättö A, Koivunen P, Wilkman T, Blomster H, Mäkitie A, Atula T. Patient and health care delays in large (class T3-T4) oral, oropharyngeal, and laryngeal carcinomas. Head Neck 2023; 45:1215-1225. [PMID: 36880833 DOI: 10.1002/hed.27335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/16/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Head and neck cancers (HNCs) are often diagnosed at an advanced stage. We investigated the lengths and factors associated with patient, primary health care (PHC), and specialist care (SC) delays in T3-T4 oral, oropharyngeal, and laryngeal cancer. METHODS A nationwide prospective questionnaire-based study (n = 203) with the 3-year long data collection period. RESULTS The median patient, PHC and SC delays were 58, 13, and 43 days, respectively. Lower level of education, heavy alcohol use, hoarseness, difficulties breathing, and eventual palliative treatment associated with a longer patient delay. A lump on the neck or facial swelling associated with a shorter PHC delay. Conversely, if symptoms were treated as an infection, PHC delay was longer. The treatment modality and tumor site affected SC delay. CONCLUSIONS Patient delay stands as the most notable factor contributing to delays before treatment. HNC symptom awareness thus remains especially important among HNC risk groups.
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Affiliation(s)
- Markus Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Heikki Irjala
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Elina Halme
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Anna Jouppila-Mättö
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Petri Koivunen
- Department of Otorhinolaryngology - Head and Neck Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tommy Wilkman
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Henry Blomster
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Clinical Sciences, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Juan YC, Su YF, Bai CH, Fan YC, Kuo TT, Ko HH, Peng HH, Chiang CP, Fwu CW, Cheng SJ. ZNF582 hypermethylation as a prognostic biomarker for malignant transformation of oral lesions. Oral Dis 2023; 29:505-514. [PMID: 34145953 DOI: 10.1111/odi.13946] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/12/2021] [Accepted: 06/05/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This hospital-based cohort study evaluated whether ZNF582 and PAX1 methylation levels at baseline can be used as biomarkers to identify lesions with a high potential for malignant transformation in patients with normal mucosa and oral potentially malignant disorders. PATIENTS AND METHODS We recruited 171 adult patients with normal mucosa and oral potentially malignant disorders in 2012-2014. They were followed until 2017. Outcomes, including advanced histopathological findings and oral cancer occurrence, were obtained from medical charts, the Taiwan Cancer Registry, and cause-of-death data. Kaplan-Meier analysis and Cox proportional hazards regression models were used to examine the association of ZNF582 and PAX1 methylation levels at baseline with subsequent outcome occurrences. RESULTS After 260,192 days of follow-up, 11 cases of oral cancer and 4 cases of advanced histopathological progression occurred. Patients with higher ZNF582 and PAX1 methylation levels at baseline had a higher incidence of disease progression. After adjustment for all studied factors using Cox proportional hazards regression models, ZNF582m level (adjusted hazard ratio, 11.41; 95% CI, 2.05-63.36; p = 0.005) was the only significant and independent predictor of disease progression. CONCLUSIONS ZNF582 hypermethylation can be an effective and noninvasive biomarker for identifying oral lesions with a high potential for malignant transformation.
