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Borges MVC, Pereira EM, Santos RTP, de Oliveira ICV, Thomaz EBAF, Rodrigues V. Temporal trends in treatment delays for oral and oropharyngeal cancer in Brazil: An analysis of the national database. J Public Health Dent 2025; 85:102-110. [PMID: 39910902 DOI: 10.1111/jphd.12658] [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: 05/31/2024] [Revised: 09/06/2024] [Accepted: 12/14/2024] [Indexed: 02/07/2025]
Abstract
OBJECTIVES This study investigated regional trends in delays between the histological diagnosis of oral and oropharyngeal cancer and initiation of treatment across Brazil's federal units from 2013 to 2019. METHODS A retrospective, observational study was conducted using secondary data from the Brazilian Health System Database (DATASUS) for the years 2013-2019. Variables collected included the year of treatment, sex, age group, anatomical location, disease stage, treatment method, and federal unit of Brazil. Thematic maps were generated, and time series were analyzed using joint-point regression. RESULTS A total of 72,062 cases were included in the study. Majority of cases were of men (79.32%) and individuals older than 45 years (91.15%). Treatment was initiated earlier in younger patients, in cases of lip cancer, and among those who had undergone surgery. In 11 states, a significant decrease was observed in initiating treatment for oral cancer 60 days from diagnosis, whereas a significant increase was observed in three states. For oropharyngeal cancer, a significant decrease was observed in initiating treatment at 60 days from diagnosis in three states, whereas a significant increase was observed in five states. CONCLUSIONS The findings revealed a high degree of heterogeneity in treatment delays for oral and oropharyngeal cancer across Brazil from 2013 to 2019. The northern states of Brazil exhibited a high percentage of treatment delays exceeding 60 days.
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Affiliation(s)
| | | | | | | | - Erika Barbara Abreu Fonseca Thomaz
- Dentistry Graduate Program, Federal University of Maranhão, São Luís, Brazil
- Department of Public Health, Federal University of Maranhão, São Luís, Brazil
| | - Vandilson Rodrigues
- Dentistry Graduate Program, Federal University of Maranhão, São Luís, Brazil
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Khaja SF, Wilke CT. Impact of Head and Neck Multidisciplinary Clinic on Treatment Package Time During 2 Years of the COVID-19 Pandemic: A Single-Institution Experience. J Am Coll Surg 2025; 240:281-287. [PMID: 39382186 DOI: 10.1097/xcs.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
BACKGROUND Prolongation of treatment package time is strongly associated with inferior oncologic outcomes. We examine the effect of creation of a multidisciplinary head and neck clinic on treatment package times. STUDY DESIGN This was a retrospective cohort study evaluating treatment package time in patients receiving adjuvant radiation through a multidisciplinary clinic compared with standard clinics at a single academic institution between July 31, 2020, and July 31, 2022. RESULTS Adjuvant radiotherapy was administered to 23 patients in multidisciplinary clinic, 68 patients in standard clinic and 17 patients in satellite clinics. Patients seen in multidisciplinary clinic began adjuvant radiation sooner (median 35 vs 41 vs 48 days, p = 0.01) with more compact treatment package times (median 78 vs 84 vs 86 days, p = 0.003). Nine patients (13%) in standard clinics and 4 patients (24%) at the satellite clinics had adjuvant treatment package times exceeding 100 days. No patient seen in multidisciplinary clinic had treatment package times exceeding 100 days. CONCLUSIONS Colocalization of radiation oncology and otolaryngology care in multidisciplinary clinic substantially improved time to postoperative radiotherapy and treatment package times. This is likely due to the identification of patients requiring adjuvant radiation earlier in their clinical presentation which in turn allowed for advanced planning and minimization of delays in initiation of adjuvant radiation.
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Affiliation(s)
- Sobia F Khaja
- From the Departments of Otolaryngology (Khaja), University of Minnesota, Minneapolis, MN
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Lee ML, Finegersh A, Chen MM. Impact of the COVID-19 Pandemic on the Treatment of Head and Neck Cancers. J Clin Med 2025; 14:1424. [PMID: 40094865 PMCID: PMC11899811 DOI: 10.3390/jcm14051424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 01/30/2025] [Accepted: 02/13/2025] [Indexed: 03/19/2025] Open
Abstract
Background/Objectives: The COVID-19 pandemic led to unprecedented disruptions to cancer care, including the care of head and neck cancer. Given the necessity of timely treatment for mucosal cancers, it is important to understand how the pandemic affected the diagnosis, presentation, and treatment of mucosal head and neck cancer. Methods: The National Cancer Database was queried for patients with primary head and neck mucosal cancer. The number of annual diagnoses and the number of days between diagnosis and the start and end of any treatment were tracked over time from 2004 to 2020. Chi-square tests were used to compare differences in patient clinical and demographic characteristics in 2019 and 2020 to provide the most direct comparison. Multivariable linear regression and logic regression analyses were also used to compare three treatment quality measures between 2019 and 2020: number of days between diagnosis and start of treatment, number of days between surgery and start of postoperative radiation, and number of days between surgery and end of radiation. Results: The number of mucosal cancer diagnoses decreased (9.1%) during the early stages of the pandemic, with a larger decrease (12.4%) among patients receiving surgery. On multivariable analysis comparing 2020 to 2019, time to treatment was shorter (2.3 days; 95% CI, 1.69 to 2.85 days), and time from surgery to start of postoperative radiation was less likely to be delayed (OR, 0.91 of radiation greater than 42 days from surgery; 95% CI, 0.85 to 0.97). However, patients who were black, female, older, or uninsured were more likely to experience treatment delays. Conclusions: Overall, there were no treatment delays for patients with surgical head cancer and patients with neck cancer during the COVID-19 pandemic. However, vulnerable groups, such as patients who were black, female, older, and uninsured, were at higher risk of experiencing treatment delays.
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Affiliation(s)
- Max L. Lee
- Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA 94304, USA; (M.L.L.); (A.F.)
| | - Andrey Finegersh
- Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA 94304, USA; (M.L.L.); (A.F.)
- Department of Surgery, Palo Alto Veterans Administration, Palo Alto, CA 94304, USA
| | - Michelle M. Chen
- Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA 94304, USA; (M.L.L.); (A.F.)
- Department of Surgery, Palo Alto Veterans Administration, Palo Alto, CA 94304, USA
- ValleyCare Pleasanton Cancer Center, Pleasanton, CA 94588, USA
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Szabó É, Kopjár E, Rumi L, Bellyei S, Zemplényi A, Mátyus E, Édes E, Girán J, Kiss I, Szanyi I, Pozsgai É. Shorter Time to Biopsy of Patients with Head and Neck Squamous Cell Carcinoma During the COVID-19 Pandemic in Hungary. Cancers (Basel) 2025; 17:360. [PMID: 39941734 PMCID: PMC11815749 DOI: 10.3390/cancers17030360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 01/15/2025] [Accepted: 01/20/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND/OBJECTIVES The goal of this investigation was to compare the time to biopsy (TBI) and time to treatment (TTI) for head and neck squamous cell carcinoma (HNSCC) patients before and during the COVID-19 pandemic and to examine the effect of demographic and clinical characteristics on these intervals. METHODS Our retrospective study at a large regional Hungarian cancer center analyzed data from patients aged 18 or older diagnosed with HNSCC between 1 January 2017 and 15 March 2020 (pre-COVID-19 period) and 16 March 2020 to 13 May 2021 (COVID-19 period). We calculated the time from initial physician contact to biopsy (TBI) and from biopsy to treatment initiation (TTI) and performed descriptive and exploratory statistical analyses. RESULTS The median TBI decreased significantly (6 vs. 3 days; p = 0.008), while the median TTI was not affected significantly (28 vs. 29 days; p = 0.972) pre-pandemic and during the pandemic, respectively. Residence in a village was linked to a significant reduction in median TBI during the pandemic (p = 0.000), coinciding with a higher proportion of rural patients diagnosed with oral cavity/oropharyngeal cancers during the pandemic (50.3% pre-pandemic vs. 67.4% during pandemic, p = 0.044). Median TTI decreased significantly during the pandemic for patients with laryngeal tumors (27.5 vs. 18.5 days; p = 0.012). CONCLUSIONS Our study, one of a few from this region, provides insights into HNSCC patient waiting times. Improvement in TBI likely resulted from the availability of telemedicine, reduced diagnostic demands from non-cancer patients, and an increased incidence of oral cavity/oropharyngeal cancer among rural patients.
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Affiliation(s)
- Éva Szabó
- Department of Otorhinolaryngology, University of Pécs Clinical Center, Munkácsy M. Street 2, 7621 Pécs, Hungary
| | - Eszter Kopjár
- Department of Otorhinolaryngology, University of Pécs Clinical Center, Munkácsy M. Street 2, 7621 Pécs, Hungary
| | - László Rumi
- Urology Clinic, University of Pécs Clinical Center, Munkácsy Mihaly Street 2, 7621 Pécs, Hungary
| | - Szabolcs Bellyei
- Department of Oncotherapy, University of Pécs Clinical Center, Édesanyák Street 17, 7624 Pécs, Hungary
| | - Antal Zemplényi
- Center for Health Technology Assessment and Pharmacoeconomics Research, University of Pécs Faculty of Pharmacy, Rákóczi Street 2, 7623 Pécs, Hungary
| | - Emese Mátyus
- Department of Oncotherapy, University of Pécs Clinical Center, Édesanyák Street 17, 7624 Pécs, Hungary
| | - Eszter Édes
- Department of Oncotherapy, University of Pécs Clinical Center, Édesanyák Street 17, 7624 Pécs, Hungary
| | - János Girán
- Department of Public Health Medicine, University of Pécs Medical School, Szigeti Street 12, 7624 Pécs, Hungary
| | - István Kiss
- Department of Public Health Medicine, University of Pécs Medical School, Szigeti Street 12, 7624 Pécs, Hungary
| | - István Szanyi
- Department of Otorhinolaryngology, University of Pécs Clinical Center, Munkácsy M. Street 2, 7621 Pécs, Hungary
| | - Éva Pozsgai
- Department of Public Health Medicine, University of Pécs Medical School, Szigeti Street 12, 7624 Pécs, Hungary
- Department of Primary Health Care, University of Pécs Medical School, Rákóczi Street 2, 7623 Pécs, Hungary
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Villemure-Poliquin N, Fu R, Gaebe K, Kwon J, Cohen M, Ruel M, Ayoo K, Bailey A, Galapin M, Hallet J, Eskander A. Delayed diagnosis to treatment interval (DTI) in head & neck cancers - A systematic review and meta-analysis. Oral Oncol 2025; 160:107106. [PMID: 39577127 DOI: 10.1016/j.oraloncology.2024.107106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 10/31/2024] [Accepted: 11/06/2024] [Indexed: 11/24/2024]
Abstract
INTRODUCTION Delayed diagnosis to treatment interval (DTI) in head and neck cancers (HNC) can significantly impact patient outcomes. The need for multimodal treatment in HNC may cause delays in initiation of treatment. This systematic review aims to provide a comprehensive understanding of the consequences of delayed DTI on both oncologic and QoL outcomes, proposing a new quality benchmark along the treatment continuum of HNC patients. METHODS We searched MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases for trials and cohort studies evaluating the impact of delayed DTI in patients with HNC. Outcomes included overall survival (OS), disease-free survival (DFS), locoregional (LRR) and local recurrences (LR) and distant metastasis. RESULTS Our search strategy initially identified 10,779 titles and abstracts, of which 63 articles met inclusion criteria for a total of 873,718 patients. The pooled analysis showed that treatment initiation within 30 days improved OS by 9 % compared to longer intervals (aHR: 1.09 [1.06-1.13]; I2 = 80 %), with no significant associations found for DFS, LRR, LR, or distant metastasis. CONCLUSION While adherence to a 30-day DTI may be associated with improved survival in some HNC patients, significant heterogeneity in the data limits the generalizability of this finding. Further research with more refined analyses, including adjustments for treatment modality and cancer stage, is necessary. Additionally, gaps remain in the literature, particularly in the methodological limitations related to DTI classification.
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Affiliation(s)
- Noémie Villemure-Poliquin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada.
| | - Rui Fu
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Karolina Gaebe
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Jin Kwon
- Faculté de médecine, Université de Montréal, Montréal, Quebec
| | - Marc Cohen
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Kennedy Ayoo
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Bailey
- Department of Radiation Oncology, Odette Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Madette Galapin
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Julie Hallet
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Odette Cancer Centre, Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; Odette Cancer Centre, Division of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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da Mota Santana LA, Dos Santos Barreto M, Santos GA, Gopalsamy RG, Brasileiro BF, Trento CL, Borges LP. Comment on "Time to treatment for head and neck cancer patients decreased during the early phase of the COVID-19 pandemic". Oral Oncol 2025; 160:107134. [PMID: 39657394 DOI: 10.1016/j.oraloncology.2024.107134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 12/01/2024] [Indexed: 12/12/2024]
Affiliation(s)
| | | | - Gilmagno Amado Santos
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rajiv Gandhi Gopalsamy
- Division of Phytochemistry and Drug Design, Department of Biosciences, Rajagiri College of Social Sciences, Kochi, Kerala, India
| | - Bernardo Ferreira Brasileiro
- School of Dentistry, Federal University of Sergipe (UFS), Aracaju, SE, Brazil; Oral and Maxillofacial Surgeon, Private Practice, Southwest Florida Oral and Facial Surgery, Fort Myers, FL, USA
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Liang QW, Gao XL, Zhang JW. Nomogram for predicting early death in elderly patients with laryngeal squamous cell carcinoma: A population-based SEER study. PLoS One 2024; 19:e0315102. [PMID: 39700154 DOI: 10.1371/journal.pone.0315102] [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: 08/04/2024] [Accepted: 11/20/2024] [Indexed: 12/21/2024] Open
Abstract
BACKGROUND The disease and mortality rates of patients with laryngeal squamous cell carcinoma (LSCC) stabilize after peaking at the age of 60 years. This study aimed to identify risk factors associated with early death (death within 6 months) in elderly (≥60 years) patients with LSCC and to establish predictive nomograms to aid clinicians in developing individualized treatment plans. METHODS Data pertaining to elderly patients with LSCC between 2004 and 2015 was obtained from the Surveillance, Epidemiology, and End Results database (version 8.4.0). Multiple logistic models were used to identify the independent risk factors associated with early mortality. The overall risk of early death was predicted using a web-based probability calculator and predictive nomogram. The cohort underwent decision curve analysis (DCA), calibration, and receiver operating characteristic curves to evaluate the clinical applicability and predictability of the models during the training and validation stages. RESULTS This study included 10,031 patients, of which 1,711 (17.0%) experienced all-cause early death, and 1,129 died from cancer-specific causes. Patients with LSCC who had overlapping laryngeal lesions, advanced age, unmarried status, high tumour and node stages, presence of distant metastases, and lack of treatment were at risk for early death. According to the nomograms, the risk of all-cause death and cancer-specific early death had an area under the curve of 0.796 and 0.790, respectively. Internal validation and DCA revealed that the prediction model was accurate and could be applied clinically. CONCLUSION The study provides an overview of the characteristics of early death in patients with LSCC. Among the prognostic factors, T stage and radiotherapy demonstrated the strongest predictive value for early mortality, while marital status and tumor grade had the worst prognostic value. Two nomogram plots were constructed to facilitate accurate prediction of all-cause and cancer-specific early mortality within 6 months in elderly patients with LSCC, thereby helping clinicians in providing more personalised treatment plans.
