|
1
|
Oglesby KR, Warren JD, McKee E, Rose A, Liddell PH, Jefferson GD, Paul O, Jackson LL, Kane AC. Survival Outcomes of Total Laryngectomy: Evaluating the Intersection of Race and Social Determinants. Laryngoscope 2025; 135:716-722. [PMID: 39352062 DOI: 10.1002/lary.31802] [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: 05/03/2024] [Revised: 08/19/2024] [Accepted: 09/13/2024] [Indexed: 10/03/2024]
Abstract
OBJECTIVE Analyze joint effects of race and social determinants on survival outcomes for patients undergoing total laryngectomy for advanced or recurrent laryngeal cancer at a tertiary care institute. METHODS Retrospective chart review of adult patients undergoing total laryngectomy for laryngeal cancer at a tertiary care center from 2013 to 2020. Extracted data included demographics, pathological staging and features, treatment modalities, and outcomes such as recurrence, fistula formation, and 2- and 5-year disease-free survival (DFS) and overall survival (OS). Area Deprivation Index (ADI) was calculated for each patient. RESULTS Among 185 patients identified, 113 were Black (61.1%) and 69 were White (37.3%). No significant differences were observed between racial groups regarding age, gender, ADI, or cancer stage. There was no significant difference in 2-year DFS/OS between groups. ADI was comparable between racial groups, with the majority in the highest deprivation quintile (63.8% of Whites vs. 62.5% of Blacks). No significant differences were observed in gender, race, cancer stage, positive margins, extracapsular extension, or smoking status among ADI quintiles. We observed a significant difference in 2-year DFS stratified by ADI (p = 0.025). Stratifying by ADI and race revealed improved survival of White patients in lower quintiles but higher survival of Black patients in the highest disparity quintile (p = 0.013). CONCLUSION Overall, survival outcomes by race were comparable among laryngectomy patients, but there was a significant difference in 2-year DFS when stratified by ADI. Further research into survival outcomes related to social determinants is needed to better delineate their effects on head and neck cancer outcomes. LEVEL OF EVIDENCE 3 Laryngoscope, 135:716-722, 2025.
Collapse
Affiliation(s)
- Kacie R Oglesby
- Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - James D Warren
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Elizabeth McKee
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Alexandra Rose
- Department of Otolaryngology - Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Peter H Liddell
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Gina D Jefferson
- Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Oishika Paul
- Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Lana L Jackson
- Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anne C Kane
- Department of Otolaryngology-Head & Neck Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| |
Collapse
|
|
2
|
Nguyen HH, Gupta I, Cellini A, Papadimitriou JC, Mehra R, Gaykalova DA, Witek ME. Comprehensive Analysis Reveals No Significant Correlation Between p16/CDKN2A Expression and Treatment Outcomes in Laryngeal Squamous Cell Carcinoma. Head Neck 2024. [PMID: 39714101 DOI: 10.1002/hed.28044] [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: 07/25/2024] [Revised: 11/16/2024] [Accepted: 12/10/2024] [Indexed: 12/24/2024] Open
Abstract
BACKGROUND The p16/CDKN2A protein is being explored as an independent prognostic marker in laryngeal cancer, with studies suggesting that p16-positive patients may have a better prognosis. While its role is well-established in oropharyngeal squamous cell carcinoma (OPSCC) related to HPV, ongoing research indicates its potential prognostic value in laryngeal cancer, even in HPV-negative cases. METHODS In this study, we investigated the association between survival outcomes and p16 expression in a cohort of 310 laryngeal cancer patients from the Cancer Genome Atlas (TCGA) Program and the University of Maryland Medical Center (UMMC). RESULTS In the TCGA cohort, patients with high p16 protein expression had a significantly higher probability of disease-free survival (DFS) at 89%, compared to 51% in the low p16 protein group (p = 0.0266). Additionally, the mean relative p16 protein expression decreased significantly with advancing TNM stage, measured at 1.116 for stage II, 1.075 for stage III, and 0.6204 for stage IV (p = 0.7871 for stage II vs. stage III, p = 0.0065 for stage III vs. stage IV, p = 0.0031 for stage I vs. stage IV). Protein expression for p16 also correlated with CDKN2A retention/deletion status (p = 0.0077), where the DFS was higher in patients with retained CDKN2A than those with deleted CDKN2A (p = 0.0187). Multivariate analysis of the UMMC and TCGA cohorts revealed that both an increase in the patient's age and higher T stage significantly increased the risk of mortality (p = 0.05, p = 0.01, respectively). CONCLUSION While this study observes trends suggesting that low p16 protein expression is associated with longer DFS and advanced TNM stage in laryngeal cancer, the multivariate analysis did not establish p16 as an independent prognostic factor. These findings suggest that while p16 may have a biological role in tumor progression, its utility as a standalone prognostic marker in clinical outcomes requires further validation.
Collapse
Affiliation(s)
| | - Ishita Gupta
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Marlene & Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ashley Cellini
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John C Papadimitriou
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ranee Mehra
- Department of Medical Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Daria A Gaykalova
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Marlene & Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew E Witek
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Medstar Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
|
3
|
Ferraro T, Ahmed AK, Niermeyer WL, Lee E, Thakkar P, Joshi AS, Sataloff RT. Racial Disparities in 30 Day Outcomes Following Total Laryngectomy. EAR, NOSE & THROAT JOURNAL 2024:1455613241298094. [PMID: 39529407 DOI: 10.1177/01455613241298094] [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: 11/16/2024] Open
Abstract
BACKGROUND Despite the growing literature on racial disparities in the utilization of total laryngectomy (TL), and survival following the treatment of laryngeal cancers, there is a paucity of research in TL cohorts evaluating disparities in the immediate postoperative setting. METHODS In a national multi-institutional cohort, TL cases between 2010 and 2021 were identified using relevant Current Procedural Terminology (CPT) codes. Logistic regression analyses investigated the association between race/ethnicity and adverse outcomes within 30 days postoperatively. RESULTS This study consisted of 1493 patients who underwent TL with or without radical neck dissection. Black patients underwent free flap and pedicled flap reconstruction more frequently than their counterparts (P = .023) and exhibited a 1.532 times higher odds of surgical complications (P < .001). CONCLUSIONS There are increased rates of surgical complications in Black patients undergoing TL. Given the limited oncologic and socioeconomic variables available through National Surgical Quality Improvement Program, future study of disparate postoperative outcomes in this population is recommended.
Collapse
Affiliation(s)
- Tatiana Ferraro
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Abdulla K Ahmed
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Weston L Niermeyer
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Esther Lee
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Punam Thakkar
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Arjun S Joshi
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Robert T Sataloff
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| |
Collapse
|
|
4
|
Kim YE, Serpedin A, Periyakoil P, German D, Rameau A. Sociodemographic reporting in videomics research: a review of practices in otolaryngology - head and neck surgery. Eur Arch Otorhinolaryngol 2024; 281:6047-6056. [PMID: 38704768 DOI: 10.1007/s00405-024-08659-0] [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: 02/19/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To assess reporting practices of sociodemographic data in Upper Aerodigestive Tract (UAT) videomics research in Otolaryngology-Head and Neck Surgery (OHNS). STUDY DESIGN Narrative review. METHODS Four online research databases were searched for peer-reviewed articles on videomics and UAT endoscopy in OHNS, published since January 1, 2017. Title and abstract search, followed by a full-text screening was performed. Dataset audit criteria were determined by the MINIMAR reporting standards for patient demographic characteristics, in addition to gender and author affiliations. RESULTS Of the 57 studies that were included, 37% reported any sociodemographic information on their dataset. Among these studies, all reported age, most reported sex (86%), two (10%) reported race, and one (5%) reported ethnicity and socioeconomic status. No studies reported gender. Most studies (84%) included at least one female author, and more than half of the studies (53%) had female first/senior authors, with no significant differences in the rate of sociodemographic reporting in studies with and without female authors (any female author: p = 0.2664; first/senior female author: p > 0.9999). Most studies based in the US reported at least one sociodemographic variable (79%), compared to those in Europe (24%) and in Asia (20%) (p = 0.0012). The rates of sociodemographic reporting in journals of different categories were as follows: clinical OHNS: 44%, clinical non-OHNS: 40%, technical: 42%, interdisciplinary: 10%. CONCLUSIONS There is prevalent underreporting of sociodemographic information in OHNS videomics research utilizing UAT endoscopy. Routine reporting of sociodemographic information should be implemented for AI-based research to help minimize algorithmic biases that have been previously demonstrated. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Yeo Eun Kim
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, 240 East 59th St, New York, NY, 10022, USA
| | - Aisha Serpedin
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, 240 East 59th St, New York, NY, 10022, USA
| | - Preethi Periyakoil
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, 240 East 59th St, New York, NY, 10022, USA
| | - Daniel German
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, 240 East 59th St, New York, NY, 10022, USA
| | - Anaïs Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, 240 East 59th St, New York, NY, 10022, USA.
| |
Collapse
|
|
5
|
Zaker A, Peyvandi A, Fazli M, Bazgir N, Vakili K, Fathi M, Mokhtarinejad F, Rahmani Z, Gachkar L, Khajavi M. Investigating the Incidence and Risk Factors of Hypocalcemia After Laryngectomy. Indian J Otolaryngol Head Neck Surg 2024; 76:4096-4101. [PMID: 39376360 PMCID: PMC11455825 DOI: 10.1007/s12070-024-04790-w] [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: 04/14/2024] [Accepted: 06/01/2024] [Indexed: 10/09/2024] Open
Abstract
Background Laryngeal cancer is a common advanced head and neck cancer. Surgery, radiation, chemotherapy, or a combination of these treatments are used to treat locally advanced laryngeal cancer. Total laryngectomy is generally preferred for T3-4 laryngeal cancers, despite being an invasive procedure. Post-surgical hypocalcemia is a known complication of neck compartment surgeries, and patients who have undergone laryngectomy are at a higher risk of developing hypoparathyroidism, leading to hypocalcemia. This study aims to investigate the prevalence and risk factors of hypocalcemia in individuals following laryngectomy. Method This retrospective study examined 50 consecutive laryngectomy patients over eight years. Data on demographic characteristics, medical history, surgical details, pre-and post-operative calcium levels, neck dissection laterality, history of radiotherapy were collected. Hypocalcemia was defined as calcium levels < 8.5 mg/dl or corrected calcium < 8.5 mg/dl. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and binary logistic regression using R studio. Results The mean age of participants was 59 years, predominating males (94%) and habitual smokers (94%). Squamous cell carcinoma was the most prevalent (98%) pathological diagnosis, and various surgical techniques were employed. While initial comparisons showed no significant changes in calcium levels pre-and post-operatively, adjusting for albumin levels revealed a significant association. Logistic regression identified neck dissection, low pre-operative calcium, radiotherapy, and total thyroidectomy as significant predictors of post-operative hypocalcemia (p < 0.05). Conclusion Surgical factors such as neck dissection and total thyroidectomy, alongside albumin levels, significantly impact postoperative hypocalcemia. These findings underscore the need for meticulous monitoring and potential preventive measures to manage calcium imbalance post-laryngectomy.
Collapse
Affiliation(s)
- Amirreza Zaker
- Hearing Disorder Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aliasghar Peyvandi
- Hearing Disorder Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Fazli
- Hearing Disorder Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Bazgir
- Hearing Disorder Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Vakili
- Student Research Committee, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Mobin Fathi
- Student Research Committee, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Farhad Mokhtarinejad
- Hearing Disorder Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Rahmani
- Hearing Disorder Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Latif Gachkar
- Department of Infectious Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Khajavi
- Hearing Disorder Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
6
|
Keirns DL, Verplancke K, McMahon K, Eaton V, Silberstein P. Demographic differences in early vs. late-stage laryngeal squamous cell carcinoma. Am J Otolaryngol 2024; 45:104282. [PMID: 38604102 DOI: 10.1016/j.amjoto.2024.104282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE This study aims to evaluate how various demographic factors impact the stage at diagnosis and, therefore, prognosis of laryngeal cancer. MATERIALS AND METHODS Using the National Cancer Database, 96,409 patients were diagnosed with laryngeal squamous cell carcinoma between 2004 and 2020. Early (stage 0 or I) vs. late-stage (stage IV) cancers were compared based on demographic variables utilizing Chi-square and multivariate analysis with a significance of p < 0.05. RESULTS Female, Black, and generally older patients were more likely to have late-stage cancer than their counterparts. When compared with a community cancer program, patients treated at other facility types were more likely to be diagnosed late. Patients with private insurance, Medicare, or other government insurance were all less likely to have late-stage cancer compared to patients without insurance. Compared to patients in the lowest median household income quartile, patients in the third quartile and fourth quartile were diagnosed earlier. Patients living in an area with the lowest level of high school degree attainment were most likely to be diagnosed late. Living in a more populous area was associated with a lower chance of being diagnosed late. Increasing Charlson-Deyo Score was associated with a stronger likelihood of being diagnosed at a later stage. CONCLUSION Patients who are female, Black, uninsured, have a low household income, live in less populated and less educated areas, are treated at non-community cancer programs, and have more comorbid conditions have later stage diagnoses. This data contributes to understanding inequities in healthcare.
