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Otolaryngology--head and Neck Surgery :... Mar 2019Opioid use and abuse is a national health care crisis, yet opioids remain the cornerstone of pain management in cancer. We sought to determine the risk of acute and...
OBJECTIVE
Opioid use and abuse is a national health care crisis, yet opioids remain the cornerstone of pain management in cancer. We sought to determine the risk of acute and chronic opioid use with head and neck squamous cell cancer (HNSCC) treatment.
STUDY DESIGN
Retrospective population-based study.
SETTING
Surveillance, Epidemiology and End Results (SEER)-Medicare database from 2008 to 2011.
SUBJECTS AND METHODS
In total, 976 nondistant metastatic oral cavity and oropharynx patients undergoing cancer-directed treatment enrolled in Medicare were included. Opiate use was the primary end point. Univariate and multivariable logistic analyses were completed to determine risk factors.
RESULTS
Of the patients, 811 (83.1%) received an opioid prescription during the treatment period, and 150 patients (15.4%) had continued opioid prescriptions at 3 months and 68 (7.0%) at 6 months. Opioid use during treatment was associated with prescriptions prior to treatment (odds ratio [OR], 3.28; 95% confidence interval [CI], 2.11-5.12) and was least likely to be associated with radiation treatment alone (OR, 0.35; 95% CI, 0.18-0.68). Risk factors for continued opioid use at both 3 and 6 months included tobacco use (OR, 2.23; 95% CI, 1.05-4.71 and OR, 3.84; 95% CI, 1.44-10.24) and opioids prescribed prior to treatment (OR, 3.84; 95% CI, 2.45-5.91 and OR, 3.56; 95% CI, 1.95-6.50). Oxycodone prescribed as the first opioid was the least likely to lead to ongoing use at 3 and 6 months (OR, 0.33; 95% CI, 0.17-0.62 and OR, 0.26; 95% CI, 0.10-0.67).
CONCLUSION
Patients with oral/oropharyngeal cancer are at a very high risk for receiving opioids as part of symptom management during treatment, and a significant portion continues use at 3 and 6 months after treatment completion.
Topics: Aged; Aged, 80 and over; Analgesics, Opioid; Cancer Pain; Carcinoma, Squamous Cell; Drug Administration Schedule; Female; Humans; Male; Mouth Neoplasms; Neoplasm Staging; Oropharyngeal Neoplasms; Retrospective Studies; SEER Program; United States
PubMed: 30396321
DOI: 10.1177/0194599818808513 -
Head & Neck May 2019The objective of the present study is to assess differences in the competing causes of death in patients with oropharyngeal carcinoma (OPC) as a function of the human... (Comparative Study)
Comparative Study
BACKGROUND
The objective of the present study is to assess differences in the competing causes of death in patients with oropharyngeal carcinoma (OPC) as a function of the human papillomavirus (HPV) status.
METHODS
We studied retrospectively 423 patients with OPC with known HPV status. Among the patients included in the study, 53 (12.5%) were HPV-positive. We analyzed overall survival and competing causes of mortality according to the HPV status of the patients.
RESULTS
Patients with HPV-negative tumors had lower OPC cancer-specific survival (P = .0001), second primary neoplasm survival (P = .0001), and noncancer-related causes survival (P = .13) than patients with HPV-positive tumors. This resulted in significant differences in overall survival depending on HPV status (P = .0001).
CONCLUSION
Conclusion: HPV-positive OPC has a better overall survival than HPV-negative OPC. Patients with HPV-positive tumors presented a significant lower OPC cancer-specific and second primary neoplasm mortality and a marginally nonsignificant lower noncancer mortality as compared to HPV-negative tumors.
Topics: Adult; Aged; Cause of Death; Databases, Factual; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prognosis; Regression Analysis; Retrospective Studies; Risk Assessment; Squamous Cell Carcinoma of Head and Neck; Statistics, Nonparametric; Survival Analysis
PubMed: 30549389
DOI: 10.1002/hed.25559 -
Journal of Surgical Oncology Nov 2021For the past two decades an increasing number of oropharyngeal cancers have been found to be associated with the human papilloma virus (HPV). These tumors are a... (Review)
Review
For the past two decades an increasing number of oropharyngeal cancers have been found to be associated with the human papilloma virus (HPV). These tumors are a biologically distinct entity with better prognosis and excellent response to therapy. Therefore, a separate staging system has been introduced for HPV-related oropharyngeal tumors in the latest edition of the American Joint Committee on Cancer (AJCC eighth Ed).
Topics: Humans; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections
PubMed: 34622962
DOI: 10.1002/jso.26584 -
Oral Oncology Jun 2021
Topics: Humans; Neck; Neck Dissection; Neoplasm Staging; Oropharyngeal Neoplasms
PubMed: 33541777
DOI: 10.1016/j.oraloncology.2021.105186 -
European Journal of Surgical Oncology :... Sep 2023Trans Oral Robotic Surgery (TORS) has proved to be a safe and feasible treatment for oropharyngeal squamous cell carcinoma (OPSCC). The aim of this study is to analyse...