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Affiliation(s)
- Qi-Wei Liang
- Department of Otorhinolaryngology of Longgang Center Hospital, The Ninth People's Hospital of Shenzhen, Shenzhen, China
| | - Xi-Lin Gao
- Department of Gastroenterology of Longgang Center Hospital, The Ninth People's Hospital of Shenzhen, Shenzhen, China
| | - Jun-Wei Zhang
- Department of Otorhinolaryngology of Longgang Center Hospital, The Ninth People's Hospital of Shenzhen, Shenzhen, China
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McIlvried LA, Martel Matos AA, Yuan MM, Atherton MA, Obuekwe F, Nilsen ML, Nikpoor AR, Talbot S, Bruno TC, Taggart DN, Johnson LK, Ferris RL, P Zandberg D, Scheff NN. Morphine treatment restricts response to immunotherapy in oral squamous cell carcinoma. J Immunother Cancer 2024; 12:e009962. [PMID: 39551606 PMCID: PMC11574397 DOI: 10.1136/jitc-2024-009962] [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] [Accepted: 10/23/2024] [Indexed: 11/19/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are becoming the standard of care for recurrent and metastatic cancer. Opioids, the primary treatment for cancer-related pain, are immunosuppressive raising concerns about their potential to interfere with the efficacy of ICIs. We hypothesize that exogenous opioids given for analgesia suppress antitumor immunity via T cell-mediated mu opioid receptor 1 (OPRM1) signaling. METHODS In silico bioinformatics were used to assess OPRM1 receptor expression on tumor-infiltrating immune cells in patients with head and neck squamous cell carcinoma (HNSCC) and across different cancer types. A syngeneic orthotopic mouse model of oral squamous cell carcinoma was used to study the impact of morphine and OPRM1 antagonism on tumor-infiltrating immune cells, tumor growth and antitumor efficacy of anti-Programmed cell death protein 1 (PD-1) monoclonal antibody treatment. RESULTS In patients with HNSCC, OPRM1 expression was most abundant in CD8+ T cells, particularly in patients who had not been prescribed opioids prior to resection and exhibited increased expression of exhaustion markers. Exogenous morphine treatment in tumor-bearing mice reduced CD4+ and CD8+ T-cell infiltration and subsequently anti-PD1 ICI efficacy. Peripherally acting mu opioid receptor antagonism, when administered in the adjunctive setting, was able to block morphine-induced immunosuppression and recover the antitumor efficacy of anti-PD1. CONCLUSIONS These findings suggest that morphine acts via a peripheral OPRM1-mediated mechanism to suppress CD8+ T cells, thereby fostering a pro-tumor-impaired immune response. Importantly, peripherally-restricted OPRM1 antagonism can effectively block this morphine-induced immunosuppression while still allowing for centrally-mediated analgesia, indicating a potential therapeutic strategy for mitigating the adverse effects of opioid pain relief in cancer treatment.
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Affiliation(s)
- Lisa A McIlvried
- Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Andre A Martel Matos
- Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mona M Yuan
- Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Megan A Atherton
- Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Fendi Obuekwe
- Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marci L Nilsen
- Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amin Reza Nikpoor
- Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Sebastien Talbot
- Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
- Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Tullia C Bruno
- Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | | | | | - Robert L Ferris
- Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Dan P Zandberg
- Hillman Cancer Center, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Nicole N Scheff
- Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
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Shyaka I, Su CL, Wei FC. Free Latissimus Dorsi Flaps in Head and Neck Reconstruction at a Modern High-Volume Microsurgery Center. J Reconstr Microsurg 2024. [PMID: 39134047 DOI: 10.1055/a-2384-8376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
BACKGROUND Over the past two decades, with the introduction of the perforator flap concept and advances in flap dissections, lower extremities have emerged as the preferred soft tissue flap donor sites. As a modern and high-volume microsurgical center, and the senior author being one of the pioneers and advocates for the use of lower extremity flap donor sites, we aim to investigate the role of latissimus dorsi (LD) free flap in head and neck reconstruction within our current practice. METHODS All free LD flaps used for head and neck reconstruction performed by a single surgeon between January 2010 and June 2023 were reviewed for their indications and immediate and short-term outcomes. RESULTS A total of 1,586 head and neck free flap reconstructions were performed, and 33 free LD flaps were identified. The patients' median age was 53 (interquartile range [IQR] 48.5-63.5) years. Twenty-nine (87.9%) flaps were used to reconstruct oro-maxillo-facial and four (12.1%) flaps were used to reconstruct scalp defects. Most patients had prior radiation (n = 28, 84.8%), neck dissection (n = 24, 72.7%), and multiple previous head and neck flap reconstructions with a median of 3.0 (IQR 3.0-3.5) previous flaps. Six (18.2%) LD flaps were used to replace failed flaps from other donor sites. No major complications such as total flap failure or takebacks, and no need for vein grafts but three (9.1%) had flap marginal necrosis. Other complications included one flap dehiscence (3.0%), one orocutaneous fistula (3.0%), two wound infections (6.1%), three plate exposures (9.1%), and three patients who developed local recurrence (9.1%). The median patient follow-up time was 16 (IQR 5-27) months. CONCLUSION This retrospective study demonstrates the role of LD free flap in head and neck reconstruction as a reliable and versatile backup soft tissue flap when workhorse flaps from lower extremity donor sites are either unavailable or unsuitable.
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Affiliation(s)
- Ian Shyaka
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung University and Medical College, Taoyuan, Taiwan
| | - Chun-Lin Su
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Fu-Chan Wei
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung University and Medical College, Taoyuan, Taiwan
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10
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Potier AL, Leroy M, Mortuaire G, Rysman B, Morisse M, Mouawad F. Impact of the 2nd, 3rd and 4th waves of the COVID-19 pandemic on wait times in head and neck cancer: A retrospective study in a French expert center. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:268-274. [PMID: 38653655 DOI: 10.1016/j.anorl.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Treatment delay in head and neck cancer is a major problem, with impact on survival. The COVID-19 (coronavirus disease 2019) pandemic, evolving in waves around the world, caused diagnostic and therapeutic delays in certain cancers. The main objective of the present study was to analyze whether there was a change in wait times during three successive waves in our center. METHOD This was a single-center retrospective study of patients with a first diagnosis of head and neck cancer. Three groups, corresponding to waves 2, 3 and 4, were compared to a control group corresponding to a pre-pandemic period. Study data comprised median times between first consultation and tumor board meeting (C1-TB) and between tumor board meeting and treatment (TB-T). The significance threshold was set at P<0.005. RESULTS Ninety-six patients were included in the control group, and 154 in the "waves 2-3-4" group. There was no increase in C1-TB interval (respectively 35 and 26days, P=0.046) or TB-T interval (respectively 27 and 28days, P=0.723). CONCLUSION Intervals between first consultation and tumor board meeting and between tumor board meeting and treatment did not increase during the 2nd, 3rd and 4th waves of COVID-19 in our center.
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Affiliation(s)
- A-L Potier
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - M Leroy
- METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, ULR 2694, Université de Lille, CHU de Lille, 59000 Lille, France
| | - G Mortuaire
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - B Rysman
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - M Morisse
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - F Mouawad
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France; Cancer Heterogeneity, Plasticity and Resistance to Therapies (CANTHER), UMR9020, CNRS, U1277 Inserm, Université de Lille, CHU de Lille, COL, 59037 Lille cedex, France.
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11
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Tasoulas J, Adams GJ, Schrank TP, Agala CB, Sheth S, Yarbrough WG, Hackman T, Sullivan CB. Time to treatment for head and neck cancer patients decreased during the early phase of the Covid-19 pandemic. Oral Oncol 2024; 155:106879. [PMID: 38852232 DOI: 10.1016/j.oraloncology.2024.106879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/01/2024] [Indexed: 06/11/2024]
Affiliation(s)
- Jason Tasoulas
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gabrielle-Jaquelline Adams
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Travis P Schrank
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chris B Agala
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siddharth Sheth
- Division of Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wendell G Yarbrough
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pathology and Laboratory Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Trevor Hackman
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher Blake Sullivan
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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12
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Lindhardt JL, Kiil BJ, Jakobsen AM, Buhl J, Krag AE. Implementation of In-house Computer-aided Design and Manufacturing for Accelerated Free Fibula Flap Reconstruction of Mandibular Defects in Cancer Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6108. [PMID: 39206213 PMCID: PMC11350334 DOI: 10.1097/gox.0000000000006108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/05/2024] [Indexed: 09/04/2024]
Abstract
Background Computer-aided design and manufacturing (CAD/CAM) is widely adopted for optimizing microsurgical reconstruction of mandibular defects. However, commercial solutions are hampered by costs and lengthy lead times, with the latter being problematic in cancer surgery. This study aimed to investigate the efficiency of an in-house CAD/CAM service for expeditious planning and execution of free fibula mandibular reconstruction in head and neck cancer patients. Methods This retrospective cohort study compared cancer patients undergoing segmental mandibulectomy and immediate free fibula flap reconstruction treated before and after implementation of in-house CAD/CAM. The primary endpoint was treatment delay from preoperative consultation to surgery. Cases in the two groups were matched on the number of fibula segments required for mandibular reconstruction. The control group underwent segmental mandibulectomy and fibula flap reconstruction by "freehand." The CAD/CAM group underwent preoperative virtual surgical planning and CAD/CAM of intraoperative cutting guides for the mandibulectomy and fibula osteotomies. Outcomes were compared with the unpaired t test or Wilcoxon rank-sum test. Results Sixteen patients were included in both groups. Treatment delay did not increase after implementation of in-house CAD/CAM with a median 6 (range 6-20) days wait in the CAD/CAM group and 8 (6-20) days wait in the control group (P = 0.48). Utilization of CAD/CAM significantly reduced fibula flap ischemia time with a mean of 18.4 [95% confidence interval 2.8; 33.9] minutes (P = 0.022). Conclusions In-house CAD/CAM was implemented for free fibula flap mandibular reconstruction in head and neck cancer patients without causing treatment delay. Furthermore, CAD/CAM reduced fibula flap ischemia time.
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Affiliation(s)
| | - Birgitte J. Kiil
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jytte Buhl
- Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Andreas E. Krag
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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13
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Tanaka R, Ueki Y, Ohshima S, Omata J, Yokoyama Y, Takahashi T, Shodo R, Yamazaki K, Ohtaki K, Togashi T, Horii A. Safety and efficacy of neoadjuvant chemotherapy with paclitaxel, carboplatin, and cetuximab for locally advanced head and neck squamous cell carcinoma. Int J Clin Oncol 2024; 29:1133-1141. [PMID: 38727853 DOI: 10.1007/s10147-024-02545-9] [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: 12/14/2023] [Accepted: 04/30/2024] [Indexed: 07/26/2024]
Abstract
BACKGROUND As a substantial waiting time is usually required for radical surgery, safe and effective preoperative neoadjuvant chemotherapy (NAC) is desired for the treatment of locally advanced head and neck squamous cell carcinoma (HNSCC). However, the significance of NAC in advanced HNSCC is still unclear. This study aimed to assess the safety and efficacy of NAC using the paclitaxel, carboplatin, and cetuximab (PCE) regimen. METHODS We retrospectively evaluated the background characteristics, incidence of adverse events, overall response rate (ORR), pathological response, recurrence-free survival (RFS), and overall survival (OS) in 26 patients. Patients receiving the PCE regimen were further divided into two groups based on the number of chemotherapy cycles (one cycle or more) and eligibility for cisplatin. Patients aged ≥ 75 years and those with an estimated glomerular filtration rate (eGFR) < 60 mL/min were classified as ineligible for cisplatin. RESULTS The median age was 70 (27-81) years. The median eGFR at treatment initiation was 63.2 (41.1-89.7) mL/min. Fourteen (53.8%) patients were ineligible for cisplatin. Grade 3 or higher neutropenia was observed in 11 of 25 (42.3%) patients. No delay in or withdrawal from surgery was observed. The ORR was 65.4%. The 2-year RFS and OS were 61.5% and 76.7%, respectively. No significant differences in safety and efficacy between the number of chemotherapy cycles and cisplatin eligibility were observed. CONCLUSION NAC using the PCE regimen for patients with locally advanced HNSCC, including cisplatin-ineligible patients, has acceptable toxicity and favorable efficacy.