Collapse
Affiliation(s)
- Darby L Keirns
- Creighton University School of Medicine, Omaha, NE, USA.
| | | | - Kevin McMahon
- Creighton University School of Medicine, Omaha, NE, USA
| | - Vincent Eaton
- Creighton University School of Medicine, Omaha, NE, USA
| | - Peter Silberstein
- Department of Medicine, Hematology and Oncology, School of Medicine, Creighton University, Omaha, NE, USA
| |
Collapse
|
|
7
|
Walsh AR, Giurintano JP, Maxwell JH, Shah AH, Haupt TL, Wadley AE, Kowkuntla SR, Habib AM, Shah V. Associations Between Race and Survival Outcomes Among Veterans With Head and Neck Cancer in a Racially Diverse Setting. OTO Open 2024; 8:e150. [PMID: 38863487 PMCID: PMC11165679 DOI: 10.1002/oto2.150] [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] [Received: 01/17/2024] [Revised: 04/14/2024] [Accepted: 05/17/2024] [Indexed: 06/13/2024] Open
Abstract
Objective There is limited data on the impact of clinical-demographic factors on survival outcomes among veterans with head and neck squamous cell carcinoma (HNSCC). This study was undertaken to evaluate the impact of race and other factors on overall survival (OS) in a population of veterans with HNSCC treated with curative intent. Methods Demographic and clinical data were collected on veterans with HNSCC treated with curative intent at our institution between 1999 and 2021. The primary outcome was 3-year OS. Secondary outcomes included treatment delay intervals, including time to treatment initiation (TTI), total package time, and duration of chemoradiation (DCRT). Results Of 260 veterans with HNSCC, black veterans had significantly lower 3-year OS (49.4%) compared to white veterans (65%, P = .019). Black veterans were also more likely to experience delays in treatment initiation (median TTI 46 vs 41 days; P = .047). Black patients were more likely to receive radiation alone (25.8% [black] vs 8.4% [white]; P < .001) and less likely to receive adjuvant therapy if treated surgically (11.1% [black] vs 22.4% [white]; P = .004), despite any statistically significant difference in stage of their tumor at presentation (Stage I: 21.2% [black] vs 19.6% [white]; P = .372); (Stage IV: 44.4% [black] vs 48.6% [white]; P = .487). Other factors associated with worse 3-year OS included older age (P = .023), lower body mass index (P = .026), neurocognitive disorder/dementia (P = .037), mental health disorders (P = .020), hypopharyngeal primary (P = .001), higher stage disease (P = .002), treatment type (P = .001), need for prophylactic gastrostomy tube (P = .048) or tracheotomy (P = .005), recurrent disease (P = .036), persistent disease (P < .001), distant metastases (P = .002), longer TTI (P = .0362), and longer DCRT (P = .004). Discussion Black race appears to be an independent predictor of 3-year OS in veterans with HNSCC. Further studies are warranted to determine the factors responsible for disparities in survival. Implications for Practice This study evaluated the ways in which race affects survival for US veterans with head and neck cancer. The authors found that black veterans had an increased risk of death compared to white patients, and also experienced delays when receiving treatment. Level of Evidence Level IV.
Collapse
Affiliation(s)
- Amanda R. Walsh
- Department of Otolaryngology–Head and Neck SurgeryMedStar Georgetown University HospitalWashingtonDistrict of ColumbiaUSA
| | - Jonathan P. Giurintano
- Department of Otolaryngology–Head and Neck SurgeryMedStar Georgetown University HospitalWashingtonDistrict of ColumbiaUSA
| | - Jessica H. Maxwell
- Department of Otolaryngology–Head and Neck SurgeryDistrict of Columbia Veteran's Affairs Medical CenterWashingtonDistrict of ColumbiaUSA
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Anuja H. Shah
- Department of Otolaryngology‐Head and Neck SurgeryGeorgetown University School of MedicineWashingtonDistrict of ColumbiaUSA
| | - Thomas L. Haupt
- Howard University College of MedicineWashingtonDistrict of ColumbiaUSA
| | - Andrew E. Wadley
- Howard University College of MedicineWashingtonDistrict of ColumbiaUSA
| | - Sandeep R. Kowkuntla
- Department of Otolaryngology‐Head and Neck SurgeryGeorgetown University School of MedicineWashingtonDistrict of ColumbiaUSA
| | - Andy M. Habib
- Department of Otolaryngology‐Head and Neck SurgeryGeorgetown University School of MedicineWashingtonDistrict of ColumbiaUSA
| | - Veranca Shah
- Department of Otolaryngology‐Head and Neck SurgeryGeorgetown University School of MedicineWashingtonDistrict of ColumbiaUSA
| |
Collapse
|
|
8
|
Cyberski TF, Wang AZ, Baird BJ. Racial Disparities in Surgical Management For Early-Stage Laryngeal Squamous Cell Carcinoma and Recurrent Dysplasia. OTO Open 2024; 8:e119. [PMID: 38420351 PMCID: PMC10900919 DOI: 10.1002/oto2.119] [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] [Received: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
Objective The aim of this study is to evaluate the association between race and the treatment of laryngeal dysplasia and early-stage laryngeal squamous cell carcinoma (LSCC). Study design Retrospective Cohort Study. Setting Large multispecialty academic medical center. Methods Patients were treated for laryngeal dysplasia or LSCC between September 2019 and September 2022. A retrospective chart review was conducted to collect demographic and clinical information. Two-sample t tests, chi-square tests, and linear regression models were used to compare characteristics (α = 0.05). Analyses were performed in STATA 17. Results Sixty-five patients were identified that underwent potassium titanyl phosphate (KTP) transoral laser microsurgery for management of early-stage LSCC (n = 29) or dysplasia (n = 36). The cohort consisted of 23 Black and 42 White patients. No significant difference was found in age, alcohol or tobacco use, rate of adjuvant radiotherapy, stage of disease, nor insurance status between the 2 groups. White patients underwent more procedures to address initial disease and subsequent recurrent dysplasia on average than Black patients (2.52 vs 1.52, P = .02). This remained true after adjusting for demographic and clinical characteristics and insurance status in a linear regression model. While Black patients were more likely to be lost to follow-up than White patients (30.4% vs 9.5%, P = .03), the average number of procedures between the groups still differed significantly (2.63 vs 1.56, P = .04) when controlling for those lost to follow-up. Conclusion The findings presented here highlight potential inequities that exist for racial minorities at early stages of treatment and in addressing premalignant conditions, which may contribute to the known downstream disparities in laryngeal cancer outcomes.
Collapse
Affiliation(s)
| | - Alexander Z. Wang
- Pritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA
| | - Brandon J. Baird
- Section of Otolaryngology–Head and Neck Surgery, Department of SurgeryThe University of Chicago MedicineChicagoIllinoisUSA
| |
Collapse
|
|
9
|
Ezeh UC, Al-Awady A, Buitron I, Lee M, Forman G, Peifer S, Deo A, Sweeny L, Weed D, Kobetz EK, Reis IM, Franzmann E. Investigating Disparities in Hypopharyngeal/Laryngeal Cancer Survival in Florida With Geospatial Mapping Analysis. Cancer Control 2024; 31:10732748241246958. [PMID: 38623948 PMCID: PMC11022680 DOI: 10.1177/10732748241246958] [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: 12/03/2023] [Revised: 03/01/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE Identify predictors of overall survival (OS) after hypopharyngeal/laryngeal cancer in Florida. MATERIAL AND METHODS We conducted a retrospective cohort study using data from the Florida Cancer Data System (FCDS) on patients diagnosed with hypopharyngeal or laryngeal cancer from 2010-2017. Primary outcome was OS. Hazard ratios (HRs) were estimated from univariable and multivariable Cox regression models for OS. Data was analyzed from November 1, 2022, to June 30, 2023. RESULTS We analyzed 6771 patients, who were primarily male (81.2%), White non-Hispanic (WNH) (78.2%), publicly insured (70.1%), married (51.8%), and residents of urban counties (73.6%). Black patients were more likely to be younger at diagnosis (38.9%), single (43.4%), to have distant SEER stage disease (25.6%). Median OS were lowest among patients who were uninsured (34 months), with hypopharyngeal site disease (18 months), and a smoking history (current: 34 months, former: 46 months, no smoking: 63 months). Multivariable Cox regression analysis showed worse OS for single/unmarried vs married (HR 1.47 [95%CI: 1.36-1.59], P < .001), history of tobacco use (current: HR 1.62 [95%CI: 1.440-1.817], P < .001; former smokers: (HR 1.28 [95%CI: 1.139-1.437], P < .001) vs no history). Improved OS was observed among White Hispanics (WH) vs WNH (HR .73 [95%CI: .655-.817], P < .001) and women vs men (HR .88 [95%CI: .807-.954], P = .002). Geographical mapping showed that mortality rates were highest in census tracts with low income and education. CONCLUSION Our findings suggest that sociodemographic and clinical factors impact OS from hypopharyngeal/laryngeal cancer in Florida and vary geographically within the state. These results will help guide future public health interventions.
Collapse
Affiliation(s)
- Uche C. Ezeh
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Abdurrahman Al-Awady
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Ming Lee
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Garrett Forman
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sophia Peifer
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alana Deo
- University of California Santa Barbara, Santa Barbara, CA, USA
| | - Larissa Sweeny
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Donald Weed
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Erin K. Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Isildinha M Reis
- Division of Biostatistics, Department of Public Health Sciences, Sylvester Biostatistics and Bioinformatics Shared Resource, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Franzmann
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
|
10
|
Batool S, Burks CA, Bergmark RW. Healthcare Disparities in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023; 11:1-14. [PMID: 37362031 PMCID: PMC10247342 DOI: 10.1007/s40136-023-00459-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review The purpose of this review is to summarize some of the recent research studies on healthcare disparities across various subspecialties within otolaryngology. This review also highlights the impact of COVID-19 pandemic on disparities and proposes potential interventions to mitigate disparities. Recent Findings Significant healthcare disparities in care and treatment outcomes have been reported across all areas of otolaryngology. Notable differences in survival, disease recurrence, and overall mortality have been noted based on race, ethnicity, socioeconomic status (SES), insurance status, etc. This is most well-researched in head and neck cancer (HNC) within otolaryngology. Summary Healthcare disparities have been identified by numerous research studies within otolaryngology for many vulnerable groups that include racial and ethnic minority groups, low-income populations, and individuals from rural areas among many others. These populations continue to experience suboptimal access to timely, quality otolaryngologic care that exacerbate disparities in health outcomes.
Collapse
Affiliation(s)
- Sana Batool
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ciersten A. Burks
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
| | - Regan W. Bergmark
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women’s Hospital and Dana Farber Cancer Institute, 45 Francis Street, Boston, MA 02115 USA
| |
Collapse
|
|
11
|
Han C, Khan NI, Mady LJ. Prognosis. Otolaryngol Clin North Am 2023; 56:389-402. [PMID: 37030950 DOI: 10.1016/j.otc.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Prognosis is defined as the likely outcome or course of a disease and is the result of a complex interplay between patient and tumor factors. Unfortunately, the prognosis of patients with laryngeal cancer has not changed significantly over the past several decades. However, as our understanding of these patient and tumor factors becomes more nuanced and the resulting treatment options become more precise, there is the potential to improve the prognosis for these patients.