OBJECTIVES
Trans Oral Robotic Surgery (TORS) has proved to be a safe and feasible treatment for oropharyngeal squamous cell carcinoma (OPSCC). The aim of this study is to analyse oncological outcomes of OPSCC patients treated with TORS.
MATERIALS AND METHODS
This study involved 139 patients with OPSCC, treated with TORS between 2008 and 2020. Clinicopathological characteristics, treatment details and oncological outcomes were evaluated retrospectively.
RESULTS
The management strategies included TORS alone in 42.5%, TORS-RT in 25.2% and TORS-CRT in 30.9%. The ENE was noted in 28.8% of neck dissections. In 19 patients clinically classified as unknown primaries, the primary was found in 73.7%. Rates of local, regional relapses and distant metastasis were 8.6%, 7.2%, and 6.5%, respectively. The 5 year- Overall Survival and Disease Free Survival were 69.6% and 71.3%, respectively.
CONCLUSION
TORS fits well in the modern management of OPSCC. Although definitive CRT remains a milestone, TORS is proving to be a valid and safe treatment option. The choice of the therapeutic strategy requires evaluation by a multidisciplinary team.
Topics: Humans; Retrospective Studies; Robotic Surgical Procedures; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Squamous Cell Carcinoma of Head and Neck; Head and Neck Neoplasms
PubMed: 37331862
DOI: 10.1016/j.ejso.2023.05.020 -
European Journal of Surgical Oncology :... Dec 2023To analyze the oncological outcomes and patterns of recurrence of patients with locoregionally advanced oropharyngeal squamous cell carcinoma (OPSCC) who underwent...
PURPOSE
To analyze the oncological outcomes and patterns of recurrence of patients with locoregionally advanced oropharyngeal squamous cell carcinoma (OPSCC) who underwent neo-adjuvant chemotherapy (NCT) with subsequent transoral robotic surgery (TORS).
METHODS
A single-center retrospective cohort study was performed, including 198 patients (mean age: 58.6, SD: 9.2). The primary outcome was disease-free survival (DFS).
RESULTS
The median follow-up time was 26.5 months (IQR: 16.0-52.0). Estimated DFS rates (95 % CI) at 1 and 3 years were 86.6 % (81.9-91.7), and 81.4 % (75.7-87.6), respectively. Estimated DSS rates (95 % CI) at 1 and 3 years were 96.7 % (94.1-99.3), and 92.6 % (88.4-97.0), respectively. Estimated OS rates (95 % CI) at 1 and 3 years were 96.2 % (93.4-99.0), and 88.7 % (83.4-94.2), respectively. A total of 31 (15.6 %) patients showed a disease relapse after a median time of 8 months (IQR: 4.0-12.0), but only 12 (6 %) patients died of the disease during the study period.
CONCLUSIONS
This study demonstrates that NCT and TORS can obtain excellent tumor control and survival in locoregionally advanced OPSCC. NCT might reduce the need for adjuvant treatments, and randomized clinical trials should be conducted to better define this aspect.
Topics: Humans; Middle Aged; Carcinoma, Squamous Cell; Retrospective Studies; Robotic Surgical Procedures; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Squamous Cell Carcinoma of Head and Neck; Oropharyngeal Neoplasms; Head and Neck Neoplasms
PubMed: 37879162
DOI: 10.1016/j.ejso.2023.107121 -
PloS One 2021Oropharyngeal cancer is an important public health problem. The aim of our study was to correlatep16 immunohistochemistry in oropharynx squamous cell carcinomas(OPSCC)...
BACKGROUND
Oropharyngeal cancer is an important public health problem. The aim of our study was to correlatep16 immunohistochemistry in oropharynx squamous cell carcinomas(OPSCC) with clinical and epidemiological features.
MATERIAL AND METHODS
We conducted across-sectional study on patients with OPSCC treated at a single institution from 2014 to 2019. Epidemiological and clinical-pathological data were collected from medical records and a questionnaire was applied to determine alcohol consumption, smoking, and sexual behavior. The HPV status was determined by p16 immunohistochemistry.
RESULTS
A total of 252 patients participated in the study, of these 221 (87.7%) were male. There were 81 (32.14%) p16 positive cases and 171 (67.85%) p16 negative cases. The p16positive group was significantly associated with younger patients (50-59 years), higher education level, lower clinical stage and patients who never drank or smoked. Through univariate logistic regression, we observed that female sex (OR, 3.47; 95% CI, 1.60-7.51) and higher education level (OR, 9.39; 95% CI, 2, 81-31,38) were significantly more likely to be p16 positive. Early clinical stage (AJCC8ed) was more associated with p16 positivity both in univariate (OR, 0.14; 95% CI, 0.07-0.26, p<0.001) and multivariate analysis (OR, 0.18; 95% CI, 0.06-0.49, p = 0.001).