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Affiliation(s)
- Ryoko Tanaka
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yushi Ueki
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan.
| | - Shusuke Ohshima
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
| | - Jo Omata
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
| | - Yusuke Yokoyama
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
| | - Takeshi Takahashi
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
| | - Ryusuke Shodo
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
| | - Keisuke Yamazaki
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Kohei Ohtaki
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Takafumi Togashi
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Arata Horii
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
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14
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Szabó É, Kopjár E, Rumi L, Boronkai Á, Bellyei S, Gyöngyi Z, Zemplényi A, Sütő B, Girán J, Kiss I, Pozsgai É, Szanyi I. Changes in Time to Initial Physician Contact and Cancer Stage Distribution during the COVID-19 Pandemic in Patients with Head and Neck Squamous Cell Carcinoma at a Large Hungarian Cancer Center. Cancers (Basel) 2024; 16:2570. [PMID: 39061209 PMCID: PMC11274479 DOI: 10.3390/cancers16142570] [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: 06/04/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of our study was to compare the characteristics and time to initial physician contact in patients with head and neck squamous cell carcinoma (HNSCC) before and during the COVID-19 pandemic at a large Hungarian cancer center. This was a retrospective study of patients 18 years or older presenting at the regional cancer center of Pécs Clinical Center with HNSCC between 1 January 2017, and 15 March 2020 (the pre-COVID-19 period) and between 16 March 2020, and 13 May 2021 (the COVID-19 period). Demographic and clinical data were collected, and the time between initial symptom onset and initial physician contact (TTP) was determined. Descriptive and exploratory statistical analyses were performed. On average, the number of patients diagnosed with HNSCC per month during the pandemic decreased by 12.4% compared with the pre-COVID-19 period. There was a significant increase in stage I and stage II cancers (from 15.9% to 20.3% and from 12.2% to 13.8%, respectively; p < 0.001); a decrease in stage III and IVa,c cancers; and a significant increase in stage IVb cancers (from 6% to 19.9%; p < 0.001) during the pandemic. The median TTP increased during the pandemic from 43 to 61 days (p = 0.032). To our knowledge, this is the first study investigating the effect of COVID-19 on patients with HNSCC in the Central-Eastern European region. We found a bidirectional shift in cancer stages and increased TTP during the pandemic. Our findings highlight the necessity for more nuanced analyses of the effects of COVID-19.
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Affiliation(s)
- Éva Szabó
- Department of Otorhinolaryngology, Clinical Center, University of Pécs, Munkácsy M. Street 2., 7621 Pécs, Hungary
| | - Eszter Kopjár
- Department of Otorhinolaryngology, Clinical Center, University of Pécs, Munkácsy M. Street 2., 7621 Pécs, Hungary
| | - László Rumi
- Urology Clinic, Clinical Center, University of Pécs, Munkácsy Mihaly Street 2, 7621 Pécs, Hungary
| | - Árpád Boronkai
- Department of Oncotherapy, Clinical Center, University of Pécs, Édesanyák Street 17, 7624 Pécs, Hungary
| | - Szabolcs Bellyei
- Department of Oncotherapy, Clinical Center, University of Pécs, Édesanyák Street 17, 7624 Pécs, Hungary
| | - Zoltán Gyöngyi
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti Street 12, 7624 Pécs, Hungary
| | - Antal Zemplényi
- Center for Health Technology Assessment and Pharmacoeconomics Research, Faculty of Pharmacy, University of Pécs, Rákóczi Street 2, 7623 Pécs, Hungary
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Balázs Sütő
- Department of Anesthesiology and Intensive Therapy, Clinical Center, University of Pécs, Ifjúság Street 13, 7624 Pécs, Hungary
| | - János Girán
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti Street 12, 7624 Pécs, Hungary
| | - István Kiss
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti Street 12, 7624 Pécs, Hungary
| | - Éva Pozsgai
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti Street 12, 7624 Pécs, Hungary
- Department of Primary Health Care, Medical School, University of Pécs, Rákóczi Street 2, 7623 Pécs, Hungary
| | - István Szanyi
- Department of Otorhinolaryngology, Clinical Center, University of Pécs, Munkácsy M. Street 2., 7621 Pécs, Hungary
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15
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Batool S, Hansen EE, Sethi RKV, Rettig EM, Goguen LA, Annino DJ, Uppaluri R, Edwards HA, Faden DL, Schnipper JL, Dohan D, Reich AJ, Bergmark RW. Perspectives on Referral Pathways for Timely Head and Neck Cancer Care. JAMA Otolaryngol Head Neck Surg 2024; 150:545-554. [PMID: 38753343 PMCID: PMC11099838 DOI: 10.1001/jamaoto.2024.0917] [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: 01/09/2024] [Accepted: 03/22/2024] [Indexed: 05/19/2024]
Abstract
Importance Timely diagnosis and treatment are of paramount importance for patients with head and neck cancer (HNC) because delays are associated with reduced survival rates and increased recurrence risk. Prompt referral to HNC specialists is crucial for the timeliness of care, yet the factors that affect the referral and triage pathway remain relatively unexplored. Therefore, to identify barriers and facilitators of timely care, it is important to understand the complex journey that patients undertake from the onset of HNC symptoms to referral for diagnosis and treatment. Objective To investigate the referral and triage process for patients with HNC and identify barriers to and facilitators of care from the perspectives of patients and health care workers. Design, Participants, and Setting This was a qualitative study using semistructured interviews of patients with HNC and health care workers who care for them. Participants were recruited from June 2022 to July 2023 from HNC clinics at 2 tertiary care academic medical centers in Boston, Massachusetts. Data were analyzed from July 2022 to December 2023. Main Outcomes and Measures Themes identified from the perspectives of both patients and health care workers on factors that hinder or facilitate the HNC referral and triage process. Results In total, 72 participants were interviewed including 42 patients with HNC (median [range] age, 60.5 [19.0-81.0] years; 27 [64%] females) and 30 health care workers (median [range] age, 38.5 [20.0-68.0] years; 23 [77%] females). Using thematic analysis, 4 major themes were identified: the HNC referral and triage pathway is fragmented; primary and dental care are critical for timely referrals; efficient interclinician coordination expedites care; and consistent patient-practitioner engagement alleviates patient fear. Conclusions and Relevance These findings describe the complex HNC referral and triage pathway, emphasizing the critical role of initial symptom recognition, primary and dental care, patient information flow, and interclinician and patient-practitioner communication, all of which facilitate prompt HNC referrals.
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Affiliation(s)
- Sana Batool
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elisabeth E. Hansen
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston
| | - Rosh K. V. Sethi
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eleni M. Rettig
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Laura A. Goguen
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donald J. Annino
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ravindra Uppaluri
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Heather A. Edwards
- Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Daniel L. Faden
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston
- Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Jeffrey L. Schnipper
- Hospital Medicine Unit and Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Daniel Dohan
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Amanda J. Reich
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Regan W. Bergmark
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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16
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Vasudev M, Martin E, Frank MI, Meller LLT, Haidar YM. Treatment Delay and HPV Status on OPSCC With Upfront Surgery: Analysis of National Cancer Database. Otolaryngol Head Neck Surg 2024; 171:124-137. [PMID: 38532532 DOI: 10.1002/ohn.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/12/2024] [Accepted: 02/05/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE Evaluate the effect of treatment delay on survival in human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing primary surgical resection. STUDY DESIGN Retrospective cohort study using the 2010-2017 National Cancer Database. SETTING Multicenter database study. METHODS Patients >18 years old with OPSCC and known HPV status, treated surgically with or without postoperative radiation/chemotherapy were included. Two cohorts based on HPV status were grouped by time to treatment initiation (TD-TI, ≤30, 31-60, ≥61 days) and surgery to radiotherapy (TS-RT, ≤42, 43-66, ≥67 days). Univariate, Kaplan-Meier, and multivariate analyses assessed correlations between demographic and clinical factors with overall survival in treatment delay groups. RESULTS Included were 1643 HPV-positive OPSCC patients and 391 HPV-negative OPSCC patients. No associations between survival and gender, age, race, insurance, or radiotherapy length were observed. Regardless of HPV status, larger tumor size (>2 cm) and lymphovascular invasion predicted worse survival. HPV negative patients with >4 lymph nodes involved had 2.5× greater mortality risk (P = .039). Robotic surgery was associated with improved survival only in HPV positive patients (hazard ratio [HR]: 0.41, P < .001). In HPV positive patients, higher TD-TI related to lower mean survival, although this was not significant on multivariate analysis. HPV negative patients with >42 days of TS-RT had decreased survival (43-66 days, HR 1.63, P = .049; ≥67 days, HR 2.10, P = .032). CONCLUSION Longer TS-RT was associated with lower overall survival in HPV negative patients. Treatment delay was not associated with survival in HPV positive OPSCC according to multivariate analysis. These findings enhance knowledge about treatment delay effects in OPSCC, aiding providers in decisions and patient communication.
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Affiliation(s)
- Milind Vasudev
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Elaine Martin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Madelyn I Frank
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Leo L T Meller
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
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17
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Melachuri M, Kurukulasuriya C, Rumde P, Patel T, Awad D, Kim S, Ferris R, Sridharan S, Duvvuri U. Treatment package time < 14 weeks improves recurrence free and disease specific survival in HPV positive OPC with high-risk features. Oral Oncol 2024; 151:106703. [PMID: 38422830 DOI: 10.1016/j.oraloncology.2024.106703] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/08/2024] [Accepted: 01/20/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Guidelines recommend treatment package time < 85 days and time from surgery to radiation initiation < 6 weeks in head and neck cancer patients. However, HPV positive primaries treated with TORS and adjuvant radiotherapy traditionally demonstrate favorable outcomes. METHODS Single center retrospective chart review of patients diagnosed with HPV positive treatment naïve primary squamous cell carcinoma treated with TORS and postoperative radiation therapy with or without Chemotherapy from 2012 to 2022 with data collection from December 2022-April 2023. Kaplan-Meier survival analysis with log-rank testing assessed the impact of time intervalsbetween diagnosis, TORS, radiation initiation and radiation completion on recurrence free and disease specific survival. Univariate Cox proportional hazards regression analysis was performed to identify factors associated with recurrence free and disease specific survival. Subgroup analysis was done with high risk (positive lymph nodes > 5, >1mm extracapsular extension, positive margins) patients who underwent concurrent Chemotherapy. RESULTS Of 255 patients (225 males [89 %], average age 58 years, 163 [64 %] high-risk, median follow-up 4.3 years), 22 (8.6 %) had recurrence and 14 died due after disease recurrence.Only radiation length of 5-7 weeks prolonged survival in the entire population. In the high-risk cohort, time from TORS to radiation initiation < 6 weeks improvedrecurrence free survival, while total package time < 14 weeks wasassociated with greater recurrence free and disease specific survival.
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Affiliation(s)
- Manasa Melachuri
- University of Pittsburgh Medical Center, Department of Otolaryngology- Head and Neck Surgery, Pittsburgh, PA, USA.
| | - Chareeni Kurukulasuriya
- University of Pittsburgh Medical Center, Department of Otolaryngology- Head and Neck Surgery, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Purva Rumde
- University of Pittsburgh Medical Center, Department of Otolaryngology- Head and Neck Surgery, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Terral Patel
- University of Pittsburgh Medical Center, Department of Otolaryngology- Head and Neck Surgery, Pittsburgh, PA, USA
| | - Daniel Awad
- University of Pittsburgh Medical Center, Department of Otolaryngology- Head and Neck Surgery, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Seungwon Kim
- University of Pittsburgh Medical Center, Department of Otolaryngology- Head and Neck Surgery, Pittsburgh, PA, USA
| | - Robert Ferris
- University of Pittsburgh Medical Center, Department of Otolaryngology- Head and Neck Surgery, Pittsburgh, PA, USA
| | - Shaum Sridharan
- University of Pittsburgh Medical Center, Department of Otolaryngology- Head and Neck Surgery, Pittsburgh, PA, USA
| | - Umamaheswar Duvvuri
- University of Pittsburgh Medical Center, Department of Otolaryngology- Head and Neck Surgery, Pittsburgh, PA, USA; New York University Grossman School of Medicine, Department of Otolaryngology- Head and Neck Surgery, Pittsburgh, PA, USA
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18
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Topkan E, Somay E, Selek U. In reply to Melachuri et al. (https://doi.org/10.1016/j.oraloncology.2024.106703). Oral Oncol 2024; 151:106753. [PMID: 38503260 DOI: 10.1016/j.oraloncology.2024.106753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Efsun Somay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kyrenia University, Girne, Cyprus.
| | - Uğur Selek
- Department of Radiation Oncology, Faculty of Medicine, Koc University, Istanbul, Turkey
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19
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Zainodini N, Abolhasani M, Mohsenzadegan M, Farajollahi MM, Rismani E. Overexpression of Transmembrane Phosphatase with Tensin homology (TPTE) in prostate cancer is clinically significant, suggesting its potential as a valuable biomarker. J Cancer Res Clin Oncol 2024; 150:165. [PMID: 38546751 PMCID: PMC10978697 DOI: 10.1007/s00432-024-05694-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/08/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE Cancer testis antigens (CTAs) are a family of proteins typically expressed in male testicles but overexpressed in various cancer cell types. Transmembrane Phosphatase with Tensin homology (TPTE) is expressed only in the testis of healthy individuals and is a member of the family of CTAs. The current study, for the first time, examined the significance of TPTE expression in prostate cancer (PCa) tissues by generating a novel antibody marker targeting TPTE protein. METHODS Polyclonal antibodies were prepared for TPTE-p1 and TPTE-p2 peptides, which are derived from the extracellular domains of TPTE. Anti-TPTE-p2 antibody was then used to study the extent and pattern of TPTE expression in 102 PCa and 48 benign prostatic hyperplasia (BPH) tissue samples by immunohistochemistry. The viability of cancer cell lines (PC-3 and MCF-7 cells) was also evaluated in the presence of anti-TPTE-p2 antibody using the MTT test. RESULTS The immunohistochemical analysis demonstrated a significant increase in cytoplasmic and membrane TPTE expression in the PCa samples compared to the BPH group (both P < 0.0001). Cytoplasmic TPTE expression was positively correlated with Gleason score and PSA levels (P = 0.03 and P = 0.001, respectively). Significant correlations were identified between the levels of PSA and perineural invasion and the membrane expression (P = 0.01, P = 0.04, respectively). Moreover, anti-TPTE-p2 antibody inhibited PC-3 and MCF-7 cells proliferation compared to the control group for 24 h (P < 0.001 and P = 0.001, respectively) as well as for 48 h (P = 0.001 and P = 0.001, respectively). CONCLUSION Our findings indicate that increased TPTE expression is associated with progression of disease. The ability of anti-TPTE-p2 antibody to recognize and target the TPTE protein makes it a potential biomarker to assess and/or target the PCa.