Collapse
|
|
12
|
Liu J, Song J, Li C. MYBPC1 is a key regulator for laryngeal carcinoma formation. Anticancer Drugs 2023; 34:1-8. [PMID: 36539363 PMCID: PMC9760473 DOI: 10.1097/cad.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/23/2022] [Indexed: 12/24/2022]
Abstract
Laryngeal carcinoma represents one of the most common types of tumor of the respiratory tract. The aim of the present study was to evaluate the functions of myosin-binding protein C1 (MYBPC1) in the progression of laryngeal carcinoma and to unravel the potential underlying molecular mechanism(s). Significantly differentially expressed mRNAs and miRNAs were analyzed, and potential genes were verified using clinically recruited patients with laryngeal carcinoma. The human laryngeal carcinoma cell lines TU686, TU212 and AMC-HN-8, as well as the control nasopharyngeal epithelial cell line NP69, were selected for the functional analysis of MYBPC1. The interaction between MYBPC1 and miR-451a was also explored in depth. The functions of MYBPC1 in the laryngeal carcinoma cell lines were examined using colony formation assay, cell proliferation and invasion assays, and via measuring the extent of apoptosis. The intracellular function of MYBPC1 was subsequently confirmed by constructing an in vivo xenograft model through the subcutaneous injection of laryngeal carcinoma cells into 4-week-old male nude mice. Compared with normal tissue, MYBPC1 was found to be the most significantly downregulated gene, whereas activating transcription factor-2 (ATF-2) was the most significantly upregulated one. At the same time, miR-451a was found to be the most significantly downregulated miRNA in laryngeal squamous cell carcinoma tissues. According to the WHO classification system, we found that the level of MYBPC1 was significantly decreased in grade IV tissues compared with grade II and grade III tissues, a finding that was consistent with the observed activity of miR-451a. MiR-451a was found to cause a marked enhancement of the activity of MYBPC1 in TU212 cells, which in turn was attenuated by ATF overexpression, suggesting that miR-451a could indirectly modulate the function of MYBPC1 through the ATF2-dependent signaling axis. MYBPC1 suppressed the invasion of cells induced by ATF2 in laryngeal carcinoma cells. Moreover, subcutaneous injection of MYBPC1 to construct an in vivo xenograft mouse model enabled rescue of the mice from laryngeal carcinoma formation. Taken together, the results of the present study have shown that MYBPC1 fulfills a pivotal role in laryngeal carcinoma formation, and these findings may provide both a new avenue for research planning and a potential therapeutic target for laryngeal carcinoma.
Collapse
Affiliation(s)
- Jing Liu
- Department of Otolaryngology, The Second Hospital of Tianjin Medical University
| | - Jinlan Song
- Department of Otolaryngology, Tianjin Nankai Hospital, Tianjin, China
| | - Chao Li
- Department of Otolaryngology, The Second Hospital of Tianjin Medical University
| |
Collapse
|
|
13
|
Shaikh N, Morrow V, Stokes C, Chung J, Fancy T, Turner MT, Stokes WA. Factors Associated With a Prolonged Diagnosis-to-Treatment Interval in Laryngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2022; 166:1092-1098. [PMID: 35380886 DOI: 10.1177/01945998221090115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Evaluate factors associated with treatment delays and their effect on survival in laryngeal squamous cell carcinoma. STUDY DESIGN Retrospective cohort study. SETTING National Cancer Database. METHODS Patients receiving primary radiation or surgery for laryngeal squamous cell carcinoma were included from 2004 to 2017. The primary outcomes were the diagnosis-to-treatment interval (DTI) and 5-year survival. Variables of prolonged DTI (>30 days) were assessed via logistic regression models. Survival was then assessed through Cox proportional hazards models. Candidate variables for both outcomes included age, sex, race, ethnicity, distance to treatment facility, insurance coverage, treatment facility type, TNM T stage, nodal status, and DTI (in models estimating survival). RESULTS An overall 136,203 patients with laryngeal cancer were identified, from which 51,747 remained after exclusions were applied: 18,499 received primary surgery and 33,248 received primary radiation. Being a member of a racial or ethnic minority, advanced age, female sex, ≥30 miles from treatment facility, lack of insurance, treatment at an academic cancer center, and primary radiation were associated with a prolonged DTI. However, in spite of a faster DTI, treatment at a community cancer center was independently associated with higher mortality (hazard ratio, 1.2; P < .0001). CONCLUSIONS Despite being associated with prolonged DTI, receiving treatment at a high-volume academic facility was associated with significantly improved survival. Our results indicate that improved referral pathways or outreach may help improve survival in laryngeal cancer, especially in high-risk populations.
Collapse
Affiliation(s)
- Noah Shaikh
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Vincent Morrow
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Cara Stokes
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Jeffson Chung
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Tanya Fancy
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Meghan T Turner
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - William A Stokes
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| |
Collapse
|
|
14
|
Nallani R, Subramanian TL, Ferguson-Square KM, Smith JB, White J, Chiu AG, Francis CL, Sykes KJ. A Systematic Review of Head and Neck Cancer Health Disparities: A Call for Innovative Research. Otolaryngol Head Neck Surg 2022; 166:1238-1248. [PMID: 35133913 DOI: 10.1177/01945998221077197] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE (1) Describe the existing head and neck cancer health disparities literature. (2) Contextualize these studies by using the NIMHD research framework (National Institute on Minority Health and Health Disparities). (3) Explore innovative ideas for further study and intervention. DATA SOURCES Ovid MEDLINE, Embase, Web of Science, and Google Scholar. REVIEW METHODS Databases were systematically searched from inception to April 20, 2020. The PRISMA checklist was followed (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Two authors reviewed all articles for inclusion. Extracted data included health disparity population and outcomes, study details, and main findings and recommendations. Articles were also classified per the NIMHD research framework. RESULTS There were 148 articles included for final review. The majority (n = 104) focused on health disparities related to at least race/ethnicity. Greater than two-thirds of studies (n = 105) identified health disparities specific to health behaviors or clinical outcomes. Interaction between the individual domain of influence and the health system level of influence was most discussed (n = 99, 66.9%). Less than half of studies (n = 61) offered specific recommendations or interventions. CONCLUSIONS There has been extensive study of health disparities for head and neck cancer, largely focusing on individual patient factors or health care access and quality. This review identifies gaps in this research, with large numbers of retrospective database studies and little discussion of potential contributors and explanations for these disparities. We recommend shifting research on disparities upstream toward a focus on community and societal factors, rather than individual, and an evaluation of interventions to promote health equity.
Collapse
Affiliation(s)
- Rohit Nallani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | - Joshua B Smith
- Department of Otolaryngology-Head and Neck Surgery, St Louis University, St Louis, Missouri, USA
| | - Jacob White
- Research and Learning, A.R. Dykes Library, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Carrie L Francis
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
|
15
|
Feit NZ, Wang Z, Demetres MR, Drenis S, Andreadis K, Rameau A. Healthcare Disparities in Laryngology: A Scoping Review. Laryngoscope 2022; 132:375-390. [PMID: 33314122 DOI: 10.1002/lary.29325] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/06/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS This scoping review aims to map out existing disparities research within the subspecialty of laryngology in order to highlight gaps in knowledge and guide future research. STUDY DESIGN Scoping Review. METHODS We completed a scoping review of PubMed, Ovid Embase, and the Cochrane Library for primary research focused on evaluating the existence and impact of disparities in race/ethnicity, sex/gender, insurance status, education level, income, geography, and LGBTQ identity in the context of various laryngological conditions. Publications of any design and date, performed in the United States, and focusing on the adult population exclusively were included. RESULTS Of the 4,999 unique abstracts identified, 51 articles were ultimately included. The most frequently examined condition in relation to disparities was laryngeal cancer (27 of 51), followed by voice disorders (15 of 51), deglutitive disorders (eight of 51), and airway disorders (one of 51). Sources of inequity evaluated from most common to least common were race/ethnicity (43 of 51), sex/gender (39 of 51), insurance status (23 of 51), geography (23 of 51), income (21 of 51), and education level (16 of 51). No study examined the association of LGBTQ identity with inequity. CONCLUSIONS This scoping review highlights the limited extent of disparities research in laryngology and establishes the need for further scholarship on the impact of disparities in laryngology care. The pathologies studied were, in decreasing order of frequency: laryngeal cancer, voice disorders, deglutitive disorders, and airway disorders. Race/ethnicity and sex/gender were the most common disparities examined, with no evaluation of LGBTQ-related care inequity. LEVEL OF EVIDENCE NA Laryngoscope, 132:375-390, 2022.
Collapse
Affiliation(s)
- Noah Z Feit
- Otolaryngology Department, Weill Cornell Medical College, New York, New York, U.S.A
| | - Zhaorui Wang
- Otolaryngology Department, Weill Cornell Medical College, New York, New York, U.S.A
| | - Michelle R Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York, U.S.A
| | - Sotirios Drenis
- Department of Otolaryngology, Head & Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
| | - Katerina Andreadis
- Department of Otolaryngology, Head & Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
- Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, U.S.A
| | - Anaïs Rameau
- Department of Otolaryngology, Head & Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
- Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, U.S.A
| |
Collapse
|
|
16
|
Kuo YC, Yu LY, Wang HY, Chen MJ, Wu MS, Liu CJ, Lin YC, Shih SC, Hu KC. Effects of Helicobacter pylori infection in gastrointestinal tract malignant diseases: From the oral cavity to rectum. World J Gastrointest Oncol 2022; 14:55-74. [PMID: 35116103 PMCID: PMC8790410 DOI: 10.4251/wjgo.v14.i1.55] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/03/2021] [Accepted: 12/09/2021] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) has infected approximately fifty percent of humans for a long period of time. However, improvements in the public health environment have led to a decreased chance of H. pylori infection. However, a high infection rate is noted in populations with a high incidence rate of gastric cancer (GC). The worldwide fraction of GC attributable to H. pylori is greater than 85%, and a high H. pylori prevalence is noted in gastric mucosa-associated lymphoid tissue lymphoma patients. These results indicate that the majority of GC cases can be prevented if H. pylori infection is eliminated. Because H. pylori exhibits oral-oral or fecal-oral transmission, the relationship between this microorganism and other digestive tract malignant diseases has also attracted attention. This review article provides an overview of H. pylori and the condition of the whole gastrointestinal tract environment to further understand the correlation between the pathogen and the host, thus allowing improved realization of disease presentation.
Collapse
Affiliation(s)
- Yang-Che Kuo
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Lo-Yip Yu
- Department of Internal Medicine, Healthy Evaluation Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Horng-Yuan Wang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Ming-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10051, Taiwan
| | - Chun-Jen Liu
- Department of Internal Medicine, Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 10051, Taiwan
| | - Ying-Chun Lin
- Department of Anesthesia, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Shou-Chuan Shih
- Division of Gastroenterology, Department of Internal Medicine, Health Evaluate Center, Mackay Memorial Hospital, Taipei 10449, Taiwan
| | - Kuang-Chun Hu
- Department of Internal Medicine, Healthy Evaluation Center, Mackay Memorial Hospital, MacKay Junior College of Medicine, Nursing, and Management, Taipei 10038, Taiwan
| |
Collapse
|
|
17
|
Shuaibu IY, Ajiya A, Adebola SN, Adewuyi SA, Aminu UM, Adamu A. Clinical profile and treatment outcome of laryngeal cancer in a Nigerian Tertiary hospital. Niger Postgrad Med J 2021; 28:259-265. [PMID: 34850753 DOI: 10.4103/npmj.npmj_657_21] [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: 11/04/2022]
Abstract
Background Laryngeal cancer is one of the most common malignancies of the upper aerodigestive tract worldwide, and its management may sometimes be challenging, especially in developing countries due to late presentation, poverty and limited resources. Aim This study aims to highlight the clinical profile and treatment outcome of laryngeal cancer in our centre. Patients and Methods This was a retrospective review of patients who were managed for laryngeal cancer between January 2011 and December 2020. Results There were 90 (89.1%) males and 11 (10.9%) females, with a male-to-female ratio of 8.2:1. The age ranged from 22 to 82 years, with a mean age of 57.2 ± 12.7 years. Fifty patients (49.5%) presented more than 1 year after the onset of the symptoms. Squamous cell carcinoma (SCCA) was the only histological diagnosis observed in our patients. The laryngeal cancer was transglottic in location in 45 (44.6%) patients, while 50 (49.5%) patients presented with Stage III disease. Twenty-one (20.8%) patients had total laryngectomy. Amongst the patients managed, 17 (17.0%) were still on follow-up. Up to 37 (37.0%) were referred for radiotherapy elsewhere after chemotherapy. Forty-one of the patients (40.0%) died during the course of their management. There was a statistically significant association between having definitive surgical management and survival beyond 5 years (Chi-square test = 8.635, P = 0.003). Conclusion Majority of the patients presented late with transglottic SCCA. Surgical extirpation of the lesion was associated with better prognosis in our patients.