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Affiliation(s)
- Yi-Chen Juan
- iStat Biomedical Co., Ltd., New Taipei City, Taiwan
| | - Yee-Fun Su
- iStat Biomedical Co., Ltd., New Taipei City, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yen-Chun Fan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Tung Kuo
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hui-Hsin Ko
- School of Dentistry, Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, College of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Hsin-Hui Peng
- School of Dentistry, Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, College of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chun-Pin Chiang
- School of Dentistry, Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | | | - Shih-Jung Cheng
- School of Dentistry, Graduate Institute of Clinical Dentistry, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.,School of Dentistry, National Taiwan University, Taipei, Taiwan
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Vieira CM, Diniz PHC, Dizon DS, Nogueira-Rodrigues A. Patient navigation (PN) support to timely access to radiotherapy in the Brazilian public health system. Support Care Cancer 2023; 31:182. [PMID: 36820917 DOI: 10.1007/s00520-023-07615-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/19/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Patient navigation (PN) is a community-based service delivery intervention designed to promote access to timely diagnosis and treatment of cancer and other chronic diseases by eliminating barriers to integral care. Considering the complex difficulties in accessing treatment and the positive results of PN in high-income countries, our group decided to evaluate this tool to improve radiotherapy (RT) access in the public system in Brazil. PATIENTS AND METHODS This pilot study took place in a public school hospital, with a historical cohort as the control arm. The primary endpoint was the time from histologic diagnosis and RT initiation among cancer patients receiving RT with curative intent in a PN program. The secondary objectives were the following time frames: referral to the first consultation by the RT team; first consultation up to RT beginning; RT beginning to RT end; referral to the end of RT and identifying/describing obstacles to the treatment; and assessing patient satisfaction with PN program. RESULTS A total of 124 patients were included in the retrospective arm and 73 in the navigation arm. Most had the loco-regionally advanced disease from the esophagus, head/neck, and rectum. PN decreased the median time from the biopsy result to the beginning of RT from 108 to 74 days (p < 0.001). PN reduced the time between biopsy results and referral to RT (53 to 40.5 days, p = 0.011), between the referral and the first consultation in the RT (25 to 13 days, p < 0.001), and between the referral to the end of the RT (98 to 78 days, p < 0.003). CONCLUSIONS Proper identification of barriers, especially in a low-resource setting, is mandatory to guide PN programs in LMICs. In an oncological context of socioeconomic vulnerability, PN is a financially viable and efficient tool to optimize access to timely RT.
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Affiliation(s)
- Carolina M Vieira
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 30130100, Brazil.
| | - Paulo H C Diniz
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, 30130100, Brazil
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Nguyen J, Yang S, Melnikova A, Abouakl M, Lin K, Takesh T, Wink C, Le A, Messadi D, Osann K, Wilder-Smith P. Novel Approach to Improving Specialist Access in Underserved Populations with Suspicious Oral Lesions. Curr Oncol 2023; 30:1046-1053. [PMID: 36661729 PMCID: PMC9858229 DOI: 10.3390/curroncol30010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/10/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
Late detection and specialist referral result in poor oral cancer outcomes globally. High-risk LRMU populations usually do not have access to oral medicine specialists, a specialty of dentistry, whose expertise includes the identification, treatment, and management of oral cancers. To overcome this access barrier, there is an urgent need for novel, low-cost tele-health approaches to expand specialist access to low-resource, remote and underserved individuals. The goal of this study was to compare the diagnostic accuracy of remote versus in-person specialist visits using a novel, low-cost telehealth platform consisting of a smartphone-based, remote intraoral camera and custom software application. A total of 189 subjects with suspicious oral lesions requiring biopsy (per the standard of care) were recruited and consented. Each subject was examined, and risk factors were recorded twice: once by an on-site specialist, and again by an offsite specialist. A novel, low-cost, smartphone-based intraoral camera paired with a custom software application were utilized to perform synchronous remote video/still imaging and risk factor assessment by the off-site specialist. Biopsies were performed at a later date following specialist recommendations. The study's results indicated that on-site specialist diagnosis showed high sensitivity (94%) and moderate specificity (72%) when compared to histological diagnosis, which did not significantly differ from the accuracy of remote specialist telediagnosis (sensitivity: 95%; specificity: 84%). These preliminary findings suggest that remote specialist visits utilizing a novel, low-cost, smartphone-based telehealth tool may improve specialist access for low-resource, remote and underserved individuals with suspicious oral lesions.