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Affiliation(s)
- Nahid Zainodini
- Department of Medical Biotechnology, School of Allied Medical Sciences, Iran University of Medical Sciences (IUMS), Hemmat Highway, Tehran, Iran
| | - Maryam Abolhasani
- Department of Pathology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Monireh Mohsenzadegan
- Department of Medical Laboratory Sciences, Faculty of Allied Medical Sciences, Iran University of Medical Sciences (IUMS), Hemmat Highway, Tehran, Iran.
| | - Mohammad M Farajollahi
- Department of Medical Biotechnology, School of Allied Medical Sciences, Iran University of Medical Sciences (IUMS), Hemmat Highway, Tehran, Iran.
| | - Elham Rismani
- Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
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Remschmidt B, Gaessler J, Brcic L, Wallner J, Muallah D, Rieder M. The impact of COVID-19 on oral squamous cell carcinoma's diagnostic stage-A retrospective study. Oral Dis 2024; 30:216-222. [PMID: 36398463 DOI: 10.1111/odi.14441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has had an impact on patients' access to primary care services. A timely diagnosis of oral squamosa cell carcinoma is paramount. This study aims to quantify the pandemic's effect on tumor volume at the time of initial diagnosis. MATERIALS AND METHODS In a retrospective study, all primarily diagnosed cancer patients between March 2018 and March 2022 were compiled; the TNM stage and the tumor volume were evaluated. Tumor volumes were calculated using pathology or radiology reports. RESULTS In total, 162 newly diagnosed tumor cases were included in this study. Of these, 76 (46.9%) cases were allocated in the "pre-COVID-19" group and 86 (53.1%) in the "COVID-19" group. Patients diagnosed during the "COVID-19" period showed a significantly advanced T stage (p < 0.001) and larger mean tumor volumes (53.16 ± 73.55 cm3 vs. 39.89 ± 102.42 cm3 ; p = 0.002) when compared to the control group. CONCLUSION Tumor volume and T stage were significantly advanced in the "COVID-19" group when compared to prepandemic data. We hypothesize that the postponement of routine dental check-ups may explain this finding. Hence, dentists and primary care providers are encouraged to place particular emphasis on screening during routine check-ups.
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Affiliation(s)
- Bernhard Remschmidt
- Department of Oral and Maxillofacial Surgery, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
- University Clinic of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
| | - Jan Gaessler
- Department of Oral and Maxillofacial Surgery, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
- University Clinic of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Jürgen Wallner
- Department of Oral and Maxillofacial Surgery, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
| | - David Muallah
- Department of Oral and Maxillofacial Surgery, Head and Neurocenter, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Marcus Rieder
- Department of Oral and Maxillofacial Surgery, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
- University Clinic of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
- Department of Oncology, University Clinic for Internal Medicine, Medical University of Graz, Graz, Austria
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Carré J, Herzog B, Reil D, Schneider C, Pflüger M, Löbel M, Herzog M. [Impact of the COVID-19 pandemic on the diagnosis and treatment of patients with head and neck cancer in Brandenburg and Berlin]. HNO 2024; 72:90-101. [PMID: 38117331 DOI: 10.1007/s00106-023-01396-6] [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] [Accepted: 10/25/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on potential limitations to the diagnosis and treatment of patients with head and neck tumours has not yet been adequately investigated. There are contradictory data on this subject. Data from larger patient collectives do not exist for Germany so far. OBJECTIVE The aim of the survey was to clarify in a large cohort whether the COVID-19 pandemic had an influence on the diagnosis and treatment of patients with head and neck tumours. METHODS A retrospective data analysis of the reporting data of the Clinical and Epidemiological Cancer Registry of Brandenburg and Berlin (Klinisch-epidemiologischen Krebsregisters Brandenburg-Berlin, KKRBB) of 4831 cases with head and neck tumours from 2018 to 2020 was performed. The period before April 01, 2020, was evaluated as a prepandemic cohort and compared with the cases of the pandemic cohort from April 1, 2020, until December 31, 2020, in terms of patient-related baseline data, tumour location, tumour stage, tumour board and treatments administered. RESULTS No differences were observed between the prepandemic and pandemic cohorts with regard to patient-related baseline data, tumour localisation and tumour stage. Likewise, no temporal delay in diagnosis, tumour board and treatment was evident during the pandemic period. On the contrary, the time interval between diagnosis and start of therapy was shortened by an average of 2.7 days in the pandemic phase. Tumours with T4 stage were more frequently treated surgically during the pandemic compared to the period before (20.8% vs. 29.6%), whereas primary radio(chemo)therapy decreased during the pandemic (53.3% vs. 40.4%). For all other tumour stages and entities, there were no differences in treatment. CONCLUSION Contrary to initial speculation that the COVID-19 pandemic may have led to a decrease in tumour cases, larger tumour stages at initial presentation and a delay in diagnosis and treatment, the cohort studied for Brandenburg and Berlin showed neither a delay in tumour treatment nor an increase in tumour size and stage at initial presentation. The treatments performed, however, were subject to a change in favour of surgery and it remains to be seen whether this trend will be maintained in the long term.
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Affiliation(s)
- Julia Carré
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Deutschland
| | - Beatrice Herzog
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Daniela Reil
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Constanze Schneider
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Maren Pflüger
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Madlen Löbel
- Interdisziplinäre Studienzentrale des Carl-Thiem-Klinikums, Thiemstr. 111, 03048, Cottbus, Deutschland
| | - Michael Herzog
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Deutschland.
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Deutschland.
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Clementine M, Camille C, Swann A, Alavi Z, Remi M, Jean-Christophe L. COVID-19 impact on the management of head and neck cancer: a French single-centre experience. Eur Arch Otorhinolaryngol 2024; 281:873-882. [PMID: 37845381 DOI: 10.1007/s00405-023-08245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has caused unprecedented pressure on medical care resources and access. The aim of this study was to evaluate the time between the cancer symptoms' onset and the first ENT specialist consultation for patients with head and neck (HNC) and salivary glands cancers during the pandemic. METHODS The outcome measures evaluated were time to diagnosis, and time to treatment onset, as well as the COVID-19 impact on the proportion of both cancer patient groups: asymptomatic and advanced stages. This is single-centre retrospective cross-sectional study, including 473 patients who were treated in our University Hospital for HNC and salivary gland cancers, 171 in the COVID-19 pandemic group (C +), and 302 patients in the pre-pandemic group (C-). RESULTS There were no significant between-group differences in the delays between cancer symptoms' onset and ENT consultation, diagnostic workup and initial treatment onset, respectively. There was a suggestive reduction in the number of diagnostic panendoscopy performed in the C + group (62%) compared to the C- group (73%) as well as a suggestive increase in the delay to adjuvant radiotherapy onset. CONCLUSION The median delay between cancer symptoms' onset and ENT specialist consultation was not affected by the COVID-19 pandemic in our centre. Our results suggest an 11% decrease in diagnostic procedures performed independently, a decrease in the delay between the ENT consultation and surgical treatment onset and a 10-day increase in the delay to adjuvant radiotherapy onset.
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Affiliation(s)
| | | | | | - Zarrin Alavi
- INSERM, CIC 1412, Brest University Hospital, Brest, France
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23
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Wei X, Yu S, Wang J, Xiang Z, Liu L, Min Y. Association between time from diagnosis to treatment and survival of patients with nasopharyngeal carcinoma: A population-based cohort study. Curr Probl Cancer 2024; 48:101060. [PMID: 38211418 DOI: 10.1016/j.currproblcancer.2024.101060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/06/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Treatment delays have frequently been observed in cancer patients. Whether the treatment delays would impair the survival of patients with nasopharyngeal carcinoma (NPC) is still unclear. METHODS The data were derived from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. Patients were divided into groups of timely treatment (<1 month), intermediate delay (1 and 2 months), and long delay (3-6 months). The influence of different treatment delay intervals on long-term survival was evaluated by multivariate Cox regression analysis. RESULTS In total, 2,048 patients with NPC were included in our study. There were 551 patients in the early stage (I, II stage: 26.9 %) and 1,497 patients in the advanced stage (III, IV stage: 73.1 %). No significant difference in overall survival (OS) or cancer-specific survival (CSS) was observed among the groups with various treatment delay intervals (p = 0.48 in OS and p = 0.43 in CSS, respectively). However, upon adjusting for covariates, a significantly improved OS probability emerged in patients with intermediate treatment delays compared to those who received timely interventions in both the entire study population (adjustedHazard Ratio (aHR)=0.86, 95 % CI: 0.74-0.99, p = 0.043) and the subgroup with advanced stage (aHR=0.85, 95 % CI: 0.72-1.00, p = 0.049). Regarding the CSS probability, similar associations were also observed in the entire study population (aHR=0.84, 95 % CI: 0.71-0.98, p = 0.030) as well as the advanced-stage patients (aHR=0.83, 95 % CI: 0.70-0.99, p = 0.038). CONCLUSIONS Our results revealed that treatment delays are not associated with worse survival of NPC patients. Tumor-specific characteristics and subsequent treatment modalities play more pivotal roles in the prognosis of NPC.
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Affiliation(s)
- Xiaoyuan Wei
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Siting Yu
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Jun Wang
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Zhongzheng Xiang
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Lei Liu
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China.
| | - Yu Min
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, PR China
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Galletti C, De Marco L, Ciodaro F, Freni F, Saraniti C, Galletti F, Galletti B. Impact of the Sars-COVID-19 Pandemic on the "Early Diagnosis" of Laryngeal Tumors: Data From Monocentric Tertiary Care Hospital of South Italy. J Voice 2024:S0892-1997(23)00404-6. [PMID: 38290926 DOI: 10.1016/j.jvoice.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The aim of this retrospective case-control study is to investigate how the Sars-COVID-19 pandemic has influenced the delay in the early diagnosis of laryngeal cancer in patients who visited the University Hospital "G. Martino" in the last 3 years of the pandemic. It is also proposed to compare the diagnosis, surgical staging, and therapeutic approach offered to patients affected by laryngeal cancer in the years affected by the COVID-19 pandemic compared to cases treated during the 3 years preceding the pandemic METHODOLOGY/PRINCIPAL: A single-center retrospective study was carried out to analyze the effects of the COVID-19 pandemic on the diagnosis and treatment of patients with squamous cell carcinoma of the larynx at our Otorhinolaryngology Division of the "Gaetano Martino" University hospital. The research period, 6 years, was divided into two sub-periods of equal months for which we divided the patients into two groups "Before COVID-19" and "During COVID-19", defined, respectively, from February 2017 to March 2020 and from April 2020 to May 2023. Patients aged 18 years and older with a diagnosis of squamous cell carcinoma, seen and surgically treated at the Otorhinolaryngology division of the "Gaetano Martino" University Hospital and patients referred from other hospitals were included in the study population. Patients affected by malignancies in other sites with secondary laryngeal involvement, patients not amenable to surgical therapy, treated only with radio-chemotherapy therapy, and patients not amenable to surgical therapy were excluded from the study. RESULTS A total of 141 patients were recruited, divided into 76 patients in the "Before COVID-19" arm and 65 patients in the "During COVID-19" arm, with a male prevalence of 119 patients (84.4%). The mean age of our study population stands at a median of 69 years (percentile 25th 60.00 and percentile 75th 77.00). Smoking and alcohol are two predominant variables in our study population with a prevalence of 89.4% and 79.4%, respectively. A higher number of TNM stage IV cases was detected, 29.2% in the group "During COVID-19" compared to 5.3 detected in the group "Before COVID-19" (P = 0.005). In the "During COVID-19" group, we find an overall percentage of 61.5% for stages II-III-IV versus 36.9% present in the "Before COVID-19" group of patients. An adjuvant radiotherapy treatment was actuated in 30.26% of patients in the "Before COVID-19" versus 41.54% in "During COVID-19". CONCLUSIONS The most important result of our research was the statistically significant difference in tumor staging at the time of diagnosis between the "Before COVID-19" and "During COVID-19" groups, with a higher mean value in the latter. The current data confirm the previously exposed hypothesis according to which the COVID-19 pandemic has led to a delay in early diagnosis, negatively influencing the staging at the time of the first ENT visit and the subsequent therapeutic approach to be offered to the patient.
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Affiliation(s)
- Cosimo Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Laura De Marco
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Francesco Ciodaro
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Francesco Freni
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Carmelo Saraniti
- Division of Otorhinolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy.
| | - Francesco Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Bruno Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
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Akbari M, Ahadi S, Karimi E, Heidari F, Lotfi M, Rezvan S, Mazarei A, Beheshti A. Increasing stage and depth of invasion (DOI) in patients with tongue cancer during the COVID-19 pandemic: A time series study. Health Sci Rep 2024; 7:e1832. [PMID: 38264159 PMCID: PMC10803884 DOI: 10.1002/hsr2.1832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 12/08/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
Background and Aims The outbreak of the Coronavirus disease 2019 (COVID-19) pandemic had a significant effect on the diagnosis and treatment of head and neck cancers. Therefore, in this study, we decided to discuss the impact of COVID-19 on the stage and histological characteristics of patients with tongue cancer from March 2020 to March 2021 and compared to the previous 3 years. Methods In this time series study, patients diagnosed with squamous cell carcinoma of the operated tongue cancer were divided into two groups. Patients who operated from March 2020 to March 2021 (n = 36) and patients who operated 3 years ago (n = 70) were included in the study. The results were analyzed using SPSS 21 software. Results The study found that during the pandemic, the stage of tongue cancer in patients who underwent surgery was higher than before the pandemic (p = 0.01). Moreover, the depth of invasion was significantly higher during the COVID-19 outbreak in the pathology sample of the patients (p = 0.006), while the involvement of lymph nodes and other variables between the groups was not statistically significant. Conclusion COVID-19 has adverse effects on the diagnosis and treatment of tongue cancer. Also, it leads to advanced stages of the tumor and increases the depth of invasion of the cancer. Hence, it is important to plan correctly and appropriately for the diagnosis and treatment of these patients in conditions such as the COVID-19 pandemic.