Collapse
Affiliation(s)
- Iliyasu Yunusa Shuaibu
- Department of Surgery, Division of Otorhinolaryngology, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Abdulrazak Ajiya
- Department of Otorhinolaryngology, Faculty of Clinical Sciences, College of Health Sciences, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Shofoluwe Nurudeen Adebola
- Department of Surgery, Division of Otorhinolaryngology, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Sunday Adeyemi Adewuyi
- Department of Radio-Oncology, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Usman Mohammed Aminu
- Department of Surgery, Division of Otorhinolaryngology, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Auwal Adamu
- Department of Otorhinolaryngology, Head and Neck Surgery, Abubakar Tafawa Balewa University Teaching Hospital/ Abubakar Tafawa Balewa University, Bauchi, Nigeria
| |
Collapse
|
|
18
|
Smith BD, Osazuwa-Peters OL, Cannon TY, Reed WT, Puscas L, Osazuwa-Peters N. Nonsurgical Risk Factors Associated With Pharyngocutaneous Fistula in Patients Who Have Undergone Laryngectomy. JAMA Otolaryngol Head Neck Surg 2021; 147:966-973. [PMID: 34591065 DOI: 10.1001/jamaoto.2021.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy. Despite the well-described clinical risk factors for PCF and its association with poor quality of life, there is a paucity of data on the nonclinical factors that may be associated with this complication. Objective To determine whether nonclinical risk factors (eg, age, sex, race and ethnicity) are associated with an increased risk of developing a PCF after total laryngectomy, and whether or not the method of reconstruction explains any differences found. Design, Setting, and Participants This retrospective multicenter cohort study used data from a nationally validated, risk-adjusted, outcomes-based, surgical quality improvement database (the National Surgical Quality Improvement Program) to examine outcomes in patients who underwent a total laryngectomy from 2005 to 2018. The database was queried from January 1, 2005, to December 31, 2018; data analyses were performed from September 1, 2020, to March 31, 2021. Main Outcomes and Measures The primary outcome was development of a PCF within 30 days of a total laryngectomy. Patient characteristics, including age, sex, race and ethnicity, comorbidities, and mode of reconstruction, were analyzed. Results A cohort of 1573 adult patients (median age [IQR], 63 [56-71] years; 1280 [81.4%] men; 293 [18.6%] women; 1001 [63.6%] non-Hispanic White individuals) had undergone a total laryngectomy during the study period and were included in the analyses. The overall rate of PCF formation was 4.3% (68 of 1573 patients). Hispanic patients had the highest rate (9.5%; 9 of 95 patients) of PCF formation, which was more than twice the rate among non-Hispanic White patients (3.8%; 38 of 1001) and non-Hispanic Black patients (4.7%; 11 of 236). After adjusting for clinical and other covariates, women were 1.9 times more likely to develop a PCF compared with men (adjusted odds ratio, 1.90; 95% CI, 1.08-3.35). We also found that the odds of developing a PCF were 3-fold higher among Hispanic patients compared with non-Hispanic White patients (adjusted odds ratio, 2.96; 95% CI, 1.36-6.47). The type of reconstruction did not differ across age or race and ethnicity after controlling for clinical risk factors. Conclusions and Relevance This multicenter cohort study found that 2 nonclinical risk factors-Hispanic ethnicity and female sex-were associated with an increased risk of PCF formation. Knowledge of these risk factors should be included in patient-physician decision-making as well as future interventions to decrease the rate of PCF formation after laryngectomy.
Collapse
Affiliation(s)
- Blaine D Smith
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Oyomoare L Osazuwa-Peters
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Trinitia Y Cannon
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - William T Reed
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Liana Puscas
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Duke Cancer Institute, Durham, North Carolina
| |
Collapse
|
|
19
|
Fang L, Wang W, Shi L, Chen Q, Rao X. Prognostic values and clinical relationship of TYK2 in laryngeal squamous cell cancer. Medicine (Baltimore) 2021; 100:e27062. [PMID: 34449498 PMCID: PMC10545095 DOI: 10.1097/md.0000000000027062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/20/2021] [Accepted: 08/03/2021] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT Laryngeal squamous cell cancer (LSCC) is the second most common head and neck cancer with the increasing mortality. The tyrosine kinase 2 (TYK2) has previously been reported to play an important role in various cancers excepting LSCC. We used available data from the cancer genome atlas program (TCGA), gene expression omnibus, and gene expression profiling interactive analysis (GEPIA) to evaluate the role of TYK2 in LSCC.The difference of TYK2 expression level between normal and tumor samples was analyzed based on TCGA, gene expression omnibus, and GEPIA databases. The relationship between clinical features and TYK2 were analyzed using the Wilcoxon signed-rank test. We applied Cox regression and the Kaplan-Meier method to finding which clinical characteristics is associated with overall survival. Also, we used GEPIA database to validate the relationship between TYK2 and overall survival. At last, we performed gene set enrichment analysis based on TCGA data set.The expression level of TYK2 in LSCC was significantly associated with gender, lymph node status and metastasis (P-values <.05). Kaplan-Meier survival analysis, as same as GEPIA validation, demonstrated that LSCC with TYK2-low had a worse prognosis than that with TYK2-high. The univariate analysis showed that TYK2-high correlated significantly with a better overall survival (hazard ratio: 0.351, 95% confidence interval: 0.194-0.637, P < .001). The multivariate analysis revealed that TYK2 remained independently associated with overall survival (hazard ratio: 0.36, 95% confidence interval: 0.185-0.699, P = .003). Gene set enrichment analysis shows that Janus kinases-STAT signaling pathway, p53 signalling pathway and natural killer cell mediated cytotoxicity, etc are enriched in TYK2 high expression phenotype.Gene TYK2 may be a potential prognostic molecular marker for LSCC. Moreover, the Janus kinases-STAT signaling pathway and p53 signaling pathway are probably the key pathway associated with TYK2 in LC.
Collapse
Affiliation(s)
- Lucheng Fang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Wen Wang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Licai Shi
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Qinjuan Chen
- Second Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Xingwang Rao
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| |
Collapse
|
|
20
|
Voora RS, Kotha NV, Kumar A, Qiao EM, Qian AS, Panuganti BA, Banegas MP, Weissbrod PA, Stewart TF, Rose BS, Orosco RK. Association of race and health care system with disease stage and survival in veterans with larynx cancer. Cancer 2021; 127:2705-2713. [PMID: 33799314 DOI: 10.1002/cncr.33557] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Black patients with laryngeal squamous cell carcinoma (LSCC) historically have inferior outcomes in comparison with White patients. The authors investigated these racial disparities within the Veterans Health Administration (VHA), an equal-access system, and within the Surveillance, Epidemiology, and End Results (SEER) program, which is representative of the US hybrid-payer system. METHODS Patients with invasive (T1 or greater) LSCC were included from SEER (2004-2015) and the VHA (2000-2017). The primary outcomes of overall survival (OS) and larynx cancer-specific survival (LCS) were evaluated in Cox and Fine-Gray models. RESULTS In the SEER cohort (7122 patients: 82.6% White and 17.4% Black), Black patients were more likely to present with advanced disease and had inferior OS (hazard ratio [HR], 1.37; 95% CI, 1.26-1.50; P < .0001) in a multivariable analysis. Black LCS was worse in a univariable analysis (HR, 1.42; 95% CI, 1.27-1.58; P < .0001), but this effect was attenuated by 83% when the authors controlled for the TNM category and was found to be insignificant in a multivariable analysis (HR, 1.05; 95% CI, 0.93-1.18; P = .42). In the VHA cohort (9248 patients: 79.7% White and 20.3% Black), the 2 racial cohorts presented with similar tumor characteristics and similar OS (HR, 0.95; 95% CI, 0.89-1.02; P = .14). Black LCS was similar in univariable (HR, 1.10; 95% CI, 1.00-1.22; P = .05) and multivariable analyses (HR, 1.02; 95% CI, 0.92-1.14; P = .67). CONCLUSIONS Black patients with LSCC had a tumor burden at diagnosis and survival outcomes comparable to those of White patients within the VHA; this was counter to what was observed in the SEER analysis and prior national trends. This study's findings point toward the notable role of health care access in contributing to racial health disparities in the realm of larynx cancer.
Collapse
Affiliation(s)
- Rohith S Voora
- School of Medicine, University of California San Diego, San Diego, California
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Nikhil V Kotha
- School of Medicine, University of California San Diego, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Abhishek Kumar
- Veterans Affairs San Diego Healthcare System, San Diego, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Edmund M Qiao
- School of Medicine, University of California San Diego, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Alexander S Qian
- School of Medicine, University of California San Diego, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
| | - Bharat A Panuganti
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California
- Moores Cancer Center, La Jolla, California
| | | | - Philip A Weissbrod
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California
- Moores Cancer Center, La Jolla, California
| | - Tyler F Stewart
- Moores Cancer Center, La Jolla, California
- Division of Hematology-Oncology, University of California San Diego, San Diego, California
- Division of Blood and Marrow Transplantation, University of California San Diego, San Diego, California
| | - Brent S Rose
- Veterans Affairs San Diego Healthcare System, San Diego, California
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California
- Moores Cancer Center, La Jolla, California
| | - Ryan K Orosco
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
- Moores Cancer Center, La Jolla, California
| |
Collapse
|
|
21
|
Echanique KA, Evans LK, Han AY, Chhetri DK, St John MA. Cancer of the Larynx and Hypopharynx. Hematol Oncol Clin North Am 2021; 35:933-947. [PMID: 34272102 DOI: 10.1016/j.hoc.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Radiation Therapy Oncology Group 91-11 trial and US Veterans Affairs trial revolutionized the way locally advanced laryngeal cancers are treated. Adjuvant therapies exist aimed toward laryngeal preservation using docetaxel, cisplatin, and fluorouracil. Cetuximab is a cornerstone of treatment due to the large role of epidermal growth factor receptor in laryngeal and hypopharyngeal carcinomas. In addition, the immune system is vital in the prevention of recurrence, and various immunomodulators against programmed cell death receptor 1 are being investigated. Multidisciplinary management of the patient with laryngeal and hypopharyngeal is key, as many vital functions are affected by this devastating disease.
Collapse
Affiliation(s)
- Kristen A Echanique
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 62-235, Los Angeles, CA 90095, USA
| | - Lauran K Evans
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 62-235, Los Angeles, CA 90095, USA
| | - Albert Y Han
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 62-235, Los Angeles, CA 90095, USA
| | - Dinesh K Chhetri
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, UCLA Head and Neck Cancer Program, 10833 Le Conte Avenue, CHS 62-235, Los Angeles, CA 90095, USA
| | - Maie A St John
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, UCLA Head and Neck Cancer Program, 10833 Le Conte Avenue, CHS 62-235, Los Angeles, CA 90095, USA.
| |
Collapse
|
|
22
|
Wang L, Cheng HX, Zhou YH, Ma M. Clinical Significance of the D-Loop Gene Mutation in Mitochondrial DNA in Laryngeal Cancer. Onco Targets Ther 2021; 14:3461-3466. [PMID: 34079291 PMCID: PMC8165653 DOI: 10.2147/ott.s304836] [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: 02/01/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of the present study was to investigate the D-loop gene mutation and microsatellite instability in the mitochondrial DNA (mtDNA) and the correlation with the clinical and pathological parameters in laryngeal cancer. Methods The tumor tissues and paratumor tissues in 60 cases of laryngeal cancer were selected, and DNA was extracted from these tissues. The D-loop region in mtDNA was amplified by PCR with the gene sequence of the amplified product being detected. The gene sequence of the detected region was compared with the revised Cambridge Reference Sequence (rCRS) and the related database by using the Mitomaster software. The correlation between the D-loop gene mutation and the clinical and pathological parameters was investigated. Results A total of 174 mutations across 38 sites were detected in 51 (85%) of samples. Most of the mutations were concentrated in the high various (HV) I region, and the main types of mutations were the substitution of a single base or insertion and deletion of a single base. There was also microsatellite instability in the D310 region. The statistical results showed that there was no correlation between the age, gender, tumor diameter, and TNM stage, and the number of the D-loop mutations in mtDNA (P > 0.05). Conclusion There existed high-frequency mutation of the D-loop gene in mtDNA in laryngeal cancer, which might play an important role in the pathogenesis of laryngeal cancer.