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Affiliation(s)
- James Nguyen
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Susan Yang
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Anastasya Melnikova
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Mary Abouakl
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Kairong Lin
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Thair Takesh
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Cherie Wink
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
| | - Anh Le
- Department of Oral and Maxillofacial Surgery/Pharmacology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Diana Messadi
- UCLA School of Dentistry, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Kathryn Osann
- School of Medicine, University of California Irvine, Irvine, CA 92617, USA
| | - Petra Wilder-Smith
- Beckman Laser Institute and Medical Clinic, University of California Irvine School of Medicine, Irvine, CA 92612, USA
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Farnum A, Parnas M, Hoque Apu E, Cox E, Lefevre N, Contag CH, Saha D. Harnessing insect olfactory neural circuits for detecting and discriminating human cancers. Biosens Bioelectron 2023; 219:114814. [PMID: 36327558 DOI: 10.1016/j.bios.2022.114814] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
There is overwhelming evidence that presence of cancer alters cellular metabolic processes, and these changes are manifested in emitted volatile organic compound (VOC) compositions of cancer cells. Here, we take a novel forward engineering approach by developing an insect olfactory neural circuit-based VOC sensor for cancer detection. We obtained oral cancer cell culture VOC-evoked extracellular neural responses from in vivo insect (locust) antennal lobe neurons. We employed biological neural computations of the antennal lobe circuitry for generating spatiotemporal neuronal response templates corresponding to each cell culture VOC mixture, and employed these neuronal templates to distinguish oral cancer cell lines (SAS, Ca9-22, and HSC-3) vs. a non-cancer cell line (HaCaT). Our results demonstrate that three different human oral cancers can be robustly distinguished from each other and from a non-cancer oral cell line. By using high-dimensional population neuronal response analysis and leave-one-trial-out methodology, our approach yielded high classification success for each cell line tested. Our analyses achieved 76-100% success in identifying cell lines by using the population neural response (n = 194) collected for the entire duration of the cell culture study. We also demonstrate this cancer detection technique can distinguish between different types of oral cancers and non-cancer at different time-matched points of growth. This brain-based cancer detection approach is fast as it can differentiate between VOC mixtures within 250 ms of stimulus onset. Our brain-based cancer detection system comprises a novel VOC sensing methodology that incorporates entire biological chemosensory arrays, biological signal transduction, and neuronal computations in a form of a forward-engineered technology for cancer VOC detection.
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Affiliation(s)
- Alexander Farnum
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Michael Parnas
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Ehsanul Hoque Apu
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA; Division of Hematology and Oncology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, 48108, USA
| | - Elyssa Cox
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Noël Lefevre
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Christopher H Contag
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA; Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA
| | - Debajit Saha
- Department of Biomedical Engineering and the Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA.
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Irace AL, Sharma RK, Smith TL, Stewart MG, Gudis DA. Impact of Medicaid Expansion on Rhinologic Cancer Presentation, Treatment, and Outcomes. Laryngoscope 2023; 133:43-50. [PMID: 35147223 DOI: 10.1002/lary.30049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/11/2022] [Accepted: 01/22/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The United States Patient Protection and Affordable Care Act allocated funds for states to expand Medicaid coverage. However, several states declined expansion. We aim to determine whether Medicaid expansion is associated with healthcare coverage, cancer stage at diagnosis, treatment, and survival among patients with rhinologic cancer. Rhinologic cancer was defined to include cancer of the nasal cavity, paranasal sinus, nasopharynx, or olfactory nerve. STUDY DESIGN Cohort study. METHODS Patients diagnosed with primary rhinologic malignancies between 2007 to 2016 were extracted from the National Cancer Institute Surveillance, Epidemiology, End Results (SEER) registry. Patients were grouped by diagnosis before and after 2014 (when Medicaid expansion became effective) and whether their state had expanded Medicaid. Multivariable logistic regression controlling for age, sex, race, ethnicity, and income/education was utilized to examine associations between Medicaid expansion/insurance status and stage at diagnosis, treatment, and survival. Overall and disease-specific survival were examined using Kaplan-Meier analysis. RESULTS Analysis included 10,164 patients. The proportion of uninsured patients decreased after 2014 (2.4%) compared to before 2014 (4.8%, P < .001). After 2014, patients in nonexpanded states were more likely to be diagnosed with advanced stage disease compared to patients in expanded states (N = 2,364; OR = 1.27, 95% CI 1.01-1.60). Being uninsured in any state was associated with advanced stage disease at diagnosis (OR = 1.75, 95% CI 1.41-2.22) and increased risk of disease-specific death (HR = 1.54, 95% CI 1.32-1.82). Survival measures were not associated with diagnosis before versus after 2014 or Medicaid expansion. CONCLUSIONS Patients lacking insurance or residing in nonexpanded states may be more likely to present with advanced stage rhinologic cancer. Longitudinal studies should validate these findings. LEVEL OF EVIDENCE 3 Laryngoscope, 133:43-50, 2023.