CONCLUSION
This study showed that drinkers and current smokers were less likely to be p16+. Female sex, higher education level and younger age at diagnosis were associated with a higher probability of being p16+. Additionally, there was a higher proportion of patients with early clinical stage (I or II) in the p16 positive group when compared to the p16 negative group.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Alcohol Drinking; Cross-Sectional Studies; Cyclin-Dependent Kinase Inhibitor p16; Female; Humans; Immunohistochemistry; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Oropharynx; Risk Factors; Sex Factors; Sexual Behavior; Smoking; Squamous Cell Carcinoma of Head and Neck; Young Adult
PubMed: 34138935
DOI: 10.1371/journal.pone.0253418 -
Seminars in Radiation Oncology Jan 2018In the effort to control human papillomavirus-related oropharyngeal cancer, the head and neck oncology community has devoted much effort to understanding its disease... (Review)
Review
In the effort to control human papillomavirus-related oropharyngeal cancer, the head and neck oncology community has devoted much effort to understanding its disease biology and clinical behavior, and refining strategies to address early diagnosis and optimal management for the affected population. This review identifies articles published up to March 2017 on tumor biology and clinical implications of human papillomavirus-related oropharyngeal cancer, and summarizes the findings in some key areas. These include potential screening strategies, possible anatomical features responsible for early lymph node involvement and its implication for staging, biological mechanisms to explain superior outcomes compared to traditional nonviral-related mucosal cancers, re-appreciation of traditional prognostic factors (eg, hypoxia, extranodal extension, and smoking), and current efforts to optimize management for this patient population. The review reflects the global effort to mitigate the influence of this burgeoning disease.
Topics: Early Diagnosis; Humans; Lymphatic Metastasis; Mass Screening; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prognosis; Risk Factors
PubMed: 29173751
DOI: 10.1016/j.semradonc.2017.08.007 -
Oral Oncology Jun 2018HPV16-positive oropharyngeal cancer (OPC) patients experience better outcomes compared to HPV16-negative patients. Currently, strategies for treatment de-escalation are...
OBJECTIVES
HPV16-positive oropharyngeal cancer (OPC) patients experience better outcomes compared to HPV16-negative patients. Currently, strategies for treatment de-escalation are based on HPV status, smoking history and disease stage. However, the appropriate cut-point for smoking and the role of other non-clinical factors in OPC survival remains uncertain.
MATERIALS AND METHODS
We examined factors associated with OPC outcome in 321 patients recruited in a large European multi-center study. Seropositivity for HPV16 E6 was used as a marker of HPV16 positive cancer. Hazard ratios (HR) and confidence intervals (CI) were estimated using Cox proportional models adjusted for potential confounders.
RESULTS
Overall 5-year survival following OPC diagnosis was 50%. HPV16-positive OPC cases were at significantly lower risk of death (aHR = 0.51, 95% CI: 0.32-0.80). A significant effect on OPC survival was apparent for female sex (aHR 0.50: 95% CI: 0.29-0.85) and being underweight at diagnosis (aHR: 2.41, 95% CI: 1.38-4.21). A 10 pack year smoking history was not associated with overall survival. Higher stage at diagnosis appeared as the only factor significantly associated with OPC recurrence (aHR: 4.88, 95% CI: 2.12-11.21).
CONCLUSION
This study confirms that HPV16 status is an independent prognostic factor for OPC survival while female sex lowers risk of death and being underweight at diagnosis increases the risk of death. Smoking was not an independent predictor of OPC survival.
Topics: Alphapapillomavirus; Body Mass Index; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Retrospective Studies; Risk Factors; Smoking; Survival Analysis; Tumor Virus Infections
PubMed: 29884419
DOI: 10.1016/j.oraloncology.2018.04.016 -
Clinical Cancer Research : An Official... Sep 2015The past two decades have been witness to a steadily increasing incidence of oropharynx cancer, specifically related to human papillomavirus (HPV), primarily affecting... (Review)
Review
The past two decades have been witness to a steadily increasing incidence of oropharynx cancer, specifically related to human papillomavirus (HPV), primarily affecting middle-aged Caucasian men, in North America and Europe. The ever-increasing incidence, now clearly an epidemic, of this unique clinicopathologic entity demands new perspectives in diagnosis and staging and presents unique challenges in clinical research, given the excellent prognosis afforded by chemoradiation for the majority of these patients. To reduce the morbidity of late toxicity in survivors without compromising the high rates of survival currently enjoyed, and simultaneously address the poor prognosis of those with recurrence, it is critical to capitalize on the viral etiology and translate discoveries in genomics, target/drug discovery, viral oncogenesis, and immunbiology to improved outcomes for patients. Herein, we review ongoing and planned clinical research for HPV-related oropharynx cancer, the basis for which is constituted by prior clinical observations, knowledge of the genomic alterations and altered biology associated with HPV-related oncogenesis, and hope that molecularly targeted and immunomodulatory therapies can be harnessed.
Topics: Alphapapillomavirus; Humans; Immunotherapy; Molecular Targeted Therapy; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomavirus Infections
PubMed: 26330505
DOI: 10.1158/1078-0432.CCR-14-1329