Collapse
Affiliation(s)
- Lei Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, People's Republic of China
| | - He-Xiang Cheng
- Department of Otolaryngology, The Luoyang First People's Hospital, Luoyang, 471000, People's Republic of China
| | - Yan-Hui Zhou
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, People's Republic of China
| | - Min Ma
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, People's Republic of China
| |
Collapse
|
|
23
|
Novel predictive tools and therapeutic strategies for patients with initially diagnosed glottic cancer in the United States. Eur Arch Otorhinolaryngol 2021; 279:399-413. [PMID: 33821328 DOI: 10.1007/s00405-021-06788-4] [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: 01/26/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this study is to identify valuable prognostic factors, build clinical prediction nomograms, and recommend the optimal therapeutic strategy for patients with initially diagnosed glottic cancer. METHODS Patients were extracted from the SEER database. Cox regression analyses, survival analyses, an internal validation, the propensity score analysis, and the competing risk analysis were performed. RESULTS Nine overlapped factors were considered as valuable prognostic factors. Furthermore, nomograms were established for clinical prediction models to assess the 1-, 3-, and 5-year overall survival (OS) and cancer-specific survival (CSS). C-indexes, receiver operating characteristic curves, calibration curves, and decision curve analyses proved that nomograms showed better predictive accuracy, ability, and prognostic value compared to the American Joint Committee on Cancer stage. For patients in stage I, primary site surgery alone would acquire best OS and CSS. For patients in stage II, primary site surgery and/or radiation would gain better OS and CSS. For patients in stage III, radiation plus chemotherapy or primary site surgery (alone or plus radiation) would acquire better OS and CSS. Moreover, for patients in stage IV, primary site surgery plus radiation would gain better OS and CSS. CONCLUSIONS Nomograms could be useful for patients' counseling and guide therapeutic decision-making. Primary site surgery alone may likely be the optimal therapy for stage I glottic cancer, and primary site surgery and/or radiation may be the recommended therapy for stage II glottic cancer. The combination treatment would be the preferred choice for advanced-stage (stage III & IV) glottic cancer, and the role of chemotherapy needs to be further explored.
Collapse
|
|
24
|
Cox SR, Daniel CL. Racial and Ethnic Disparities in Laryngeal Cancer Care. J Racial Ethn Health Disparities 2021; 9:800-811. [PMID: 33733426 DOI: 10.1007/s40615-021-01018-3] [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: 11/04/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
There is a long history of racial and ethnic disparities in healthcare and they continue to persist in contemporary society. These disparities have the potential to negatively affect morbidity and mortality in racial and ethnic minorities diagnosed with laryngeal cancer. Diagnosis, medical treatment, and rehabilitation for laryngeal cancer have improved considerably, leading to improvements in overall survival rates and physical, social, and psychological functioning. Yet members of minority and underrepresented groups are at an increased risk for experiencing reduced access to quality care and delays between diagnosis and treatment, and as a result have lower survival rates. Increasing health providers' awareness of racial and ethnic disparities in laryngeal cancer is necessary to facilitate changes in patient and provider education, clinical practice, and health policies. The purpose of this review is to summarize current literature on disparities in laryngeal cancer diagnosis, treatment, and rehabilitation among Black and Hispanic patients. We present recent data from the Surveillance, Epidemiology, and End Results database to examine trends in laryngeal cancer and patient, provider, and health systems factors that may perpetuate these disparities. In addition, we offer interventions to address racism and other racial and ethnic biases in laryngeal cancer care and describe research and legislative actions that are needed to reduce disparities in this area.
Collapse
Affiliation(s)
- Steven R Cox
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY, 11530, USA.
| | - Carolann L Daniel
- School of Social Work, Adelphi University, Garden City, NY, 11530, USA
| |
Collapse
|
|
25
|
Qureshi MM, Oladeru OT, Lam CM, Dyer MA, Mak KS, Hirsch AE, Truong MT. Disparities in Laryngeal Cancer Treatment and Outcomes: An Analysis by Hospital Safety-Net Burden. Laryngoscope 2021; 131:E1987-E1997. [PMID: 33555062 DOI: 10.1002/lary.29416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/28/2020] [Accepted: 01/10/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVES/HYPOTHESIS To analyze the impact of hospital safety-net burden on survival outcomes for laryngeal squamous cell carcinoma (LSCC) patients. STUDY DESIGN Retrospective cohort study. METHODS From 2004 to 2015, 59,733 LSCC patients treated with curative intent were identified using the National Cancer Database. Low (LBH) <25th, medium (MBH) 25th-75th, and high (HBH) >75th safety-net burden hospitals were defined by the percentage quartiles (%) of uninsured/Medicaid-insured patients treated. Social and clinicopathologic characteristics and overall survival (using Kaplan-Meier survival analysis) were evaluated. Crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed using Cox regression modeling. RESULTS There were 324, 647, and 323 hospitals that met the criteria as LBH, MBH, and HBH, respectively. The median follow-up was 38.6 months. A total of 27,629 deaths were reported, with a median survival of 75.8 months (a 5-year survival rate of 56.6%). Median survival was 83.2, 77.8, and 69.3 months for patients from LBH, MBH, and HBH, respectively (P < .0001). The median % of uninsured/Medicaid-insured patients treated among LBH, MBH, and HBH were 3.6%, 14.0%, and 27.0%, respectively. Patients treated at HBH were significantly more likely to be young, Black, Hispanic, of low income, and present with more advanced disease compared to LBH and MBH. Survival was comparable for LBH and MBH (HR = 1.02; 95% CI = 0.97-1.07, P = .408) on multivariate analysis. HBH, compared to LBH patients, had inferior survival (HR = 1.07; 95% CI = 1.01-1.13, P = .023). CONCLUSIONS High burden safety-net hospitals receive disproportionately more patients with advanced-stage and low socioeconomic status, yielding inferior survival compared to low burden hospitals. LEVEL OF EVIDENCE 3 (individual cohort study) Laryngoscope, 131:E1987-E1997, 2021.
Collapse
Affiliation(s)
- Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Oluwadamilola T Oladeru
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Christa M Lam
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Michael A Dyer
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Kimberley S Mak
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| |
Collapse
|
|
26
|
Seeking Medical Assistance for Dysphonia Is Associated with an Improved Survival Rate in Laryngeal Cancer: Real-World Evidence. Diagnostics (Basel) 2021; 11:diagnostics11020255. [PMID: 33562222 PMCID: PMC7915002 DOI: 10.3390/diagnostics11020255] [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: 01/05/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Patients with laryngeal cancer usually present with dysphonia. However, some studies reported that the duration from dysphonia to cancer diagnosis has been prolonged significantly in recent years. This study aimed to evaluate that in the initial dysphonia-related diagnosis and the interval between the diagnosis of laryngeal cancer may affect the overall survival (OS). (2) Methods: The 1997–2013 Longitudinal Health Insurance Database was used in this study. A propensity score with 1-to-1 matching was applied to balance the baseline characteristics. The OS was examined by the Kaplan-Meier method and log-rank test. (3) Results: A total of 2753 patients with a first primary laryngeal cancer diagnosis were identified. The patients without prior dysphonia-related diagnosis (PD−) group did have a significantly worse five-year survival (p = 0.015) comparing with those with a prior dysphonia-related diagnosis (PD+) group among glottic cancer patients. The group with a shorter dysphonia-to-diagnosis interval had a better five-year OS than the prolonged group (p = 0.007) in laryngeal cancer. (4) Conclusions: Looking for medical assistance before a diagnosis of glottic cancer is associated with a better overall survival, while a diagnostic delay of more than 30 days from the first medical examination for dysphonia is associated with a worse outcome among in patients with laryngeal cancer.
Collapse
|
|
27
|
Ding Z, Yu D, Li H, Ding Y. Effects of marital status on overall and cancer-specific survival in laryngeal cancer patients: a population-based study. Sci Rep 2021; 11:723. [PMID: 33436991 PMCID: PMC7803965 DOI: 10.1038/s41598-020-80698-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 12/24/2020] [Indexed: 02/06/2023] Open
Abstract
Marital status has long been recognized as an important prognostic factor for many cancers, however its' prognostic effect for patients with laryngeal cancer has not been fully examined. We retrospectively analyzed 8834 laryngeal cancer patients in the Surveillance Epidemiology and End Results database from 2004 to 2010. Patients were divided into four groups: married, widowed, single, and divorced/separated. The difference in overall survival (OS) and cancer-specific survival (CSS) of the various marital subgroups were calculated using the Kaplan-Meier curve. Multivariate Cox regression analysis screened for independent prognostic factors. Propensity score matching (PSM) was also conducted to minimize selection bias. We included 8834 eligible patients (4817 married, 894 widowed, 1732 single and 1391 divorced/separated) with laryngeal cancer. The 5-year OS and CSS of married, widowed, single, and separated/divorced patients were examined. Univariate and multivariate analyses found marital status to be an independent predictor of survival. Subgroup survival analysis showed that the OS and CSS rates in widowed patients were always the lowest in the various American Joint Committee on Cancer stages, irrespective of sex. Widowed patients demonstrated worse OS and CSS in the 1:1 matched group analysis. Among patients with laryngeal cancer, widowed patients represented the highest-risk group, with the lowest OS and CSS.
Collapse
Affiliation(s)
- Zhao Ding
- Clinical Medical College, Dali University, Dali, 671000, Yunnan, China
| | - Deshun Yu
- Department of Otolaryngology, The First Affiliated Hospital of Dali University, Dali, 671000, Yunnan, China
| | - Hefeng Li
- Clinical Medical College, Dali University, Dali, 671000, Yunnan, China
| | - Yueming Ding
- Department of Otolaryngology, The First Affiliated Hospital of Dali University, Dali, 671000, Yunnan, China.
| |
Collapse
|
|
28
|
Pasvenskaite A, Liutkeviciene R, Gedvilaite G, Vilkeviciute A, Liutkevicius V, Uloza V. Impact of IL-10 Promoter Polymorphisms and IL-10 Serum Levels on Advanced Laryngeal Squamous Cell Carcinoma and Survival Rate. Cancer Genomics Proteomics 2021; 18:53-65. [PMID: 33419896 DOI: 10.21873/cgp.20241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND/AIM Prognosis of advanced stages of laryngeal squamous cell carcinoma (LSCC) remains poor. To clarify therapeutic targets and improve survival rate, identification of new specific and prognostic biomarkers of LSCC is required. The study aimed to evaluate the impact of IL-10:rs1800871, rs1800872, rs1800896 single nucleotide polymorphisms (SNPs), and IL-10 serum levels on LSCC development and determine associations of selected SNPs with patient survival rate. PATIENTS AND METHODS A total of 300 LSCC patients and 533 controls were included in the study. Genotyping was carried out using RT-PCR; IL-10 serum levels were analyzed by ELISA. RESULTS Significant associations were identified between IL-10 rs1800871 variants and advanced stage of LSCC patient group in the codominant, recessive and additive models (OR=0.473, p=0.027; OR=0.510, p=0.040; and OR=0.733; p=0.037). Significant variants of IL-10 rs1800872 were determined in the codominant, recessive and additive models (OR=0.473, p=0.027; OR=0.510, p=0.040; and OR=0.733, p=0.037). The distribution of IL-10 SNPs genotypes did not impact LSCC patient survival rate (respectively, p=0.952; p=0.952; p=0.991). CONCLUSION IL-10:rs1800871 and rs1800872 SNPs are associated with advanced stage of LSCC. The genotypic distribution of IL-10 SNPs does not influence the survival rate of LSCC patients.