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Affiliation(s)
- Alexandria L Irace
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Rahul K Sharma
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Sinus Center, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Michael G Stewart
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, U.S.A
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Meltzer C, Nguyen NT, Zhang J, Aguilar J, Blatchins MA, Quesenberry CP, Wang Y, Sakoda LC. Survival Associated With Consolidated Multidisciplinary Care in Head and Neck Cancer: A Retrospective Cohort Study. Otolaryngol Head Neck Surg 2023; 168:82-90. [PMID: 34752163 DOI: 10.1177/01945998211057852] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/12/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare survival among patients with head and neck cancer before and after implementing a weekly multidisciplinary clinic and case conference. METHODS A retrospective cohort study with chart review was conducted of 3081 patients (1431 preimplementation, 1650 postimplementation) diagnosed with stage I-IVB tumors in the oral cavity, oropharynx, hypopharynx, nasopharynx, or larynx. Pre- and postimplementation differences in overall and disease-specific survival 1, 2, and 3 years after diagnosis were assessed with unadjusted Kaplan-Meier curves and multivariable Cox proportional hazard regression models adjusted for demographic characteristics, comorbidity burden, smoking status, tumor site and stage, p16 status for oropharyngeal squamous cell cancer, and initial treatment modality. RESULTS Patients less commonly presented with oropharyngeal squamous cell cancer and advanced tumors (III-IVB) and received primary treatment with surgery alone or with adjuvant therapy preimplementation than postimplementation. Overall survival at 3 years was 77.1% and 79.9% (P = .07) and disease-specific survival was 84.9% and 87.5% (P = .05) among pre- and postimplementation patients, respectively. At 3 years, preimplementation patients had slightly poorer overall (hazard ratio, 1.20; 95% CI, 1.02-1.40) and disease-specific (hazard ratio, 1.26; 95% CI, 1.03-1.54) adjusted survival than postimplementation patients. In unadjusted and adjusted analyses, survival improvements were more pronounced among patients with advanced disease. DISCUSSION A multidisciplinary clinic and case conference were associated with improved outcomes among patients with head and neck cancer, especially those with advanced tumors. IMPLICATIONS FOR PRACTICE All patients with head and neck cancer should receive multidisciplinary team management, especially those with advanced tumors.
