Patient Burden with Current Surveillance Paradigm and Factors Associated with Interest in Altered Surveillance for Early Stage HPV‐Related Oropharyngeal Cancer

Abstract BackgroundTransoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT.MethodsConsecutive cases of early T stage (T1-T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014-2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the CTCAE criteria.ResultsA total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p=0.0026). ConclusionsPrimary RT or CRT provides outstanding survival for early T-stage HPV-positive disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery.

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1037 Prognostic Factors Associated with Survival Following Hepatic Resection of Early-Stage Hepatocellular Carcinoma

Gastroenterology ◽

10.1016/s0016-5085(08)64031-7 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-860

Author(s):

Hari Nathan ◽

Michael Choti ◽

Richard D. Schulick ◽

Timothy M. Pawlik

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Hepatic Resection ◽

Early Stage ◽

Factors Associated

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Prognostic and Predictive Value of Circulating and Disseminated Tumor Cells in Breast Cancer: A National Cancer Database (NCDB) Analysis

Technology in Cancer Research & Treatment ◽

10.1177/1533033820980107 ◽

2020 ◽

Vol 19 ◽

pp. 153303382098010

Author(s):

Nadeem Bilani ◽

Leah Elson ◽

Hong Liang ◽

Elizabeth Blessing Elimimian ◽

Rafael Arteta-Bulos ◽

...

Keyword(s):

Breast Cancer ◽

Tumor Cells ◽

Late Stage ◽

Early Stage ◽

Disseminated Tumor Cells ◽

Her2 Status ◽

National Cancer Database ◽

Factors Associated ◽

Stage Disease ◽

Chemotherapy Efficacy

Importance: Our understanding of the utility of circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) as clinical biomarkers continues to evolve. Objective: This study evaluated (1) clinicopathologic factors associated with the presence of CTCs or DTCs, (2) the prognostic value of CTCs or DTCs by disease stage, 3), the value of these biomarkers in predicting the benefit of chemotherapy. Design: This is a retrospective analysis of patients with breast cancer (BC) diagnosed between 2004 and 2016 using the National Cancer Database (NCDB). To evaluate variables associated with the presence of CTCs or DTCs at the univariate level, we used chi-squared and Wilcoxon rank-sum tests. Multivariate logistic regression models were then constructed using significant variables. Consequently, we included CTC or DTC status (i.e. positive or negative) in multivariate, stage-by-stage Cox regression analyses for overall survival (OS). After stratifying by receptor status and staging, we used the Kaplan-Meier method to explore chemotherapy efficacy in CTC- or DTC-positive vs. CTC- or DTC-negative subsets. Results: Factors significantly associated with CTCs were race, progesterone receptor status, HER2 status, histology and AJCC N- and M-staging. Factors associated with DTCs were race, HER2 status, histology and AJCC N-staging. CTCs were associated with poor OS in late-stage (III and IV) but not early-stage (0-II) BC. DTCs were not significantly associated with OS in either context. In hormone receptor (HR)-positive disease, chemotherapy was associated with better OS when CTC status was positive, both in early-stage and late-stage disease. In a subset of patients without CTCs, however, chemotherapy conferred no survival benefit. DTC status was not a significant predictor of chemotherapy efficacy in early or late-stage, HR+ disease. Conclusions: This study suggests that CTC-status is a significant prognostic factor at later stages of BC; yet it can also help guide management of early-stage disease as it appears predictive for chemotherapy benefit.

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Lower Patient Ratings of Physician Communication Are Associated With Unmet Need for Symptom Management in Patients With Lung and Colorectal Cancer

Journal of Oncology Practice ◽

10.1200/jop.2015.005538 ◽

2016 ◽

Vol 12 (6) ◽

pp. e654-e669 ◽

Cited By ~ 16

Author(s):

Anne M. Walling ◽

Nancy L. Keating ◽

Katherine L. Kahn ◽

Sydney Dy ◽

Jennifer W. Mack ◽

...

Keyword(s):

Colorectal Cancer ◽

Symptom Management ◽

Unmet Needs ◽

Early Stage ◽

Unmet Need ◽

Physician Communication ◽

Common Symptom ◽

Factors Associated ◽

Management Interventions ◽

Communication Score

Purpose: Little is known about factors associated with unmet needs for symptom management in patients with cancer. Methods: Patients with a new diagnosis of lung and colorectal cancer from the diverse nationally representative Cancer Care Outcomes Research and Surveillance cohort completed a survey approximately 5 months after diagnosis (N = 5,422). We estimated the prevalence of unmet need for symptom management, defined as patients who report that they wanted help for at least one common symptom (pain, fatigue, depression, nausea/vomiting, cough, dyspnea, diarrhea) during the 4 weeks before the survey but did not receive it. We identified patient factors associated with unmet need by using logistic regression with random effects to account for clustering within study sites. Results: Overall, 15% (791 of 5,422) of patients had at least one unmet need for symptom management. Adjusting for sociodemographic and clinical factors, African American race, being uninsured or poor, having early-stage lung cancer, and the presence of moderate to severe symptoms were associated with unmet need (all P < .05). Furthermore, patients who rated their physician’s communication score < 80 (on a 0 to 100 scale) had adjusted rates of an unmet need for symptom management that were more than twice as high as patients who rated their physicians with a perfect communication score (23.1% v 10.0%; P < .001). Conclusion: A significant minority of patients with newly diagnosed lung and colorectal cancer report unmet needs for symptom management. Interventions to improve symptom management should consider the importance of physician communication to the patient’s experience of disease.

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