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Affiliation(s)
- Maryam Akbari
- Otorhinolaryngology Research Center, Amir Alam HospitalTehran University of Medical SciencesTehranIran
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Samira Ahadi
- Otorhinolaryngology Research Center, Amir Alam HospitalTehran University of Medical SciencesTehranIran
| | - Ebrahim Karimi
- Otorhinolaryngology Research Center, Amir Alam HospitalTehran University of Medical SciencesTehranIran
| | - Farrokh Heidari
- Otorhinolaryngology Research Center, Amir Alam HospitalTehran University of Medical SciencesTehranIran
| | - Maryam Lotfi
- Department of Pathology, Amir‐Alam HospitalTehran University of Medical SciencesTehranIran
| | - Sajjad Rezvan
- Department of RadiologyQom University of Medical SciencesQomIran
| | - Alireza Mazarei
- Otorhinolaryngology Research Center, Amir Alam HospitalTehran University of Medical SciencesTehranIran
| | - Amin Beheshti
- Otorhinolaryngology Research Center, Amir Alam HospitalTehran University of Medical SciencesTehranIran
- Department of Pathology, Amir‐Alam HospitalTehran University of Medical SciencesTehranIran
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Nguyen J, Patel R, Eloy JA, Baredes S, Park RCW. Assessing the Association Between Time to Surgery and Survival in Sinonasal Squamous Cell Carcinoma. Laryngoscope 2023; 133:3389-3395. [PMID: 37194665 DOI: 10.1002/lary.30738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION To assess the association between time to surgery (TTS) and survival in sinonasal squamous cell carcinoma patients (SSCC). METHODS We queried the 2004-2016 National Cancer Database for all cases of adult SSCC undergoing primary surgical treatment. Patients with missing TTS information were excluded. We conducted a multivariate analysis of patient demographic and clinicopathological characteristics' effect on overall survival (OS) using a Cox proportional hazards model enhanced with cubic spline non-linear approximation. Bootstrapping methods were utilized to detect the aggregate risk of TTS delay on patient OS. RESULTS A total of 2,881 patients met the inclusion criteria. The majority of patients were male (63.5%), White (86.3%), and over the age of 60 (58.4%). Parametric cubic spline approximation Cox hazard model detected a non-linear association between patient OS and TTS below 30 days with the lowest risk occurring at 18 days and steadily increasing subsequently. To analyze the aggregate risk and identify the optimal TTS cut-off after 30 days of surgical delay, the cohort sample was bootstrapped and dichotomized. The largest increase in aggregated risk was identified at 59 days (Hazards Ratio [HR] = 1.006 [0.839-1.084], p = 0.003). 60 days were used as the optimal TTS cut-off for analyzing the survival rate using the Cox proportional hazard model. Undergoing surgery within 60 days translated to a 14.6% decreased chance of death (HR: 0.854 [0.83-0.96]). CONCLUSIONS Increasing TTS is associated with worse overall survival in patients with SSCC. Our study suggests that surgery should be done within 60 days to achieve optimal survival results. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3389-3395, 2023.
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Affiliation(s)
- Julia Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rushi Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJ Barnabas Health, Livingston, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Patel TR, Prince ADP, Benjamin WJ, Basura GJ. Role of the otologist/neurotologist in managing auricular and periauricular cutaneous malignancies: A 10-year otologic oncology experience. Laryngoscope Investig Otolaryngol 2023; 8:1637-1647. [PMID: 38130268 PMCID: PMC10731494 DOI: 10.1002/lio2.1171] [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: 05/24/2023] [Revised: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023] Open
Abstract
Objective Auricular/periauricular cutaneous malignancies can be challenging to manage surgically due to the complex anatomy of the region. Otologists/neurotologists have unique skillsets that are well-suited to surgically treat these patients. We aim to highlight the role of otologists and neurotologists in providing surgical care of patients with auricular and periauricular malignancies by describing the experience of a single fellowship-trained neurotologist over a 10-year period. Methods Retrospective chart review of 387 patients with auricular and periauricular malignancy treated by a single neurotologist between 2012 and 2022 was completed. Tumor histology and procedures performed for each patient were extracted. Additional data was collected for a subset of 84 patients with complex cases requiring selective neck dissection, parotidectomy, lateral temporal bone resection, regional advancement or rotational flap reconstruction, and/or free tissue transfer reconstruction. Results Within the series of 387 patients, squamous cell carcinoma was the most common histology (42.6%, n = 165), followed by basal cell carcinoma (40.8%, n = 158), and melanoma (9.8%, n = 38). Common surgical procedures included wide local excision (61.8%, n = 239), partial/sub-total auriculectomy 18.3% (n = 71), or total auriculectomy 5.2% (n = 20). Within the 84-patient subset, median age at diagnosis was 71.9 years. Dermatologists provided most patient referrals (50.0%, n = 42). Most common tumor locations included: auricular (58.3%, n = 49), pre-auricular (21.4%, n = 18), and parotid (27.4%, n = 23). Revision surgery occurred in 22.6% of cases (n = 19), of which 26.3% (n = 5) for positive margins and 31.6% (n = 6) for recurrence. Mean follow-up was 22.8 months. Disease-specific 5-year survival was 91%. Conclusions We demonstrate the feasibility of an otologist/neurotologist incorporating the surgical management of auricular and periauricular malignancies into their practice. Level of Evidence 4.
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Affiliation(s)
- Tirth R Patel
- Department of Otorhinolaryngology-Head and Neck Surgery Rush University Chicago Illinois USA
| | - Andrew D P Prince
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Ann Arbor Michigan USA
| | - William J Benjamin
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Ann Arbor Michigan USA
| | - Gregory J Basura
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Ann Arbor Michigan USA
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Tirelli G, Boscolo-Rizzo P, Pelloso L, Gardenal N, Giudici F, Marcuzzo AV, Tofanelli M. Impact of time-to-surgery on survival and quality of life in oral cancer. Am J Otolaryngol 2023; 44:103984. [PMID: 37437337 DOI: 10.1016/j.amjoto.2023.103984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE To investigate the association between time-to-surgery (TTS) and overall survival (OS), disease specific survival (DSS) and quality of life (QoL) in patients with oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS 116 patients with OSCC candidate to surgery were examined. TTS intervals starting from diagnosis (TTS-clinical-based) and from histological reports (TTS-biopsy-based) were calculated. The effects of TTS intervals and prognostic factors on 5-year OS and DSS were explored. RESULTS In our cohort advanced T-categories OSCCs with TTS < 30 days showed a trend to have higher DSS rate (p = 0.049). Patients with TTS-clinical-based < 30 days showed better postoperative QoL. Positive surgical margins, nodal involvement (pN+), DOI >10 mm, invasive surgery and extra-capsular extension in pN+ were found to be significantly associated with a poor OS and DSS. CONCLUSIONS TTS ≥ 30 days can adversely affect DSS, especially in the advanced T categories. Short TTS intervals resulted associated with a better postoperative QoL.
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Affiliation(s)
- Giancarlo Tirelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Ludovica Pelloso
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Nicoletta Gardenal
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Fabiola Giudici
- Department of Medicine, Surgery and Health Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Margherita Tofanelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy.
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Day AT, Prestwood CA, Emmett TR, Eary RL, Salley JR, Cerda V, Mayfield Arnold E, Lee SC, Tiro JA. Unmet Needs and Receipt of Supportive Care Services in Head and Neck Cancer Patients Prior to Oncologic Treatment: A Prospective, Cross-Sectional Pilot Study. Ann Otol Rhinol Laryngol 2023; 132:1361-1372. [PMID: 36890749 DOI: 10.1177/00034894231154182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To characterize the supportive care (SC) needs and receipt of SC services among head and neck cancer (HNC) patients prior to oncologic treatment and to explore the influence of social determinants of health on these outcomes. MATERIALS AND METHODS Newly diagnosed HNC patients were surveyed via telephone prior to oncologic treatment between 10/2019 and 1/2021 using a prospective, cross-sectional, bi-institutional, pilot study design. The primary study outcome was unmet SC needs (Supportive Care Needs Survey-Short Form34 [SCNS-SF34]). Hospital type (university- vs county safety-net) was explored as an exposure. Descriptive statistics were performed using STATA16 (College Station, TX). RESULTS Among 158 potentially eligible patients, 129 were successfully contacted, 78 met the study criteria, and 50 completed the survey. The mean age was 61, 58% exhibited clinical stage III-IV disease, and 68% and 32% were treated at the university and county safety-net hospital, respectively. Patients were surveyed a median of 20 days after their first oncology visit and 17 days prior to initiation of oncology treatment. They had a median of 24 total needs (11 were met and 13 were unmet) and preferred to see a median of 4 SC services but received care from none. County safety-net patients had comparatively more unmet needs than university patients (14.5 vs 11.5, P = .04). CONCLUSION Pretreatment HNC patients at a bi-institutional academic medical center report a high number of unmet SC needs with corollary poor receipt of available SC services. Novel interventions to address this significant gap in care are needed.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Courtney A Prestwood
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas R Emmett
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rebecca L Eary
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jordan R Salley
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Vanessa Cerda
- Department of Population and Data Sciences; UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Simon Craddock Lee
- Department of Population and Data Sciences; UT Southwestern Medical Center, Dallas, TX, USA
| | - Jasmin A Tiro
- Department of Population and Data Sciences; UT Southwestern Medical Center, Dallas, TX, USA
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Tasoulas J, Schrank TP, Smith BD, Agala CB, Kim S, Sheth S, Shen C, Yarbrough WG, Hackman T, Sullivan CB. Time to treatment patterns of head and neck cancer patients before and during the Covid-19 pandemic. Oral Oncol 2023; 146:106535. [PMID: 37625360 DOI: 10.1016/j.oraloncology.2023.106535] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES The delivery of healthcare has changed significantly over the past decades. This study analyzes the clinicodemographic factors and treatment patterns of head and neck squamous cell carcinoma (HNSCC) patients between 2004 and 2020. MATERIALS AND METHODS Retrospective cohort analysis of HNSCC patients from the National Cancer Data Base from 2004 to 2020. RESULTS A total of 164,290 patients were included. Increased times from diagnosis to definitive surgery (TTS) were seen across all facility types (academic centers, AC; non-academic centers, NAC) between 2004 and 2019, with NAC affected more. TTS < 15 days (RR = 1.05, 95%CI:1.05-1.09) and > 75 days (1.07, 95%CI:1.05-1.09) were associated with increased mortality risk. This association was more prominent among HPV + HNSCC (RR = 1.45; 95%CI:1.18-1.78). Treatment in AC was associated with a decreased mortality risk (RR = 0.94, 95%CI:0.93-0.95). Despite the universal increase in wait times from 2004 to 2019, short-term mortality was significantly decreased from 2016 to 2019, relative to 2004-2007 (3-month mortality: RR = 0.77, 95%CI:0.70-0.85; 12-month mortality: RR = 0.80, 95%CI:0.77-0.84). Wait times decreased in 2020. CONCLUSIONS TTS increased between 2004 and 2019, with NAC affected more. However, despite longer wait times, short-term survival increased significantly. Very short (<15 days) and very long (>75 days) TTS were associated with increased mortality risk. Patients with HPV + HNSCC have the highest increase among those treated > 75 days from diagnosis. Treatment at AC was associated with improved survival, which could be explained by the presence of multidisciplinary teams and subspecialists that may be less available at NAC. The 2021 NCDB data are required for a comprehensive analysis of wait times in 2020.
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Affiliation(s)
- Jason Tasoulas
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Travis P Schrank
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Blaine D Smith
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chris B Agala
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sulgi Kim
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siddharth Sheth
- Division of Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colette Shen
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wendell G Yarbrough
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pathology and Laboratory Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Trevor Hackman
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher Blake Sullivan
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Kshirsagar RS, Eide JG, Qatanani A, Harris J, Birkenbeuel JL, Wang BY, Kuan EC, Palmer JN, Adappa ND. Frailty does not worsen postoperative outcomes in sinonasal squamous cell carcinoma. Am J Otolaryngol 2023; 44:103972. [PMID: 37459744 DOI: 10.1016/j.amjoto.2023.103972] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE Sinonasal squamous cell carcinoma (SCC) is an aggressive malignancy frequently requiring surgical resection and adjuvant treatment. Frailty is a metric that attempts to estimate a patient's ability to tolerate the physiologic stress of treatment. There is limited work describing frailty in patients with sinonasal cancer. We sought to determine the impact of frailty on postoperative outcomes in patients undergoing treatment for sinonasal SCC. MATERIALS AND METHODS Cases of patients undergoing surgical resection of sinonasal SCC at two tertiary medical centers were queried. Demographic, treatment, and survival data were recorded. Frailty was calculated using validated indexes, including the American Society of Anesthesiologists (ASA) classification, modified 5-item frailty index (mFI-5), and the Charlson Comorbidity Index (CCI). Primary outcomes included medical and surgical complications, readmission, and length of stay (LOS). RESULTS 38 patients were included. There were 23 (60.5 %) men and 15 (39.5 %) women with an average age of 59.6 ± 12.1 years. MFI-5 was 0.76 ± 0.54 and CCI was 5.71 ± 2.64. No significant association was noted between frailty measures and postoperative outcomes including 30-day medical complications, 30-day surgical complications, any 30-day complication, and readmission. Increased ASA was noted to be predictive of increased length of stay (Incidence Rate Ratio: 1.80, 95 % confidence interval [CI]: 1.16-2.83, p = 0.009). CONCLUSIONS We found no association between frailty metrics and worsening surgical or medical postoperative outcomes. This suggests that frailty metrics may not be as relevant for sinonasal surgery even for advanced pathologies, given the more limited physiologic impact of minimally invasive surgery.
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Affiliation(s)
- Rijul S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Redwood City Medical Center, Redwood City, CA, United States of America
| | - Jacob G Eide
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI, United States of America
| | - Anas Qatanani
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA, United States of America
| | - Jacob Harris
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, United States of America
| | - Beverly Y Wang
- Department of Pathology, University of California Irvine, Orange, CA, United States of America
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, United States of America
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States of America.