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Affiliation(s)
- Charles Meltzer
- Department of Head and Neck Surgery, The Permanente Medical Group, Santa Rosa, California, USA
| | - Nathalie T Nguyen
- Department of Radiation Oncology, The Permanente Medical Group, Rancho Cordova, California, USA
| | - Jie Zhang
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jillian Aguilar
- Department of Radiation Oncology, The Permanente Medical Group, Rancho Cordova, California, USA
| | - Maruta A Blatchins
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Charles P Quesenberry
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Yan Wang
- Department of Pathology, The Permanente Medical Group, Roseville, California, USA
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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Cao Y, Fabre V, Anderson R, Bova G, Souranis AN, Briner V, Kleinberg LR, Han-Oh S, Wright JL, Viswanathan AN. From Alpha to Omicron: A Radiation Oncology Network's Biocontainment-Based COVID-19 Experience. Adv Radiat Oncol 2023; 8:101094. [PMID: 36311821 PMCID: PMC9597568 DOI: 10.1016/j.adro.2022.101094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/27/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose To develop the safest possible environment for treating urgent patients with COVID-19 requiring radiation, we describe the unique construction of negative air pressure computed tomography simulator and linear accelerator treatment vaults in addition to screening, delay, and treatment protocols and their evolution over the course of the COVID-19 pandemic. Methods and Materials Construction of large high-efficiency particulate air filter air-flow systems into existing ductwork in computed tomography simulator rooms and photon and proton treatment vaults was completed to create negative-pressure rooms. An asymptomatic COVID-19 screening protocol was implemented for all patients before initiation of treatment. Patients could undergo simulation and/or treatment in the biocontainment environments according to a predefined priority scale and protocol. Patients treated under the COVID-19 protocol from June 2020 to January 2022 were retrospectively reviewed. Results Negative air-flow environments were created across a regional network, including a multi-gantry proton therapy unit. In total, 6525 patients were treated from June 2020 through January 2022 across 5 separate centers. The majority of patients with COVID-19 had radiation treatment deferred when deemed safe. A total of 42 patients with COVID-19, who were at highest risk of an adverse outcome should there be a radiation delay, were treated under the COVID-19 biocontainment protocol in contrast to those who were placed on treatment break. For 61.9% of patients, these safety measures mitigated an extended break during treatment. The majority of patients (64.3%) were treated with curative intent. The median number of biocontainment sessions required by each patient was 6 (range, 1-15) before COVID-19 clearance and resumption of treatment in a normal air-flow environment. Conclusions Constructing negative-pressure environments and developing a COVID-19 biocontainment treatment protocol allowed for the safe treatment of urgent radiation oncology patients with COVID-19 within our department and strengthens future biopreparedness. These biocontainment units set a high standard of safety in radiation oncology during the current or for any future infectious outbreak.
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Affiliation(s)
- Yilin Cao
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Valeria Fabre
- Department of Medicine – Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Roberta Anderson
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregory Bova
- Johns Hopkins Health System, Baltimore, Maryland
| | - Annette N. Souranis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Valerie Briner
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lawrence R. Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah Han-Oh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean L. Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Akila N. Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland,Corresponding author: Akila N. Viswanathan, MD, MPH
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Pietruszewska W, Burduk P, Rosiak O, Podlawska P, Zakrzewski B, Barańska M, Kowalczyk M, Piątkowski J, Śmigielski G, Solarz P, Staszak M, Wierzbicka M, Mikaszewski B. Impact of COVID-19 on Head and Neck Cancer Advancement Measured by Increasing Numbers of Urgent Dyspnea Cases-What Could Be Improved in the Event of Subsequent Pandemics? J Clin Med 2022; 11:6385. [PMID: 36362613 PMCID: PMC9659278 DOI: 10.3390/jcm11216385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 08/26/2023] Open
Abstract