Collapse
Affiliation(s)
- Agne Pasvenskaite
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania;
| | - Rasa Liutkeviciene
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Greta Gedvilaite
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alvita Vilkeviciute
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vykintas Liutkevicius
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Virgilijus Uloza
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
|
29
|
Sánchez-Siles M, Pelegrín-Hernández JP, Hellin-Meseguer D, Guerrero-Sánchez Y, Corno-Caparrós A, Cabezas-Herrera J, Pastor-Quirante F, Fernández-Ruiz JA, Aliaga-Sánchez A, Lucero-Berdugo M, Camacho-Alonso F. Genotype of Null Polymorphisms in Genes GSTM1, GSTT1, CYP1A1, and CYP1A1*2A (rs4646903 T>C)/CYP1A1*2C (rs1048943 A>G) in Patients with Larynx Cancer in Southeast Spain. Cancers (Basel) 2020; 12:cancers12092478. [PMID: 32882964 PMCID: PMC7563952 DOI: 10.3390/cancers12092478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023] Open
Abstract
Simple Summary Epidemiological studies have shown that individual susceptibility to cancer is mediated by genetic and environmental factors. The aim of the present study is to evaluate the individuals’ metabolic genetic susceptibility to toxic habits (smoking and alcohol consumption) by detecting polymorphisms CYP1A1 rs1048943 T>C and CYPA1A2 rs4646903 A>G, and null polymorphisms in GSTM1 and GSTT1 genotypes, comparing a group of healthy control subjects with a population of larynx cancer patients from southeastern Spain. As results patients with larynx cancer present more gene GSTM1 and GSTT1 null polymorphisms, and CYP1A1 rs4646903 T>C polymorphisms. Abstract Background: some types of cancer have been associated with the presence of single nucleotide polymorphisms (SNPs) of some genes that encode enzymes: glutathione-S transferase (GST), whose alteration leads to loss of function and a lower capacity to eliminate toxic GSTM1 and GSTT1 null genotypes; SNPs causing loss of function of CYP1A1 or CYP1A1–2 cytochrome P450 enzymes related with a lower capacity to deactivate hydrocarbons related to smoking, which involves a higher risk of developing some smoking-dependent cancers including larynx cancer. Objective: to compare the presence of null SNPs in genes GSTM1, GSTT1, and CYP1A1 rs 4646903 T>C, and CYP1A1–2 RS1048943 A>G in patients with hypopharyngeal and larynx cancer with a healthy control group. Materials and method: The study included a total of 80 patients with hypopharyngeal and laryngeal cancer and 23 healthy subjects. Genomic DNA was obtained from saliva samples, determining genotype GSTM1 (present +, or null −), GSTT1 (present + or null −). Polymorphisms (SNP) in CYP1A1 T>C (present + CC, or absent − TC/TT), and CYP1A1–2 A>G (present + GG, or absent − AG/AA). Results: the mean age of patients with larynx cancer was 62 years and of control subjects 63 years. Of the total sample, over 95% were men, and over 90% were smokers. The presence of null genotypes for GTM1 was 50% in patients with larynx cancer (p = 0.042), while GSTT1 was 88.75% (p = 0.002). CYP1A1 rs4646903 T>C polymorphisms were detected in 100% of cases of larynx cancer and 17.39% of healthy subjects (p > 0.001). Conclusions: patients with larynx cancer present more gene GSTM1 and GSTT1 null polymorphisms, and CYP1A1 rs4646903 T>C polymorphisms.
Collapse
Affiliation(s)
| | | | - Diego Hellin-Meseguer
- Otorhinolaryngology, University Hospital Virgen de la Arrixaca, 30005 Murcia, Spain; (J.P.P.-H.); (D.H.-M.)
| | - Yolanda Guerrero-Sánchez
- Department of Human Anatomy and Psychobiology, University of Murcia, 30100 Murcia, Spain
- Correspondence:
| | | | - Juan Cabezas-Herrera
- Molecular Therapy and Biomarkers Research Group, Clinical Analysis Service, IMIB, 30005 Murcia, Spain;
| | | | | | | | - Mayra Lucero-Berdugo
- Department of Oral Medicine, Catholic University of Murcia, 30107 Murcia, Spain;
| | | |
Collapse
|
|
30
|
Chen S, Dee EC, Muralidhar V, Nguyen PL, Amin MR, Givi B. Disparities in Mortality from Larynx Cancer: Implications for Reducing Racial Differences. Laryngoscope 2020; 131:E1147-E1155. [PMID: 32869893 DOI: 10.1002/lary.29046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Race predicts overall mortality (OM) of laryngeal squamous cell carcinoma (LSCC) in the United States (US). We assessed whether racial disparities affect cancer-specific mortality (CSM) using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Adults with LSCC from 2004 to 2015 were selected. Univariable and multivariable Cox proportional hazards and Fine-Gray competing-risks regression analysis adjusted for clinicodemographic factors defined hazard ratios (aHR). RESULTS We identified 14,506 patients. The median age was 63 years. Most were male (11,725, 80.8%) and white (11,653, 80.3%), followed by Black (2294, 15.8%). Most had early-stage disease (7544, 52.0%) and received radiotherapy only (4107, 28.3%), followed by chemoradiation (3748, 25.8%). With median follow-up of 60 months, overall 3- and 5-year OM were 34.0% and 43.2%; CSM were 16.0% and 18.9%, respectively. Black patients had higher OM than white patients on univariable (HR 1.35, 95% CI, 1.26-1.44, P < .001) and multivariable (aHR 1.10, 95% CI, 1.02-1.18, P = .011) analyses. Black patients had higher CSM on univariable analysis (HR 1.22, 95% CI, 1.09-1.35, P < .001) but not on multivariable CSM analysis (aHR 1.01, 95% CI, 0.90-1.13, P = .864). On multivariable analysis, year of diagnosis, age, disease site, stage, treatment, nodal metastasis, marital status, education, and geography significantly predicted CSM. CONCLUSION On multivariable analyses controlling for sociodemographic, clinical, and treatment characteristics, Black and white patients differed in OM but not in CSM. However, Black patients presented with greater proportions of higher stage cancers and sociodemographic factors such as income and marital status that were associated with worse outcomes. Efforts to target sociodemographic disparities may contribute to the mitigation of racial disparities in LSCC. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1147-E1155, 2021.
Collapse
Affiliation(s)
- Sophia Chen
- Department of Otolaryngology-Head & Neck Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Edward Christopher Dee
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Milan R Amin
- Department of Otolaryngology-Head & Neck Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Babak Givi
- Department of Otolaryngology-Head & Neck Surgery, New York University Langone Health, New York, New York, U.S.A
| |
Collapse
|
|
31
|
Gamez ME, Blakaj A, Zoller W, Bonomi M, Blakaj DM. Emerging Concepts and Novel Strategies in Radiation Therapy for Laryngeal Cancer Management. Cancers (Basel) 2020; 12:cancers12061651. [PMID: 32580375 PMCID: PMC7352689 DOI: 10.3390/cancers12061651] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
Laryngeal squamous cell carcinoma is the second most common head and neck cancer. Its pathogenesis is strongly associated with smoking. The management of this disease is challenging and mandates multidisciplinary care. Currently, accepted treatment modalities include surgery, radiation therapy, and chemotherapy—all focused on improving survival while preserving organ function. Despite changes in smoking patterns resulting in a declining incidence of laryngeal cancer, the overall outcomes for this disease have not improved in the recent past, likely due to changes in treatment patterns and treatment-related toxicities. Here, we review emerging concepts and novel strategies in the use of radiation therapy in the management of laryngeal squamous cell carcinoma that could improve the relationship between tumor control and normal tissue damage (therapeutic ratio).
Collapse
Affiliation(s)
- Mauricio E. Gamez
- Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (W.Z.); (D.M.B.)
- Correspondence:
| | - Adriana Blakaj
- Department of Therapeutic Radiology, Yale School of Medicine, 35 Park St., New Haven, CT 06519, USA;
| | - Wesley Zoller
- Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (W.Z.); (D.M.B.)
| | - Marcelo Bonomi
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, 320 West 10th Avenue, Columbus, OH 43210, USA;
| | - Dukagjin M. Blakaj
- Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (W.Z.); (D.M.B.)
| |
Collapse
|
|
32
|
Racial/ethnic disparities in penile squamous cell carcinoma incidences, clinical characteristics, and outcomes: A population-based study, 2004-2016. Urol Oncol 2020; 38:688.e11-688.e19. [PMID: 32340796 DOI: 10.1016/j.urolonc.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/23/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE This study assessed the impact of race/ethnicity on penile squamous cell carcinoma (PSCC) incidence rates, clinical characteristics, and outcomes. MATERIALS AND METHODS Surveillance, Epidemiology and End Results data from 2004 to 2016 was used for this study. We evaluated racial/ethnic differences in clinical characteristics using χ2 tests. Overall survival (OS) and PSCC-specific survival (PSCC-SS) were estimated using the Kaplan-Meier method, and differences were determined using the log-rank test. Cox regression models were performed to assess independent predictors for PSCC patient survival. RESULTS A total of 2,720 PSCC patients were included for incidence analysis, and 2,438 patients were identified for the χ2 testing and survival analyses.The overall incidence of PSCC during 2004 to 2016 was 0.30 per 100,000. Only non-Hispanic white (NHW) patients had a statistically significant increase in age-adjusted incidence rates (annual percent change = 2.26, 95% confidence interval [CI]: 0.78-3.76; P = 0.01). In univariate analysis, race/ethnicity was an independent prognostic factor for OS and PSCC-SS. After adjusting for age, marital status, income, grade, TNM (tumor, node, metastasis) stage, and treatment strategies, non-Hispanic black patients still had a statistically significant hazard ratio of 1.35 (95% CI: 1.08-1.68; P = 0.007) for OS, and a hazard ratio of 1.36 (95% CI: 1.01-1.82; P = 0.045) for PSCC-SS compared to NHW. CONCLUSION NHW patients had a statistically significant increase in age-adjusted incidence rate during the period 2004 to 2016. Race/ethnicity is an independent prognostic factor for OS and PSCC-SS, and non-Hispanic black were proven to have unfavorable OS and PSCC-SS compared with NHW.
Collapse
|
|
33
|
Fullmer T, Wilde DC, Shi JW, Wagner T, Skinner H, Eicher SA, Sandulache VC, Hernandez DJ. Demographic and Tumor Characteristic Impact on Laryngeal Cancer Outcomes in a Minority Underserved Patient Population. Otolaryngol Head Neck Surg 2020; 162:888-896. [PMID: 32093532 DOI: 10.1177/0194599820907064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Advanced laryngeal squamous cell carcinoma remains associated with approximately 50% mortality at 5 years. Delivery of multimodality treatment remains critical to maximizing survival for this disease, but achieving this at a national level remains a difficult undertaking, particularly in under- and uninsured patients as well as minority patients. We sought to evaluate laryngeal cancer treatment delivery and clinical outcomes in a predominantly minority and underserved cohort of largely under- and uninsured patients in a county hospital. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care county hospital in Houston, Texas. SUBJECTS AND METHODS Patients (N = 210) with a new diagnosis of laryngeal squamous cell carcinoma treated between 2005 and 2015 were included in a retrospective analysis of patient demographics, tumor and treatment characteristics, and oncologic outcomes. RESULTS The majority of patients presented with advanced disease (T4 = 43%, N>0 = 45%). Treatment selection was compliant with National Comprehensive Cancer Network guidelines in 81% of cases, but 76% of patients who required adjuvant radiotherapy were unable to start it within 6 weeks postsurgery. Overall survival and disease-free survival were 52% and 63% for the entire cohort, respectively. Supraglottic subsite and nodal metastases were significantly associated with decreased overall survival and disease-free survival. Race/ethnicity and insurance status were not associated with worse oncologic outcomes. CONCLUSION Under- and uninsured patients often present with advanced laryngeal cancer. Oncologic outcomes in this cohort of patients is similar to that of other published series. Moreover, tumor characteristics rather than demographic variables drive oncologic outcomes for the predominantly minority and underserved patients seeking care in our tertiary care county hospital.
Collapse
Affiliation(s)
- Tanner Fullmer
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - David C Wilde
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Justin W Shi
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Timothy Wagner
- Department of Radiation Oncology, UT Health San Antonio, San Antonio, Texas, USA
| | - Heath Skinner
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Susan A Eicher
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - David J Hernandez
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
|
34
|
Global burden of larynx cancer, 1990-2017: estimates from the global burden of disease 2017 study. Aging (Albany NY) 2020; 12:2545-2583. [PMID: 32035421 PMCID: PMC7041735 DOI: 10.18632/aging.102762] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/12/2020] [Indexed: 12/13/2022]
Abstract
Larynx cancer is one of the most common cancers in head and neck. This study aimed to investigate the health burden of larynx cancer at global, regional, and national levels. We collected data of larynx cancer between 1990 and 2017 from the Global Burden of Disease study, including incidence, mortality, and disability adjusted life-years (DALYs). Estimated annual percentage changes (EAPCs) were calculated to assess the changes in age-standardized rate (ASR) of larynx cancer. From 1990 to 2017, LC incident cases increased by 58.67%; however, age-standardized incidence rate (ASIR) decreased, with an EAPC of -0.99. Additionally, the incident cases and ASIR of LC were 6-fold higher for male than those for female in 2017. Over the past 28 years, deaths and DALYs of larynx cancer increased by 33.84% and 25%. Contrarily, age-standardized death and DALY rate showed a downward trend. Incidence, death, and DALYs of larynx cancer were always the highest in people aged 50-69 years. Overall, all the ASRs showed downward trends globally. The majority of larynx cancer burden was observed in men, especially among male aged 50-69 years. South and East Asia carried the heaviest burden of larynx cancer worldwide.