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Gallogly JA, Armstrong AT, Brinkmeier JV, Salas J, Simpson MC, Ideker H, Walker RJ, Massa ST. Association Between Antibiotic Prescribing and Time to Diagnosis of Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:919-928. [PMID: 37615970 PMCID: PMC10450587 DOI: 10.1001/jamaoto.2023.2423] [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: 02/27/2023] [Accepted: 06/27/2023] [Indexed: 08/25/2023]
Abstract
Importance Diagnostic delay can negatively affect patient outcomes in head and neck cancer (HNC). Neck mass and other symptoms of undiagnosed HNC may be treated with antibiotics, delaying diagnosis and treatment, despite current clinical practice guidelines. Objective To investigate temporal trends, associated factors, and time from symptom onset to antibiotic prescribing before an HNC diagnosis. Design, Setting, and Participants A retrospective cohort study was conducted using data obtained from a deidentified electronic health records data set from January 1, 2011, to December 31, 2018. Patients with HNC enrolled in the data set for at least 1 year before diagnosis date determined by either 1 inpatient encounter or first of 2 outpatient encounters within 6 months were included. Data analysis was conducted from May 1 to November 9, 2022. Exposure Antibiotic prescription within 3 months before HNC diagnosis date. Main Outcomes and Measures The primary outcome was days from the first documented symptom to HNC diagnosis. Results The cohort included 7811 patients with HNC (4151 [53.1%] men, mean [SD] age, 60.2 [15.8] years). At least 1 antibiotic was prescribed for 1219 patients (15.6%) within 3 months before HNC diagnosis. This represented an increase over the 8.9% prescribing rate during the baseline period 12 to 9 months before diagnosis. The rate of antibiotic prescribing within 3 months before diagnosis did not change significantly over time (quarterly percent change, 0.49%; 95% CI, -3.06% to 4.16%). Patients receiving an antibiotic prescription within 3 months of an HNC diagnosis had a 21.1% longer time between symptom onset and HNC diagnoses (adjusted rate ratio [ARR], 1.21; 95% CI, 1.14-1.29). Compared with diagnosis by otolaryngologists, primary care/internal medicine physicians were most likely to prescribe antibiotics for patients who were diagnosed with a presenting symptom (adjusted prevalence ratio, 1.60; 95% CI, 1.27-2.02). In patients presenting with neck mass/swelling, those presenting with other symptoms were more likely to have longer intervals from symptom onset to diagnosis (ARR, 1.31; 95% CI, 1.08-1.59). Conclusions and Relevance The findings of this cohort study suggest there is an increased rate of antibiotic prescription in the 3 months before HNC diagnosis, which is associated with an increased time to diagnosis. These findings identify an area for improvement in HNC care and guidelines.
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Affiliation(s)
- James A. Gallogly
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri
| | - Austin T. Armstrong
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri
| | - Jennifer V. Brinkmeier
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Joanne Salas
- AHEAD Institute, Saint Louis University, St Louis, Missouri
| | - Matthew C. Simpson
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri
- AHEAD Institute, Saint Louis University, St Louis, Missouri
| | - Henry Ideker
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri
| | - Ronald J. Walker
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri
| | - Sean T. Massa
- Department of Otolaryngology–Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri
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Sangal NR, Kaki P, Brant J, Brody RM. Effects of the COVID-19 Pandemic on H&N SCCa Incidence: A Population-based Analysis. Laryngoscope 2023; 133:2073-2074. [PMID: 37272897 DOI: 10.1002/lary.30804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Neel R Sangal
- Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Praneet Kaki
- Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Jason Brant
- Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Robert M Brody
- Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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34
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Lopez B, Gottlieb BR, Naples JG. Longer Times to Delivery of Otolaryngology Care for Patients With Limited English Proficiency. Otolaryngol Head Neck Surg 2023; 169:651-659. [PMID: 37194741 DOI: 10.1002/ohn.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Limited English proficiency (LEP) is known to contribute to poorer health outcomes and delays in management. However, to our knowledge, no other studies have explored the impact of LEP on delays to care within otolaryngology. This study aims to investigate the relationship between LEP and the time to delivery of otolaryngology care. METHODS We retrospectively reviewed 1125 electronic referrals to an otolaryngologist from primary care providers at 2 health centers in the greater Boston area, between January 2015 and December 2019. Multivariable logistic regression analyses were conducted to determine if patient LEP status (preferred language non-English and language interpreter use) has an impact on total time to appointment (TTTA). RESULTS Patients with non-English preferred languages were 2.6 times more likely to experience extended TTTA (odds ratio [OR] = 2.61, 95% confidence interval [CI] = 1.99-3.42, p < .001) relative to English-speaking patients. Patients who required interpreter use were 2.4 times more likely to experience extended TTTA (OR = 2.42, 95% CI = 1.84-3.18, p < .001) relative to patients who did not require an interpreter. There was no difference in age, sex, insurance type, education level, or marital status. TTTA did not vary by diagnosis category (p = .09). DISCUSSION LEP is an important factor that influences the time to appointment in our cohort. Notably, the impact of LEP on appointment wait times was independent of diagnosis. IMPLICATIONS FOR PRACTICE Clinicians should recognize LEP as a factor that can impact the overall delivery of care in otolaryngology. Specifically, mechanisms to streamline care for LEP patients should be considered.
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Affiliation(s)
- Betzamel Lopez
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Barbara R Gottlieb
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - James G Naples
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Cordunianu AGV, Ganea G, Cordunianu MA, Cochior D, Moldovan CA, Adam R. Hypopharyngeal cancer trends in a high-incidence region: A retrospective tertiary single center study. World J Clin Cases 2023; 11:5666-5677. [PMID: 37727730 PMCID: PMC10506015 DOI: 10.12998/wjcc.v11.i24.5666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/11/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Hypopharyngeal cancer has the bleakest prognosis among head and neck cancers due to its extensive submucosal involvement, advanced tumor stage, and limited surgical reconstruction options. Its primary causes include alcohol consumption, tobacco use, genetic predisposition, 1` diet, and socioeconomic conditions. While squamous cell carcinoma (SCC) accounts for 95% of hypopharyngeal tumors, it remains a rare form, comprising only 3%-5% of all SCC cases in the head and neck region. Globally, Central and Eastern Europe have the highest incidence rates for males (3.9 per 100000) and the third highest for females (2.26 per 100000), underscoring the significance of this seemingly uncommon condition. In Romania, hypopharyngeal cancer ranked 24th in incidence rate, with 634 new cases in 2020. AIM To study the incidence, treatment and survival rates of hypopharyngeal tumor cases in a major ear, nose, throat (ENT) surgical center. METHODS A retrospective epidemiological clinical study was conducted on patients diagnosed and treated for hypopharyngeal cancer at the ENT department of "Carol Davila Central University Emergency Military Hospital" in Bucharest between January 2018 and August 2022. The study included 53 patients and was authorized by the Ethics Committee of Titu Maiorescu Doctoral School (Bucharest, Romania) and the Ethics Committee of Carol Davila Central University Emergency Military Hospital (Bucharest, Romania). Inclusion criteria required a positive histopathological diagnosis of hypopharyngeal cancer, tumor localization in the hypopharyngeal region, and informed consent for data usage. Exclusion criteria involved major psychiatric pathologies and disagreement for data usage. Diagnosis was based on ENT assessment, imaging reports, and laboratory data. Treatment methods were determined based on various factors. Additional tools, such as Adult Comorbidity Evaluation-27 and Karnofski Performance Status Scale, were used for risk assessment and functional capacity evaluation. Quality of life aspects were measured using the European Organisation for Reasearch and Treatment of Cancer Quality of Life Questionnaire Head and Neck-35 questionnaire. RESULTS Our retrospective study examined 53 patients with hypopharyngeal cancer between January 2018 and August 2022. The majority of patients were male (94.3%), with an average age at diagnosis of 62.5 years. Among the patients, 20.75% were employed, 66.03% were retired, and 9.43% were unemployed. Smoking was prevalent among 69.81% of patients, while alcohol consumption was frequent in 32.07% of cases. The tumors were mostly diagnosed at an advanced stage (stage IV) and were predominantly SCC. Comorbidities were present in 83.01% of patients, with cardiovascular diseases being the most common. Dysphagia and neck mass were the most common symptoms reported. Treatment methods included surgery, radiation therapy, and chemotherapy. A favorable treatment response was observed in 22.64% of cases, while relapse occurred in 6 cases. Follow-up data was unavailable for some patients. CONCLUSION In summary, our findings align with existing literature; however, we observed a higher severity.
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Affiliation(s)
- Alina-Georgiana Vulcu Cordunianu
- Doctoral School of Medicine, Titu Maiorescu University of Bucharest, Bucharest 040317, Romania
- Department of Ear Nose Throat Head and Neck Surgery, Carol Davila Central University Emergency Military Hospital, Bucharest 10825, Romania
| | - Gabriel Ganea
- Department of Ear Nose Throat Head and Neck Surgery, Carol Davila Central University Emergency Military Hospital, Bucharest 10825, Romania
| | - Mihai Alexandru Cordunianu
- Doctoral School of Medicine, Titu Maiorescu University of Bucharest, Bucharest 040317, Romania
- Department of Pediatric Orthopedics, Victor Gomoiu Hospital, Bucharest 022102, Romania
| | - Daniel Cochior
- Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University, Bucharest 031593, Romania
- Department of General Surgery, Sanador Clinical Hospital, Bucharest 010991, Romania
- Department of General Surgery, Monza Clinical Hospital, Bucharest 021967, Romania
| | - Cosmin Alec Moldovan
- Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University, Bucharest 031593, Romania
- Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, Romania
| | - Razvan Adam
- Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University, Bucharest 031593, Romania
- Department of Orthopedics and Traumatology, Elias Emergency University Hospital, Bucharest 011461, Romania
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Jaworska N, Schalm E, Kersen J, Smith C, Dorman J, Brindle M, Dort J, Sauro KM. The impact of delayed nonurgent surgery during the COVID-19 pandemic on surgeons in Alberta: a qualitative interview study. CMAJ Open 2023; 11:E587-E596. [PMID: 37402553 DOI: 10.9778/cmajo.20220188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, nonurgent surgeries were delayed to preserve capacity for patients admitted with COVID-19; surgeons were challenged personally and professionally during this time. We aimed to describe the impact of delays to nonurgent surgeries during the COVID-19 pandemic from the surgeons' perspective in Alberta. METHODS We conducted an interpretive description qualitative study in Alberta from January to March 2022. We recruited adult and pediatric surgeons via social media and through personal contacts from our research network. Semistructured interviews were conducted via Zoom, and we analyzed the data via inductive thematic analysis to identify relevant themes and subthemes related to the impact of delaying nonurgent surgery on surgeons and their provision of surgical care. RESULTS We conducted 12 interviews with 9 adult surgeons and 3 pediatric surgeons. Six themes were identified: accelerator for a surgical care crisis, health system inequity, system-level management of disruptions in surgical services, professional and interprofessional impact, personal impact, and pragmatic adaptation to health system strain. Participants also identified strategies to mitigate the challenges experienced due to nonurgent surgical delays during the COVID-19 pandemic (i.e., additional operating time, surgical process reviews to reduce inefficiencies, and advocacy for sustained funding of hospital beds, human resources and community-based postoperative care). INTERPRETATION Our study describes the impacts and challenges experienced by adult and pediatric surgeons of delayed nonurgent surgeries because of the COVID-19 pandemic response. Surgeons identified potential health system-, hospital- and physician-level strategies to minimize future impacts on patients from delays of nonurgent surgery.
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Affiliation(s)
- Natalia Jaworska
- Alberta Health Services (Jaworska, Brindle); Departments of Critical Care Medicine (Jaworska, Schalm) and Community Health Sciences (Jaworska, Schalm, Kersen, Smith, Brindle, Sauro), and O'Brien Institute for Public Health (Sauro), University of Calgary; Department of Surgery (Brindle, Dort, Sauro), and Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary; Faculty of Nursing (Dorman), University of Calgary, Calgary, Alta
| | - Emma Schalm
- Alberta Health Services (Jaworska, Brindle); Departments of Critical Care Medicine (Jaworska, Schalm) and Community Health Sciences (Jaworska, Schalm, Kersen, Smith, Brindle, Sauro), and O'Brien Institute for Public Health (Sauro), University of Calgary; Department of Surgery (Brindle, Dort, Sauro), and Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary; Faculty of Nursing (Dorman), University of Calgary, Calgary, Alta
| | - Jaling Kersen
- Alberta Health Services (Jaworska, Brindle); Departments of Critical Care Medicine (Jaworska, Schalm) and Community Health Sciences (Jaworska, Schalm, Kersen, Smith, Brindle, Sauro), and O'Brien Institute for Public Health (Sauro), University of Calgary; Department of Surgery (Brindle, Dort, Sauro), and Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary; Faculty of Nursing (Dorman), University of Calgary, Calgary, Alta
| | - Christine Smith
- Alberta Health Services (Jaworska, Brindle); Departments of Critical Care Medicine (Jaworska, Schalm) and Community Health Sciences (Jaworska, Schalm, Kersen, Smith, Brindle, Sauro), and O'Brien Institute for Public Health (Sauro), University of Calgary; Department of Surgery (Brindle, Dort, Sauro), and Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary; Faculty of Nursing (Dorman), University of Calgary, Calgary, Alta
| | - Jennifer Dorman
- Alberta Health Services (Jaworska, Brindle); Departments of Critical Care Medicine (Jaworska, Schalm) and Community Health Sciences (Jaworska, Schalm, Kersen, Smith, Brindle, Sauro), and O'Brien Institute for Public Health (Sauro), University of Calgary; Department of Surgery (Brindle, Dort, Sauro), and Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary; Faculty of Nursing (Dorman), University of Calgary, Calgary, Alta
| | - Mary Brindle
- Alberta Health Services (Jaworska, Brindle); Departments of Critical Care Medicine (Jaworska, Schalm) and Community Health Sciences (Jaworska, Schalm, Kersen, Smith, Brindle, Sauro), and O'Brien Institute for Public Health (Sauro), University of Calgary; Department of Surgery (Brindle, Dort, Sauro), and Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary; Faculty of Nursing (Dorman), University of Calgary, Calgary, Alta
| | - Joseph Dort
- Alberta Health Services (Jaworska, Brindle); Departments of Critical Care Medicine (Jaworska, Schalm) and Community Health Sciences (Jaworska, Schalm, Kersen, Smith, Brindle, Sauro), and O'Brien Institute for Public Health (Sauro), University of Calgary; Department of Surgery (Brindle, Dort, Sauro), and Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary; Faculty of Nursing (Dorman), University of Calgary, Calgary, Alta
| | - Khara M Sauro
- Alberta Health Services (Jaworska, Brindle); Departments of Critical Care Medicine (Jaworska, Schalm) and Community Health Sciences (Jaworska, Schalm, Kersen, Smith, Brindle, Sauro), and O'Brien Institute for Public Health (Sauro), University of Calgary; Department of Surgery (Brindle, Dort, Sauro), and Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine, University of Calgary; Faculty of Nursing (Dorman), University of Calgary, Calgary, Alta.