The COVID-19 pandemic has altered all aspects of the healthcare system's organization and impacted patients with head and neck cancer (HNC) who have experienced delayed diagnosis and treatment. The pandemic resulted in the admission of patients with severe dyspnea and a need for tracheotomy due to extremely advanced HNC. This study's objective was to evaluate the clinical characteristics of two multi-center cohorts, "pre-COVID-19" and "COVID-19", of HNC patients admitted as emergencies for dyspnea. The therapeutic activity of HNC patients in four University Departments of Otolaryngology was studied over two time periods: September-February 2019/2020 and 2020/2021. A group of 136 HNC patients who underwent a tracheotomy in two-time cohorts, pre-COVID-19 (N = 59) and COVID-19 (N = 77), was analyzed. The mean tracheotomies incidence proportion was 1.82 (SD: 1.12) for the pre-COVID-19 and 3.79 (SD: 2.76) for COVID-19 period. A rise in the occurrence of emergency dyspnea was observed in the COVID-19 cohort, and the greatest increase was seen in the centers with the highest limitations on planned surgeries. In the pre-COVID-19 period, 66% of patients presented with symptoms for more than a month in comparison to 78% of patients in the COVID-19 period (p = 0.04). There was a higher incidence of laryngeal and laryngopharyngeal cancer in the COVID-19 period (63% vs. 75%, respectively). The number of tracheotomies performed under general anesthesia dropped in favor of local anesthesia during COVID-19 (64% vs. 56%, respectively) due to extremely advanced HNC. In the COVID-19 cohort, most patients received a telemedicine consultation (N = 55, 71%) in comparison to the pre-COVID-19 period (N = 14, 24%). Reorganization of the referral system, adjustment of treatment capacity for an increased number of HNC, and a reserve for more extensive resection and reconstruction surgeries should be made in the profile of otorhinolaryngological departments, ensuring future HNC treatment is not hampered in case of a new pandemic wave.
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Affiliation(s)
- Wioletta Pietruszewska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, 22 Kopcińskiego Str., 90-153 Lodz, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 75 Ujejskiego, 85-168 Bydgoszcz, Poland
| | - Oskar Rosiak
- Balance Disorder Unit, Department of Otolaryngology, Medical University of Lodz, 22 Kopcińskiego Str., 90-153 Lodz, Poland
| | - Paulina Podlawska
- Department of Otolaryngology and Laryngological Oncology, University of Medical Sciences, 49 Przybyszewskiego Str., 60-357 Poznań, Poland
| | - Bartosz Zakrzewski
- Department of Otolaryngology and Laryngological Oncology, University of Medical Sciences, 49 Przybyszewskiego Str., 60-357 Poznań, Poland
| | - Magda Barańska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, 22 Kopcińskiego Str., 90-153 Lodz, Poland
| | - Magdalena Kowalczyk
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, 22 Kopcińskiego Str., 90-153 Lodz, Poland
| | - Jakub Piątkowski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego, 80-214 Gdańsk, Poland
| | - Grzegorz Śmigielski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego, 80-214 Gdańsk, Poland
| | - Paweł Solarz
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 75 Ujejskiego, 85-168 Bydgoszcz, Poland
| | - Marta Staszak
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 75 Ujejskiego, 85-168 Bydgoszcz, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, University of Medical Sciences, 49 Przybyszewskiego Str., 60-357 Poznań, Poland
- Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479 Poznan, Poland
| | - Bogusław Mikaszewski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego, 80-214 Gdańsk, Poland
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ENT Emergencies During the First Wave of the COVID-19 Pandemic at the Mohammed VI Hospital in Marrakech: Comparative Study Between Pre-and During COVID Pandemic in ENT Department. Indian J Otolaryngol Head Neck Surg 2022; 74:3333-3336. [PMID: 36267487 PMCID: PMC9568947 DOI: 10.1007/s12070-022-03146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 08/19/2022] [Indexed: 11/07/2022] Open
Abstract
The rapid global spreading of SARS-CoV2 virus had triggered a state of alert in health systems imposing safety measures to limit its spreading. The aim of our study is to compare the number and type of emergency admissions in our university hospital between the first wave of COVID-19 pandemic and the same period of the previous year. A decrease in the number of patients and the nature of pathologies admitted to the emergency room during the COVID-19 pandemic. This study highlights that the Covid 19 epidemic and the containment have largely reduced the influx of patients treated in the ENT university emergency department of Marrakech, thus demonstrating that level 2 regional hospitals can take care of the majority of ENT emergencies and leave access to the level 3 university hospital to patients requiring heavy and multidisciplinary management.
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