Collapse
|
|
35
|
Fullmer TM, Shi J, Skinner HD, Hernandez DJ, Huang AT, Mai W, Parke RB, Donovan DT, Sandulache VC. Early glottic cancer in a veteran population: Impact of race on management and outcomes. Laryngoscope 2019; 130:1733-1739. [PMID: 31461171 DOI: 10.1002/lary.28262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/03/2019] [Accepted: 08/12/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Multiple population studies have shown racial discrepancies in head and neck cancer treatment and outcomes. We sought to characterize the impact of race on clinical outcomes for patients with early glottic squamous cell carcinoma (SCC) in a tertiary institution which provides equivalent access to care. METHODS We retrospectively reviewed all early glottic (T1-T2) squamous cell carcinoma at a single institution, the Michael E. DeBakey Veterans' Administration Medical Center (MEDVAMC). Data collected included demographic information, primary and adjuvant treatment modalities, time to diagnosis, time to treatment, recurrences, recurrence treatment modality, secondary malignancies, recurrence-free survival (RFS), and overall survival (OS). RESULTS One hundred seventeen patients with a primary diagnosis of T1-T2 glottic squamous cell carcinoma were included. Black and white patients demonstrated equivalent rates of recurrence, RFS, and OS. There was no significant difference in treatment delivery by race for all recorded parameters. T1b tumors were associated with an increased risk of recurrence which did not translate into a statistically significant decrease in RFS or OS. Surgical treatment was associated with increased recurrence but similar RFS and OS compared to radiation-based treatment. Secondary malignancies were common; 12% of patients were diagnosed with a second primary lung cancer during the study period. CONCLUSION At our institution, race did not impact survival when access to care, treatment selection, and delivery are equivalent for early glottic SCC. Secondary lung cancer is a critical risk factor for mortality in this patient group and requires long-term surveillance and monitoring. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1733-1739, 2020.
Collapse
Affiliation(s)
- Tanner M Fullmer
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Justin Shi
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Heath D Skinner
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - David J Hernandez
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Andrew T Huang
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Weiyuan Mai
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Robert B Parke
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Donald T Donovan
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| | - Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, U.S.A
| |
Collapse
|
|
36
|
Nachalon Y, Reicher Y, Alkan U, Levi L, Bachar G, Popovtzer A. Prognostic factors for survival and nonfunctional larynx in patients with squamous cell carcinoma of the larynx. Laryngoscope 2019; 130:1202-1205. [DOI: 10.1002/lary.28173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Yuval Nachalon
- Department of Otolaryngology–Head and Neck SurgeryRabin Medical Center Petach Tikva Israel
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Yael Reicher
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Uri Alkan
- Department of Otolaryngology–Head and Neck SurgeryRabin Medical Center Petach Tikva Israel
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Lirit Levi
- Department of Otolaryngology–Head and Neck SurgeryRabin Medical Center Petach Tikva Israel
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Gideon Bachar
- Department of Otolaryngology–Head and Neck SurgeryRabin Medical Center Petach Tikva Israel
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Aron Popovtzer
- Davidoff Cancer CenterRabin Medical Center Petach Tikva Israel
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| |
Collapse
|
|
37
|
Anzalone CL, Glasgow AE, Van Gompel JJ, Carlson ML. Racial Differences in Disease Presentation and Management of Intracranial Meningioma. J Neurol Surg B Skull Base 2018; 80:555-561. [PMID: 31750040 DOI: 10.1055/s-0038-1676788] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022] Open
Abstract
Objective/Hypothesis The aim of the study was to determine the impact of race on disease presentation and treatment of intracranial meningioma in the United States. Study Design This study comprised of the analysis of a national population-based tumor registry. Methods Analysis of the surveillance, epidemiology, and end results (SEER) database was performed, including all patients identified with a diagnosis of intracranial meningioma. Associations between race, disease presentation, treatment strategy, and overall survival were analyzed in a univariate and multivariable model. Results A total of 65,973 patients with intracranial meningiomas were identified. Of these, 45,251 (68.6%) claimed white, 7,796 (12%) black, 7,154 (11%) Hispanic, 4,902 (7%) Asian, and 870 (1%) patients reported "other-unspecified" or "other-unknown." The median annual incidence of disease was lowest among black (3.43 per 100,000 persons) and highest among white (9.52 per 100,000 persons) populations ( p < 0.001). Overall, Hispanic patients were diagnosed at the youngest age and white patients were diagnosed at the oldest age (mean of 59 vs. 66 years, respectively; p < 0.001). Compared with white populations, black, Hispanic, and Asian populations were more likely to present with larger tumors ( p < 0.001). After controlling for tumor size, age, and treatment center in a multivariable model, Hispanic patients were more likely to undergo surgery than white, black, and Asian populations. Black populations had the poorest disease specific and overall survival rates at 5 years following surgery compared with other groups. Conclusion Racial differences among patients with intracranial meningioma exist within the United States. Understanding these differences are of vital importance toward identifying potential differences in the biological basis of disease or alternatively inequalities in healthcare delivery or access Further studies are required to determine which factors drive differences in tumor size, age, annual disease incidence, and overall survival between races.
Collapse
Affiliation(s)
- C Lane Anzalone
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Amy E Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Minnesota, United States
| | - Jamie J Van Gompel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| |
Collapse
|
|
38
|
Morse E, Berson E, Fujiwara R, Judson B, Mehra S. Hypopharyngeal Cancer Treatment Delays: Benchmarks and Survival Association. Otolaryngol Head Neck Surg 2018; 160:267-276. [DOI: 10.1177/0194599818797605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective To characterize treatment delays in hypopharyngeal cancer, identify factors associated with delays, and associate delays with overall survival. Study Design Retrospective cohort. Setting Commission on Cancer hospitals nationwide. Subjects and Methods We included patients in the National Cancer Database who were treated for hypopharyngeal cancer with primary radiation, concurrent chemoradiation, or induction chemotherapy and radiation. We identified median durations of diagnosis to treatment initiation (DTI), radiation treatment duration (RTD), and diagnosis to treatment end (DTE). We associated delays with patient, tumor, and treatment factors and overall survival via multivariable logistic and Cox proportional hazards regression, respectively. Results A total of 3850 patients treated with primary radiation or concurrent chemoradiation were included. Median durations of DTI, RTD, and DTE were 37, 52, and 92 days, respectively. Nonwhite race was associated with delays in DTI (odds ratio [OR] = 0.64; 95% CI, 0.51-0.80; P < .001) and DTE (OR = 0.60; 95% CI, 0.49-0.75; P < .001). Medicaid insurance was associated with delays in DTI (OR = 1.43; 95% CI, 1.07-1.90; P = .015), RTD (OR = 1.39; 95% CI, 1.06-1.83; P = .018), and DTE (OR = 1.48; 95% CI, 1.12-1.97; P = .007). Delays in RTD (hazard ratio [HR] = 1.24; 95% CI, 1.11-1.37; P < .001), not DTI (HR = 0.92; 95% CI, 0.82-1.03; P = .150) or DTE (HR = 1.01; 95% CI, 0.90-1.15; P = .825), were associated with impaired overall survival. We identified 922 patients who received induction chemotherapy. Delays in DTI, RTD, and DTE were not associated with overall survival in this cohort (HR = 1.10; 95% CI, 0.87-1.39; P = 0.435; HR = 1.05; 95% CI, 0.83-1.32; P = 0.686; HR = 1.11; 95% CI, 0.88-1.41; P = 0.377, respectively). Conclusions The median durations identified can serve as national benchmarks. Delays during radiation are associated with impaired overall survival among patients treated with primary radiation or chemoradiation but not patients treated with induction chemotherapy.
Collapse
Affiliation(s)
- Elliot Morse
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Elisa Berson
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Rance Fujiwara
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Benjamin Judson
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| |
Collapse
|
|
39
|
Treatment of early-stage laryngeal cancer: A comparison of treatment options. Oral Oncol 2018; 87:8-16. [PMID: 30527248 DOI: 10.1016/j.oraloncology.2018.09.012] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/02/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022]
Abstract
Over the course of the last several decades, the treatment options for early laryngeal cancers (T1 and T2) have evolved; however, simultaneously the mortality rate has increased. As larynx preservation approaches have become the standard of care, the selection of the proper treatment modality has become paramount. Radiation therapy or transoral laser microsurgery are the most common options for treatment of these early lesions. Oncologic and functional outcomes are considered equivalent between the two modalities for early glottic cancers; however, no direct comparisons exist for robust analysis. In terms of larynx preservation, there also is not compelling data favoring one treatment option or another. For early stage lesions, the goal for any larynx-sparing technique, either radiation or surgery, should be the intent to cure with single modality treatment and minimal short- and long-term toxicity. This article is designed to create a frame of reference for managing early stage disease with respect to lesions of the glottis and supraglottis while weighing treatment implications from an oncologic, functional, and cost perspective.
Collapse
|
|
40
|
Otolaryngology-Related Disorders in Underserved Populations, Otolaryngology Training and Workforce Considerations in North America. Otolaryngol Clin North Am 2018; 51:685-695. [DOI: 10.1016/j.otc.2018.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
|
41
|
Kravietz A, Angara P, Le M, Sargi Z. Disparities in Screening for Head and Neck Cancer: Evidence from the NHANES, 2011-2014. Otolaryngol Head Neck Surg 2018; 159:683-691. [DOI: 10.1177/0194599818773074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Adam Kravietz
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Prashant Angara
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Mina Le
- Veterans Affairs Medical Center, West Palm Beach, Florida, USA
| | - Zoukaa Sargi
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| |
Collapse
|
|
42
|
Shi X, Hu WP, Ji QH. Development of comprehensive nomograms for evaluating overall and cancer-specific survival of laryngeal squamous cell carcinoma patients treated with neck dissection. Oncotarget 2018; 8:29722-29740. [PMID: 28430613 PMCID: PMC5444698 DOI: 10.18632/oncotarget.15414] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/01/2017] [Indexed: 12/13/2022] Open
Abstract
Background Neck dissection for laryngeal squamous cell carcinoma (LSCC) patients could provide complementary prognostic information for AJCC N staging, like lymph node ratio (LNR). The aim of this study was to develop effective nomograms to better predict survival for LSCC patients treated with neck dissection. Results 2752 patients were identified and randomly divided into training (n = 2477) and validation (n = 275) cohorts. The 3- and 5-year probabilities of cancer-specific mortality (CSM) were 30.1% and 37.2% while 3- and 5-year death resulting from other causes (DROC) rate were 6.2% and 11.3%, respectively. 13 significant prognostic factors including LNR for overall (OS) and 12 (except race) for CSS were enrolled in the nomograms. Concordance index as a commonly used indicator of predictive performance, showed the nomograms had superiority over the no-LNR models and TNM classification (Training-cohort: OS: 0.713 vs 0.703 vs 0.667, CSS: 0.725 vs 0.713 vs 0.688; Validation-cohort: OS: 0.704 vs 0.690 vs 0.658, cancer-specific survival (CSS): 0.709 vs 0.693 vs 0.672). All calibration plots revealed good agreement between nomogram prediction and actual survival. Materials and Methods We identified LSCC patients undergoing neck dissection diagnosed between 1988 and 2008 from Surveillance, Epidemiology, and End Results (SEER) database. Optimal cutoff points were determined by X-tile program. Cumulative incidence function was used to analyze cancer-specific mortality (CSM) and death resulting from other causes (DROC). Significant predictive factors were used to establish nomograms estimating overall (OS) and cancer-specific survival (CSS). The nomograms were bootstrapped validated both internally and externally. Conclusions Comprehensive nomograms were constructed to predict OS and CSS for LSCC patients treated with neck dissection more accurately.
Collapse
Affiliation(s)
- Xiao Shi
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei-Ping Hu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
|
43
|
Morse E, Fujiwara RJT, Judson B, Mehra S. Treatment Times in Salivary Gland Cancer: National Patterns and Association with Survival. Otolaryngol Head Neck Surg 2018; 159:283-292. [PMID: 29460669 DOI: 10.1177/0194599818758020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective To characterize treatment times in salivary cancer; associate treatment times with patient, tumor, and treatment characteristics; and examine the association of treatment times and overall survival. Study Design Retrospective cohort. Setting Commission-on-Cancer Accredited Hospitals 2004-2013. Subjects and Methods In total, 5953 patients with salivary cancer included in the National Cancer Database were identified. For each treatment interval, patients in the fourth quartile ("prolonged") were compared to patients in the first and second quartiles ("not prolonged"). Patient, tumor, and treatment characteristics were associated with prolonged times via multivariable binary logistic regression. Prolongation of each interval was associated with overall survival via multivariable Cox proportional hazards regression, controlling for clinically relevant factors. Results Median durations for diagnosis-to-treatment initiation, surgery-to-radiation treatment (RT), RT duration, total treatment package, and diagnosis-to-treatment end were 31, 44, 47, 92, and 110 days, respectively. Race, insurance status, comorbidities, age, T and N stage, facility volume and location, and a facility care transition from diagnosis to initial treatment were associated with prolonged treatment time. Prolonged RT duration was associated with decreased overall survival (OS) (62% vs 75% 5-year OS, HR = 1.26 [95% confidence interval (CI), 1.09-1.47]; P = .002), but prolonged diagnosis-to-treatment initiation, surgery-to-RT, total treatment package, and diagnosis-to-treatment end intervals were not (70% vs 67% 5-year OS, HR = 1.11 [95% CI, 0.92-1.34], P = .284; 72% vs 68%, HR = 0.93 [95% CI, 0.79-1.09], P = .370; 70% vs 70%, HR = 1.00 [95% CI, 0.84-1.20], P = .974; 66% vs 71%, HR = 0.99 [95% CI, 0.84-1.18], P = .920, respectively). Conclusion The median durations identified here can serve as reference points. Radiation therapy duration is associated with overall survival in salivary cancer and could be considered a quality indicator.