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Azimian A, Jiao J. Durations of Dockless E-Scooter Trips Before and During the COVID-19 Pandemic in Austin, TX: An Analysis Using Hazard-Based Duration Models. TRANSPORTATION RESEARCH RECORD 2023; 2677:629-640. [PMID: 38603346 PMCID: PMC9827134 DOI: 10.1177/03611981221138807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The pandemic arising from the 2019 coronavirus disease has significantly affected all facets of human life across the world, including economies and transportation systems, thereby changing people's travel behaviors. This research was aimed at exploring the relationship between socio-economic factors and e-scooter trip durations before and during the pandemic. We developed a hazard-based duration approach and estimated multiple spatial and non-spatial models on the basis of 2019 and 2020 dockless e-scooter data collected from the City of Austin's Open Data Portal. The results indicated an overall increase in e-scooter trip durations after the pandemic. Moreover, analysis of variables revealed potential changes in users' behavior before and during the pandemic. In particular, whereas e-scooter trip durations were found to be positively associated with aggregate travel time to work before the pandemic, this trend was reversed during the pandemic. In addition, during the pandemic, e-scooter travel time was positively correlated with the ratio of individuals with bachelor's degrees or greater to those with associate degrees or lower. However, no specific pattern was observed before the pandemic. Lastly, the results showed the presence of disparities within the study area; therefore, it is vital to extend e-scooter service areas to cover underserved communities.
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Affiliation(s)
- Amin Azimian
- Urban Information Lab, University of
Texas at Austin, Austin, TX
| | - Junfeng Jiao
- Urban Information Lab, University of
Texas at Austin, Austin, TX
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Salahuddin Z, Chen Y, Zhong X, Woodruff HC, Rad NM, Mali SA, Lambin P. From Head and Neck Tumour and Lymph Node Segmentation to Survival Prediction on PET/CT: An End-to-End Framework Featuring Uncertainty, Fairness, and Multi-Region Multi-Modal Radiomics. Cancers (Basel) 2023; 15:1932. [PMID: 37046593 PMCID: PMC10093277 DOI: 10.3390/cancers15071932] [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: 02/21/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Automatic delineation and detection of the primary tumour (GTVp) and lymph nodes (GTVn) using PET and CT in head and neck cancer and recurrence-free survival prediction can be useful for diagnosis and patient risk stratification. We used data from nine different centres, with 524 and 359 cases used for training and testing, respectively. We utilised posterior sampling of the weight space in the proposed segmentation model to estimate the uncertainty for false positive reduction. We explored the prognostic potential of radiomics features extracted from the predicted GTVp and GTVn in PET and CT for recurrence-free survival prediction and used SHAP analysis for explainability. We evaluated the bias of models with respect to age, gender, chemotherapy, HPV status, and lesion size. We achieved an aggregate Dice score of 0.774 and 0.760 on the test set for GTVp and GTVn, respectively. We observed a per image false positive reduction of 19.5% and 7.14% using the uncertainty threshold for GTVp and GTVn, respectively. Radiomics features extracted from GTVn in PET and from both GTVp and GTVn in CT are the most prognostic, and our model achieves a C-index of 0.672 on the test set. Our framework incorporates uncertainty estimation, fairness, and explainability, demonstrating the potential for accurate detection and risk stratification.
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Affiliation(s)
- Zohaib Salahuddin
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Reproduction, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Yi Chen
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Reproduction, Maastricht University, 6200 MD Maastricht, The Netherlands
- Key Laboratory of Intelligent Medical Image Analysis and Precise Diagnosis, College of Computer Science and Technology, Guizhou University, Guiyang 550025, China
| | - Xian Zhong
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Reproduction, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Henry C. Woodruff
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Reproduction, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, GROW—School for Oncology and Reproduction, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - Nastaran Mohammadian Rad
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Reproduction, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Shruti Atul Mali
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Reproduction, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Reproduction, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, GROW—School for Oncology and Reproduction, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
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Lizambri D, Giacalone A, Shah PA, Tovani-Palone MR. Reconstruction surgery in head and neck cancer patients amidst the COVID-19 pandemic: Current practice and lessons for the future. World J Clin Cases 2023; 11:1434-1441. [PMID: 36926409 PMCID: PMC10011991 DOI: 10.12998/wjcc.v11.i7.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has imposed a radical change in daily life and work routine. In this context, health systems have suffered important and serious repercussions in all fields. Among the changes brought about by the state of global health emergency, adjustments to guidelines, priorities, structures, professional teams, and epidemiological data stand out. In light of this, the oncological field has witnessed several changes in the approach to cancer, whether due to delay in diagnosis, screening deficit, personnel shortage or the psychological impact that the pandemic has had on cancer patients. This article focuses on the management of oral carcinoma and the surgical approaches that oral and maxillofacial specialists have had at their disposal during the health emergency. In this period, the oral and maxillofacial surgeons have faced many obstacles. The proximity of maxillofacial structures to the airways, the need of elective and punctual procedures in cancerous lesions, the aggressiveness of head and neck tumors, and the need for important healthcare costs to support such delicate surgeries are examples of some of the challenges imposed for this field. One of the possible surgical 'solutions' to the difficulties in managing surgical cases of oral carcinoma during the pandemic is locoregional flaps, which in the pre-COVID-19 era were less used than free flaps. However, during the health emergency, its use has been widely reassessed. This setback may represent a precedent for opening up new reflections. In the course of a long-term pandemic, a reassessment of the validity of different medical and surgical therapeutic approaches should be considered. Finally, given that the pandemic has high-lighted vulnerabilities and shortcomings in a number of ways, including the issues of essential resource shortages, underinvestment in public health services, lack of coordination and versatility among politicians, policymakers and health leaders, resulting in overloaded health systems, rapid case development, and high mortality, a more careful analysis of the changes needed in different health systems to satisfactorily face future emergencies is essential to be carried out. This should be directed especially towards improving the management of health systems, their coordination as well as reviewing related practices, even in the surgical field.
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Affiliation(s)
- Daniele Lizambri
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Caserta 81100, Italy
| | - Andrea Giacalone
- Department of Industrial Engineering, Technologies for Sports Medicine and Rehabilitation, University of Rome Tor Vergata, Rome 00133, Italy
| | - Pritik A Shah
- Bangalore Medical College and Research Institute, Karnataka 560002, India
| | - Marcos Roberto Tovani-Palone
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai 600077, India
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Patel R, Didzbalis CJ, Tseng CC, Talmor G, Park RCW. Facility volume and survival: Human papilloma virus positive oropharyngeal squamous cell carcinoma. Am J Otolaryngol 2023; 44:103762. [PMID: 36628908 DOI: 10.1016/j.amjoto.2022.103762] [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: 11/03/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND To analyze the impact of facility volume on survival for human papilloma virus positive oropharyngeal squamous cell carcinoma (HPV+ OPSCC) patients. METHODS Patients treated for HPV+ OPSCC from 2010 to 2017 were queried from the National Cancer Database. Facilities of average annual case volume <50th percentile were categorized as low-volume (LV) and >95th percentile as high-volume (HV). RESULTS 11,546 were included, with 10,305 patients (89.3 %) treated at LV and 1241 (10.7 %) at HV facilities. A greater proportion of cases involving resection of base of tongue and lingual tonsil were treated at HV (30.3 %) compared to LV (22.3 %) facilities (p < 0.001). Patients treated at a HV facility had greater percentage of clinical T4 (11.2 % vs. 8.6 %, p = 0.001) and N+ disease (90.5 % vs. 85.7 %, p < 0.001) patients. Survival analysis showed no statistically significant difference between five-year overall survival rates by facility volume (p = 0.388) for all patients. On multivariable analysis, facility volume was not associated with survival (HR: 0.968 [0.758-1.235], p = 0.791). These trends were found for both patients undergoing primary surgery or chemoradiotherapy. CONCLUSION Our data indicates that patients with HPV+ OPSCC do not experience a survival benefit with treatment at HV facility, suggesting these patients may be adequately treated at LV centers.
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Affiliation(s)
- Rushi Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Christopher J Didzbalis
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Christopher C Tseng
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Guy Talmor
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
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Zhang L, Lin S, Zhang Z, Yan C, Liu F. The role of p21-activated kinase 4 in the progression of oral squamous cell carcinoma by targeting PI3K-AKT signaling pathway. Clin Transl Oncol 2023; 25:739-747. [PMID: 36593383 DOI: 10.1007/s12094-022-02980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/09/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Oral squamous carcinoma (OSCC), the most common head and neck malignancy, has a strong propensity for malignant proliferation and metastasis, which will decrease the survival of patients. P21-activated kinase 4 (PAK4), a classical serine/threonine protein kinase with multiple cellular functions, has an essential role in cancer cell migration and invasion. Here, we elucidated the function and possible molecular mechanisms of the effect of PAK4 on the biological behaviors of OSCC. METHODS The expression of genes and protein was detected by real-time PCR and western blotting. We used oral squamous carcinoma cell lines, Tca8117, Cal 27, SCC 4, and SCC 9 for validation of our cell function data. Flow cytometry, 3D cultures, and clone formation assay were used to detect proliferation of cells. RNA sequencing and bioinformatic analysis was performed to determine the potential function of PAK4. RESULTS Immunohistochemistry, western blotting and real-time PCR demonstrated that PAK4 expression was up-regulated in OSCC tissues. Overexpression of PAK4 promoted the proliferation, migration and invasion of OSCC cell lines. RNA sequencing (RNA-seq) for the transcriptome-wide analysis of differential gene expression followed by bioinformatic analysis was performed to determine the potential function of PAK4. Based on the KEGG enrichment analysis and GO analysis of differential expression genes (DEGs) we found that PAK4 promotes the cell-cycle machinery, which associated with 44 regulated genes, thereby promoting cancer cell differentiation. CONCLUSIONS This study demonstrates that the PAK4 regulates the biological behaviors of OSCC by PI3K-AKT signaling pathway, and these findings might provide a novel strategy for OSCC treatment.
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Affiliation(s)
- Lan Zhang
- Department of Oromaxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease, Shenyang, China.,Nosocomial Infection Management Office, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Shanfeng Lin
- Department of Oromaxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease, Shenyang, China
| | - Zeying Zhang
- Department of Oromaxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease, Shenyang, China.,Department of Endodontics, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease, Shenyang, China
| | - Cong Yan
- Department of Oromaxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease, Shenyang, China
| | - Fayu Liu
- Department of Oromaxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Disease, Shenyang, China.
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Meltzer C, Nguyen NT, Zhang J, Aguilar J, Blatchins MA, Quesenberry CP, Wang Y, Sakoda LC. Survival Associated With Consolidated Multidisciplinary Care in Head and Neck Cancer: A Retrospective Cohort Study. Otolaryngol Head Neck Surg 2023; 168:82-90. [PMID: 34752163 DOI: 10.1177/01945998211057852] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/12/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare survival among patients with head and neck cancer before and after implementing a weekly multidisciplinary clinic and case conference. METHODS A retrospective cohort study with chart review was conducted of 3081 patients (1431 preimplementation, 1650 postimplementation) diagnosed with stage I-IVB tumors in the oral cavity, oropharynx, hypopharynx, nasopharynx, or larynx. Pre- and postimplementation differences in overall and disease-specific survival 1, 2, and 3 years after diagnosis were assessed with unadjusted Kaplan-Meier curves and multivariable Cox proportional hazard regression models adjusted for demographic characteristics, comorbidity burden, smoking status, tumor site and stage, p16 status for oropharyngeal squamous cell cancer, and initial treatment modality. RESULTS Patients less commonly presented with oropharyngeal squamous cell cancer and advanced tumors (III-IVB) and received primary treatment with surgery alone or with adjuvant therapy preimplementation than postimplementation. Overall survival at 3 years was 77.1% and 79.9% (P = .07) and disease-specific survival was 84.9% and 87.5% (P = .05) among pre- and postimplementation patients, respectively. At 3 years, preimplementation patients had slightly poorer overall (hazard ratio, 1.20; 95% CI, 1.02-1.40) and disease-specific (hazard ratio, 1.26; 95% CI, 1.03-1.54) adjusted survival than postimplementation patients. In unadjusted and adjusted analyses, survival improvements were more pronounced among patients with advanced disease. DISCUSSION A multidisciplinary clinic and case conference were associated with improved outcomes among patients with head and neck cancer, especially those with advanced tumors. IMPLICATIONS FOR PRACTICE All patients with head and neck cancer should receive multidisciplinary team management, especially those with advanced tumors.