Collapse
Affiliation(s)
- Elliot Morse
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rance J T Fujiwara
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin Judson
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- 1 Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
|
44
|
Patient Choice of Nonsurgical Treatment Contributes to Disparities in Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2018; 158:1057-1064. [DOI: 10.1177/0194599818755353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives There are well-established outcome disparities among different demographic groups with head and neck squamous cell carcinoma (HNSCC). We aimed to investigate the potential contribution of patient choice of nonsurgical treatment to these disparities by estimating the rate of this phenomenon, identifying its predictors, and estimating the effect on cancer-specific survival. Study Design Retrospective nationwide analysis. Settings Surveillance, Epidemiology, and End Results Database (2004-2014). Subjects and Methods Patients with HNSCC, who were recommended for primary surgery, were included. Multivariable logistic regression was used to identify demographic and clinical factors associated with patient choice of nonsurgical treatment, and Kaplan Meier/Cox regression was used to analyze survival. Results Of 114,506 patients with HNSCC, 58,816 (51.4%) were recommended for primary surgery, and of those, 1550 (2.7%) chose nonsurgical treatment. Those who chose nonsurgical treatment were more likely to be older (67.1 ± 12.6 vs 63.6 ± 13.1, P < .01), were of Black (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.28-1.74) or Asian (OR = 1.79; 95% CI, 1.46-2.20) ethnicity, were unmarried (OR married, 0.50; 95% CI, 0.44-0.58), had an advanced tumor, and had a hypopharyngeal or laryngeal primary. Choice of nonsurgical treatment imparted a 2.16-fold (95% CI, 2.02-2.30) increased risk of cancer-specific death. Conclusion Of the patients, 2.7% chose nonsurgical treatment despite a provider recommendation that impairs survival. Choice of nonsurgical treatment is associated with older age, having Black or Asian ethnicity, being unmarried, having an advanced stage tumor, and having a primary site in the hypopharynx or larynx. Knowledge of these disparities may help providers counsel patients and help patients make informed decisions.
Collapse
|
|
45
|
McClelland S, Perez CA. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States-part 3: Hispanic-American patients. Adv Radiat Oncol 2017; 3:93-99. [PMID: 29904731 PMCID: PMC6000066 DOI: 10.1016/j.adro.2017.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/30/2017] [Accepted: 12/06/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose Health disparities have profoundly affected underrepresented minorities throughout the United States, particularly with regard to access to evidence-based interventions such as surgery or medication. The degree of disparity in access to radiation therapy (RT) for Hispanic-American patients with cancer has not been previously examined in an extensive manner. Methods and materials An extensive literature search was performed using the PubMed database to examine studies investigating disparities in RT access for Hispanic-Americans. Results A total of 34 studies were found, spanning 10 organ systems. Disparities in access to RT for Hispanic-Americans were most prominently studied in cancers of the breast (15 studies), prostate (4 studies), head and neck (4 studies), and gynecologic system (3 studies). Disparities in RT access for Hispanic-Americans were prevalent regardless of the organ system studied and were compounded by limited English proficiency and/or birth outside of the United States. A total of 26 of 34 studies (77%) involved analysis of a population-based database, such as Surveillance, Epidemiology and End Result (15 studies); Surveillance, Epidemiology and End Result-Medicare (4 studies); National Cancer Database (3 studies); or a state tumor registry (4 studies). Conclusions Hispanic-Americans in the United States have diminished RT access compared with Caucasian patients but are less likely to experience concomitant disparities in mortality than other underrepresented minorities that experience similar disparities (ie, African-Americans). Hispanic-Americans who are born outside of the United States and/or have limited English proficiency may be more likely to experience substandard RT access. These results underscore the importance of finding nationwide solutions to address such inequalities that hinder Hispanic-Americans and other underrepresented minorities throughout the United States.
Collapse
Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Carmen A Perez
- Department of Radiation Oncology, New York University, New York, New York
| |
Collapse
|
|
46
|
Zuniga SA, Lango MN. Effect of rural and urban geography on larynx cancer incidence and survival. Laryngoscope 2017; 128:1874-1880. [PMID: 29238975 DOI: 10.1002/lary.27042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/09/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES/HYPOTHESIS Investigate the impact of rural geography on larynx cancer incidence and survival. STUDY DESIGN Surveillance, Epidemiology, and End Results (SEER) database study. METHODS Incidence and survival rates by Rural-Urban Continuum codes for larynx squamous cell carcinoma patients diagnosed from 2004 to 2012 were evaluated using SEER statistical software and Cox proportional hazards survival analysis. RESULTS The lowest age-adjusted incidence rates for larynx cancer were seen in densely populated urban regions, with mean rates of 2.8 per 100,000 person years (95% confidence interval [CI]: 2.7-2.8); the highest were in the most rural areas, with mean rates of 5.3 per 100,000 person years (95% CI: 4.7-5.9). Nevertheless, of 23,659 larynx cancer patients diagnosed over this period, 19,556 (82.7%) arose in urban residents, compared with 1,428 or 6% from rural areas. Urban larynx cancer patients more likely lived in counties with an American College of Surgeons-approved cancer center and/or a fourfold greater otolaryngology physician supply. Nevertheless, frequency of advanced stage at initial presentation was similar. Cause-specific and overall survival were no different, both on univariable and multivariable analyses. CONCLUSIONS Compared with urban populations, Rural populations are at greater risk of developing larynx cancer, but initial stage and survival after diagnosis are comparable. Priority should be given to prevention strategies to decrease incidence rates. LEVEL OF EVIDENCE 4 Laryngoscope, 1874-1880, 2018.
Collapse
Affiliation(s)
- Steven A Zuniga
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University
| | - Miriam N Lango
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University
- Department of Surgical Oncology, Head and Neck Surgery Section, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, U.S.A
| |
Collapse
|
|
47
|
Forastiere AA, Ismaila N, Lewin JS, Nathan CA, Adelstein DJ, Eisbruch A, Fass G, Fisher SG, Laurie SA, Le QT, O'Malley B, Mendenhall WM, Patel S, Pfister DG, Provenzano AF, Weber R, Weinstein GS, Wolf GT. Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2017; 36:1143-1169. [PMID: 29172863 DOI: 10.1200/jco.2017.75.7385] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To update the guideline recommendations on the use of larynx-preservation strategies in the treatment of laryngeal cancer. Methods An Expert Panel updated the systematic review of the literature for the period from January 2005 to May 2017. Results The panel confirmed that the use of a larynx-preservation approach for appropriately selected patients does not compromise survival. No larynx-preservation approach offered a survival advantage compared with total laryngectomy and adjuvant therapy as indicated. Changes were supported for the use of endoscopic surgical resection in patients with limited disease (T1, T2) and for initial total laryngectomy in patients with T4a disease or with severe pretreatment laryngeal dysfunction. New recommendations for positron emission tomography imaging for the evaluation of regional nodes after treatment and best measures for evaluating voice and swallowing function were added. Recommendations Patients with T1, T2 laryngeal cancer should be treated initially with intent to preserve the larynx by using endoscopic resection or radiation therapy, with either leading to similar outcomes. For patients with locally advanced (T3, T4) disease, organ-preservation surgery, combined chemotherapy and radiation, or radiation alone offer the potential for larynx preservation without compromising overall survival. For selected patients with extensive T3 or large T4a lesions and/or poor pretreatment laryngeal function, better survival rates and quality of life may be achieved with total laryngectomy. Patients with clinically involved regional cervical nodes (N+) who have a complete clinical and radiologic imaging response after chemoradiation do not require elective neck dissection. All patients should undergo a pretreatment baseline assessment of voice and swallowing function and receive counseling with regard to the potential impact of treatment options on voice, swallowing, and quality of life. Additional information is available at www.asco.org/head-neck-cancer-guidelines and www.asco.org/guidelineswiki .
Collapse
Affiliation(s)
- Arlene A Forastiere
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Nofisat Ismaila
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Jan S Lewin
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Cherie Ann Nathan
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - David J Adelstein
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Avraham Eisbruch
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Gail Fass
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Susan G Fisher
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Scott A Laurie
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Quynh-Thu Le
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Bernard O'Malley
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - William M Mendenhall
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Snehal Patel
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - David G Pfister
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Anthony F Provenzano
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Randy Weber
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Gregory S Weinstein
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| | - Gregory T Wolf
- Arlene A. Forastiere, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Jan S. Lewin and Randy Weber, The University of Texas MD Anderson Cancer Center, Houston, TX; Cherie Ann Nathan, LSU Health, Shreveport, LA; David J. Adelstein, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Avraham Eisbruch and Gregory T. Wolf, University of Michigan, Ann Arbor, MI; Gail Fass, Support for People With Oral Head and Neck Cancer, Locust Valley; Bernard O'Malley, Snehal Patel, and David G. Pfister, Memorial Sloan Kettering Cancer Center; Anthony F. Provenzano, New York-Presbyterian Lawrence Hospital, New York, NY; Susan G. Fisher, Temple University; Gregory S. Weinstein, University of Pennsylvania School of Medicine, Philadelphia, PA; Scott A. Laurie, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Quynh-Thu Le, Stanford University, Stanford, CA; and William M. Mendenhall, University of Florida, Gainesville, FL
| |
Collapse
|
|
48
|
Jalisi S, Rubin SJ, Wu KY, Kirke DN. Outcomes of head and neck cancer surgery in the geriatric population based on case volume at academic centers. Laryngoscope 2017; 127:2539-2544. [DOI: 10.1002/lary.26750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/06/2017] [Accepted: 05/30/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Scharukh Jalisi
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston Massachusetts U.S.A
| | - Samuel J. Rubin
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston Massachusetts U.S.A
| | - Kevin Y. Wu
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston Massachusetts U.S.A
| | - Diana N. Kirke
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston Massachusetts U.S.A
| |
Collapse
|
|
49
|
Abstract
Answer questions and earn CME/CNE Laryngeal cancer remains one of the most common tumors of the respiratory tract. Fortunately, significant advancements have been made over the past decade in the treatment of laryngeal cancer. Although surgery has been the historical mainstay for localized disease and still is an integral part of treatment, nonsurgical options like radiation and systemic therapy have emerged as viable options. In addition, in the metastatic setting, novel agents are showing promise for this patient population. The care for patients with laryngeal cancer continues to evolve and truly requires a multidisciplinary team-based approach. Unique morbidities, such as loss of natural voice, respiration, and airway protection during swallowing, are observed with this disease and require special consideration. CA Cancer J Clin 2017;67:31-50. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Conor E Steuer
- Assistant Professor, Department of Hematology Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Mark El-Deiry
- Associate Professor, Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Jason R Parks
- Resident, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Kristin A Higgins
- Assistant Professor, Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Nabil F Saba
- Professor and Director of the Head and Neck Medical Oncology Program, Department of Hematology Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| |
Collapse
|
|
50
|
Cheraghlou S, Kuo P, Judson BL. Treatment delay and facility case volume are associated with survival in early-stage glottic cancer. Laryngoscope 2016; 127:616-622. [DOI: 10.1002/lary.26259] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 07/09/2016] [Accepted: 07/28/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Shayan Cheraghlou
- Department of Surgery; Yale School of Medicine; New Haven Connecticut U.S.A
| | - Phoebe Kuo
- Department of Surgery; Yale School of Medicine; New Haven Connecticut U.S.A
| | - Benjamin L. Judson
- Department of Surgery; Yale School of Medicine; New Haven Connecticut U.S.A
| |
Collapse
|