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Affiliation(s)
- Charles Meltzer
- Department of Head and Neck Surgery, The Permanente Medical Group, Santa Rosa, California, USA
| | - Nathalie T Nguyen
- Department of Radiation Oncology, The Permanente Medical Group, Rancho Cordova, California, USA
| | - Jie Zhang
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jillian Aguilar
- Department of Radiation Oncology, The Permanente Medical Group, Rancho Cordova, California, USA
| | - Maruta A Blatchins
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Charles P Quesenberry
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Yan Wang
- Department of Pathology, The Permanente Medical Group, Roseville, California, USA
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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Abdel-Rahman O, Ghosh S. Impact of Time From Diagnosis to Treatment Start on the Outcomes of Patients With Nonmetastatic Anal Squamous Cell Carcinoma. Am J Clin Oncol 2023; 46:31-35. [PMID: 36453694 DOI: 10.1097/coc.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To assess the impact of time from diagnosis to treatment on the survival outcomes of patients with nonmetastatic anal squamous cell carcinoma, controlling for other clinicopathological features. METHODS Surveillance, Epidemiology, and End Results research plus database was accessed, and patients with nonmetastatic anal squamous cell carcinoma were reviewed. Factors associated with longer time to treatment were evaluated through multivariable logistic regression analysis. Kaplan-Meier survival estimates were used to examine survival differences according to time to treatment (≤2 vs. >2 mo), and multivariable Cox regression analysis was used to examine factors associated with worse overall and cancer-specific survival. RESULTS A total of 13,032 patients were considered eligible and they were included in this study. The following factors were associated with longer time to treatment (>2 mo): male sex (odds ratio [OR]: 1.503; 95% CI, 1.292 to 1.749), and non-White race (OR for Black vs. White patients: 1.846; 95% CI, 1.488 to 2.290; OR for American Indian vs. White patients: 2.414; 95% CI, 1.197 to 4.872; OR for Asian-Pacific Islanders vs. White patients: 2.182; 95% CI, 1.440 to 3.309). Using Kaplan-Meier survival estimates, longer time to treatment was associated with worse overall survival (median OS for >2 mo=109 mo; for ≤2 mo=164 mo P <0.0001). Using multivariable Cox regression analysis, the following factors were associated with worse overall survival: older age (hazard ratio [HR]: 1.037; 95% CI, 1.034 to 1.039), male sex (HR: 1.650; 95% CI, 1.548 to 1.758), Black race (HR: 1.341; 95% CI, 1.210 to 1.487), advanced stage (HR for regional vs. localized stage: 1.596; 95% CI, 1.500 to 1.698), and longer time to treatment (HR: 1.385; 95% CI, 1.222 to 1.571). CONCLUSIONS Time from diagnosis to treatment longer than 2 months is associated with worse survival outcomes among patients with nonmetastatic anal squamous cell carcinoma.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
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Wang Y, Zheng Y, Wen Z, Zhou Y, Wang Y, Huang Z. Effects of frailty on patients undergoing head and neck cancer surgery with flap reconstruction: a retrospective analysis. BMJ Open 2022; 12:e062047. [PMID: 36600384 PMCID: PMC9743268 DOI: 10.1136/bmjopen-2022-062047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To establish the implications of frailty as a predictor of outcome in patients with head and neck cancer requiring flap repair. DESIGN Retrospective cohort. DATA SOURCE We captured data from patients above 60 years old undergoing head and neck tumour resection and free flap reconstruction surgery between June 2019 and June 2020 at the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The data contain all treatment information. OUTCOME VARIABLES Surgery repeated in 30 days, postoperative complications, hospital length of stay, postoperative main biochemical standards. EXPOSURE VARIABLES Age, sex, smoking history, alcoholism history, American Society of Anesthesiologists score, National Nosocomial Infection Surveillance score and Clinical T staging were exposure variables. The frailty index is the main variable. RESULT A total of 254 patients were included in this study. Among them, 124 patients were classified as frail, while 130 patients were classified as non-frail. We found that frail patients stayed in the hospital longer than non-frail patients after surgery (p=0.018). According to the data of 26 frail patients who directly entered the intensive care unit (ICU), we found that these patients had a lower leucocyte count (p=0.005). CONCLUSIONS Frailty is a useful predictor of outcomes in patients undergoing head and neck cancer surgery with flap reconstruction. Frailty can be a clinical tool used to identify high-risk patients and guide perioperative care to optimise patient outcomes. Frail patients have better outcomes if they directly enter the ICU.
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Affiliation(s)
- Yuepeng Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Yukai Zheng
- Department of Intensive Care Unit, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zuozhen Wen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Yuwei Zhou
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Yan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Zhiquan Huang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, People's Republic of China
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Gršić K, Blivajs I, Pastorčić Grgić M, Prgomet D, Lukinović J, Vugrinec O, Matoc L, Miličić B, Leović D. THE IMPACT OF COVID-19 ON HEAD AND NECK CANCER TREATMENT DELAY. Acta Clin Croat 2022; 61:19-25. [PMID: 37250665 PMCID: PMC10218083 DOI: 10.20471/acc.2022.61.s4.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024] Open
Abstract
The aim of this study was to demonstrate the impact of COVID-19 pandemic on the number and characteristics of head and neck cancer patients in two consecutive periods, pre-pandemic and pandemic. For this purpose, we performed a retrospective analysis of patients with primary carcinomas of head and neck mucosal sites, salivary gland tumors, as well as neck metastases. Two pre-COVID-19 years (2018-2019) and two pandemic years (2020-2021) were compared. Demographic data, overall number of patients, TNM classification of the two most affected sites (oral cavity and larynx), time from symptom onset to first outpatient admission to our department, and time from first admission to treatment initiation were noted. Study results revealed a higher number of patients during the pandemic period and difference in the distribution of tumor sites (χ2=33.68, df=9, p<0.001). Oral cavity cancer prevailed over laryngeal cancer during the pandemic period. A statistically significant difference was observed in delay of initial presentation to head and neck surgeon for oral cavity cancer during the pandemic period (p=0.019). Furthermore, significant delay was found for both sites concerning time from initial presentation to the beginning of treatment (larynx: p=0.001 and oral cavity: p=0.006). Despite these facts, there were no differences in TNM stages comparing two observed periods. Study results indicated that there was a statistically significant delay of surgical treatment for both cancer sites observed (oral cavity and larynx) during the COVID-19 pandemic. A survival study is necessary in the future to definitely reveal the true consequences of COVID-19 pandemic on treatment outcomes.
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Affiliation(s)
- Krešimir Gršić
- Zagreb University Hospital Center, Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia
| | - Igor Blivajs
- Zagreb University Hospital Center, Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia
| | - Marija Pastorčić Grgić
- Zagreb University Hospital Center, Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia
| | - Drago Prgomet
- Zagreb University Hospital Center, Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Juraj Lukinović
- Zagreb University Hospital Center, Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia
| | - Ozren Vugrinec
- Zagreb University Hospital Center, Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia
| | - Lovro Matoc
- Zagreb University Hospital Center, Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia
| | - Borna Miličić
- Zagreb University Hospital Center, Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia
| | - Dinko Leović
- Zagreb University Hospital Center, Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb, Croatia
- Josip Juraj Strossmayer University of Osijek, School od Dental Medicine and Health, Osijek, Croatia
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Vanderhaegen T, Pierache A, Mortuaire G, Rysman B, Nicot R, Chevalier D, Mouawad F. The first wave of COVID-19 did not cause longer wait times in head and neck cancer. Experience of a French expert center. Eur Ann Otorhinolaryngol Head Neck Dis 2022; 139:261-267. [PMID: 35534362 PMCID: PMC9023346 DOI: 10.1016/j.anorl.2022.03.003] [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] [Indexed: 11/23/2022]
Abstract
BACKGROUND Head and neck cancers (HNC) have poor survival prognosis, as tumors are often diagnosed at advanced stages in patients consulting late. The first lockdown linked to the 1st wave of COVID-19 (Coronavirus Disease 2019) disrupted consultation schedules in France. OBJECTIVE The principal aim of the present study was to analyze consultation wait time in HNC during and after lockdown, in our university expert oncology reference center, to disclose any increase in treatment wait time. METHODS A single-center retrospective study included patients with a first diagnosis of HNC. Three groups were distinguished: "lockdown", "post-lockdown", and a "control" group (corresponding to a reference period 1 year earlier). Intervals between first oncologic consultation and multidisciplinary tumor board (FC-MTB) and between MTB and first treatment (MTB-T) were assessed. RESULTS One hundred and seven patients were included in the control group, 60 in the lockdown group and 74 in the post-lockdown group. There was no increase in median FC-MTB interval (respectively 35, 29 and 28 days) between the lockdown and post-lockdown groups compared to the control group (respectively P=0.2298 and P=0.0153). Likewise, there was no increase in MTB-T interval (27, 20 and 26 days respectively) (P=0.4203). CONCLUSION No increase in wait times was observed during the lockdown and post-lockdown periods in our center.
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Affiliation(s)
- T Vanderhaegen
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - A Pierache
- METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales - ULR 2694 - University Lille - CHU Lille, 59000 Lille, France
| | - G Mortuaire
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - B Rysman
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - R Nicot
- Service de stomatologie et de chirurgie maxillo-faciale, hôpital Roger Salengro, université de Lille, CHU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - D Chevalier
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU Lille, rue Michel-Polonovski, 59037 Lille cedex, France; CANTHER "Cancer Heterogeneity, Plasticity and Resistance to Therapies", UMR9020 CNRS - U1277 Inserm - Université de Lille - CHU de Lille-COL, 59037 Lille cedex, France
| | - F Mouawad
- ENT and Head and Neck Department, Huriez Hospital, Lille University, CHU Lille, rue Michel-Polonovski, 59037 Lille cedex, France; CANTHER "Cancer Heterogeneity, Plasticity and Resistance to Therapies", UMR9020 CNRS - U1277 Inserm - Université de Lille - CHU de Lille-COL, 59037 Lille cedex, France.
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Prgomet D, Bišof V, Prstačić R, Curić Radivojević R, Brajković L, Šimić I. THE MULTIDISCIPLINARY TEAM (MDT) IN THE TREATMENT OF HEAD AND NECK CANCER - A SINGLE-INSTITUTION EXPERIENCE. Acta Clin Croat 2022; 61:77-87. [PMID: 37250663 PMCID: PMC10218076 DOI: 10.20471/acc.2022.61.s4.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Head and neck cancers are associated with significant morbidity and mortality despite advancements in treatment in recent decades. A multidisciplinary approach to the treatment of these diseases is thus of essential importance and is becoming the gold standard. Head and neck tumors also endanger relevant structures of the upper aerodigestive tracts, including bodily functions such as voice, speech, swallowing, and breathing. Damage to these functions can significantly influence quality of life. Thus, our study examined not only the roles of head and neck surgeons, oncologists and radiotherapists, but also the importance of the participation of different scientific professions such as anesthesiologists, psychologists, nutritionists, stomatologists, and speech therapists in the work of a multidisciplinary team (MDT). Their participation results in a significant improvement of patient quality of life. We also present our experiences in the organization and work of the MDT as part of the Center for Head and Neck Tumors of the Zagreb Clinical Hospital Center.
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Affiliation(s)
- Drago Prgomet
- Department of ENT and Head and Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, Zagreb University, Croatia
| | - Vesna Bišof
- School of Medicine, Zagreb University, Croatia
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ratko Prstačić
- Department of ENT and Head and Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, Zagreb University, Croatia
| | | | - Lovorka Brajković
- Department of Psychology, Faculty of Croatian Studies, Zagreb, Croatia
| | - Ivana Šimić
- Department of ENT and Head and Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
- Faculty of Education and Rehabilitation Sciences, Zagreb University, Croatia
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Spalthoff S, Nejati-Rad N, Rahlf B, Jehn P, Gellrich NC, Lentge F, Korn P. Time is crucial in malignant tumor cases: Speeding up the process of patient-specific implant creation. Front Oncol 2022; 12:904343. [PMID: 36212406 PMCID: PMC9533641 DOI: 10.3389/fonc.2022.904343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Patient-specific implants are commonly used to reconstruct lower jaw defects following surgical treatment for head and neck squamous cell carcinoma. The planning process of surgery is time-consuming and can delay the “time to surgery,” which should be as short as possible. Therefore, this study aimed to evaluate the planning process to speed up and identify any sources of problems. Patients and methods In this retrospective study, we enrolled patients who underwent continuous resection of the mandible in combination with reconstruction with a patient-specific implant between 2016 and 2021. The predictor variables were in-house training of the engineers and implant complexity (complex [with additional features] vs. less complex [resembling standard reconstruction plates]). The outcome variables were the duration of communication, message length, and the need for synchronous communication or modifications to the original design. Descriptive and univariate statistics were computed, and statistical significance was set at P < 0.05. Results The data from 83 patients were included in this study. The mean duration of communication was 14.05 ± 13.58 days. The implant complexity and training status of the engineer had no statistically significant influence on the primary outcome variables. As for the secondary outcome variables, the implant complexity significantly influenced the chance that the planned operation had to be postponed (15/16 [93.75%] were complex cases, P = 0.001). The most frequent cause of problems in the planning process was an insufficient dataset, which was not dependent on the type of imaging. Conclusions The overall duration of the patient-specific implant creation process is too long to meet oncological requirements. Therefore, standardization of the planning process to accelerate implant creation is of utmost importance. In addition, a common standard imaging format (independent of the type of imaging) for oncological cases could eliminate all delays caused by insufficient datasets in the future.
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Nyirjesy SC, Heller M, von Windheim N, Gingras A, Kang SY, Ozer E, Agrawal A, Old MO, Seim NB, Carrau RL, Rocco JW, VanKoevering KK. The role of computer aided design/computer assisted manufacturing (CAD/CAM) and 3- dimensional printing in head and neck oncologic surgery: A review and future directions. Oral Oncol 2022; 132:105976. [PMID: 35809506 DOI: 10.1016/j.oraloncology.2022.105976] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/17/2022] [Indexed: 01/12/2023]
Abstract
Microvascular free flap reconstruction has remained the standard of care in reconstruction of large tissue defects following ablative head and neck oncologic surgery, especially for bony structures. Computer aided design/computer assisted manufacturing (CAD/CAM) and 3-dimensionally (3D) printed models and devices offer novel solutions for reconstruction of bony defects. Conventional free hand techniques have been enhanced using 3D printed anatomic models for reference and pre-bending of titanium reconstructive plates, which has dramatically improved intraoperative and microvascular ischemia times. Improvements led to current state of the art uses which include full virtual planning (VP), 3D printed osteotomy guides, and patient specific reconstructive plates, with advanced options incorporating dental rehabilitation and titanium bone replacements into the primary surgical plan through use of these tools. Limitations such as high costs and delays in device manufacturing may be mitigated with in house software and workflows. Future innovations still in development include printing custom prosthetics, 'bioprinting' of tissue engineered scaffolds, integration of therapeutic implants, and other possibilities as this technology continues to rapidly advance. This review summarizes the literature and serves as a summary guide to the historic, current, advanced, and future possibilities of 3D printing within head and neck oncologic surgery and bony reconstruction. This review serves as a summary guide to the historic, current, advanced, and future roles of CAD/CAM and 3D printing within the field of head and neck oncologic surgery and bony reconstruction.
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Affiliation(s)
- Sarah C Nyirjesy
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Margaret Heller
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Natalia von Windheim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amelia Gingras
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Stephen Y Kang
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Enver Ozer
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Amit Agrawal
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Matthew O Old
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Nolan B Seim
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Ricardo L Carrau
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - James W Rocco
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States
| | - Kyle K VanKoevering
- Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210, United States.
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The Many Faces of Head and Neck Surgery in 2022 and Looking Ahead! J Clin Med 2022; 11:jcm11113174. [PMID: 35683558 PMCID: PMC9181701 DOI: 10.3390/jcm11113174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
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