Impact of Race and Insurance Status on Primary Treatment for HPV-Associated Oropharyngeal Squamous Cell Carcinoma

2021 ◽  
pp. 019459982110298
Author(s):  
Andy M. Habib ◽  
Ryan M. Carey ◽  
Aman Prasad ◽  
Leila J. Mady ◽  
Justin R. Shinn ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Sociodemographic Factors ◽  
Primary Treatment ◽  
Treatment Choice ◽  
Insurance Status ◽  
National Cancer Database ◽  
Primary Surgery ◽  
Insured Patients ◽  
To Receive

Objective To assess the impact of sociodemographic factors on primary treatment choice (surgery vs radiotherapy) in patients with human papillomavirus–associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Study Design Retrospective analysis of the National Cancer Database. Setting Data from >1500 Commission on Cancer institutions (academic and community) via the National Cancer Database. Methods Our sample consists of patients diagnosed with HPV+ OPSCC from 2010 to 2015. The primary outcome of interest was initial treatment modality: surgery vs radiation. We performed multivariable logistic models to assess the relationship between treatment choice and sociodemographic factors, including sex, race, treatment facility, and insurance status. Results Of the 16,043 patients identified, 5894 (36.7%) underwent primary surgery while 10,149 (63.3%) received primary radiotherapy. Black patients were less likely than White patients to receive primary surgery (odds ratio [OR], 0.80; 95% CI, 0.66-0.96). When compared with privately insured patients, those who were uninsured or on Medicaid or Medicare were also less likely to receive primary surgery (OR, 0.70 [95% CI, 0.56-0.86]; OR, 0.77 [95% CI, 0.65-0.91]; OR, 0.85 [95% CI, 0.75-0.96], respectively). Patients receiving treatment at an academic/research cancer program were more likely to undergo primary surgery than those treated at comprehensive community cancer programs (OR, 1.33; 95% CI, 1.14-1.56). Conclusion In this large sample of patients with HPV+ OPSCC, race and insurance status affect primary treatment choice. Specifically, Black and nonprivately insured patients are less likely to receive primary surgery as compared with White or privately insured patients. Our findings illuminate potential disparities in HPV+ OPSCC treatment.

scholarly journals Treatment patterns and survival outcomes in advanced hypopharyngeal squamous cell carcinoma

2020 ◽  
Author(s):  
Yao-Te Tsai ◽  
Wen-Cheng Chen ◽  
Chih-Yen Chien ◽  
Cheng-Ming Hsu ◽  
Yi-Chan Lee ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Primary Treatment ◽  
Free Survival ◽  
Hypopharyngeal Squamous Cell Carcinoma ◽  
Primary Surgery ◽  
Kaplan Meier

Abstract Background This study aimed to evaluate the treatment outcomes of the primary surgery (PS) or concurrent chemoradiotherapy (CCRT) as the initial treatment of hypopharyngeal squamous cell carcinoma (HPSCC). Methods A retrospective cohort study of HPSCC patients with stage III-IV HPSCC in four tertiary referral centers consecutively enrolled from 2003 to 2012, total of 213 (32.6%) patients received PS, and 439 (67.4%) patients received CCRT as their primary treatment. Overall survival (OS) and disease-free survival (DFS) were analyzed by Kaplan-Meier method and Cox regression models. Results The 5-year OS and DFS for patients undergoing PS and CCRT were 45.0% vs 33.1% and 36.2% vs 28.9% ( p < 0.001 and 0.003, respectively). In subgroup analysis, PS was associated with better OS in patients with stage IVA of the disease ( p = 0.002), specifically in those with T4 or N2 classification ( p = 0.021 and 0.002, respectively). Multivariate analysis indicated that stages IVA and IVB and CCRT were independent adverse prognostic factors for OS ( p = 0.004, <0.001, and 0.014, respectively). Furthermore, CCRT was also significantly associated with lower OS rates than PS in stage IVA patients more than 65 years of age and with N2 classification ( p = 0.027 and 0.010, respectively). Conclusions In patients with advanced HPSCC, PS was significantly associated with better prognosis and should be considered a favorable primary treatment in patients with stage IVA of the disease, especially if they are over 65 years of age or have T4 and N2 classification.

Treatment trends for stage III non-small cell lung cancer for noninsured patients compared with other types of insurances: A National Cancer Database analysis.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 262-262
Author(s):  
Khaled Abou El Ezz ◽  
David Charles Olson ◽  
Peter T. Silberstein
Keyword(s):  
Stage Iii ◽  
Insurance Status ◽  
National Cancer Database ◽  
Database Analysis ◽  
Medicare Patients ◽  
Stage Iii Nsclc ◽  
Insured Patients ◽  
Treatment Trends ◽  
To Receive ◽  
Privately Insured

262 Background: This study investigated trends in management of stage III NSCLC in patients with no insurance versus other insurance types using the National Cancer Database (NCDB). Methods: 281,277 patients with Stage III NSCLC were identified from 2000 to 2009 using the NCDB. Reported use of surgery, radiation, chemotherapy, or no treatment were analyzed by insurance status. Results: Radiation/chemotherapy was most often used to treat stage III NSCLC among non-insured (41.7%), Medicare (31.3%), Medicaid (42.3%), and private insured patients (43.9%). Non-insured were just as likely to receive radiation/chemotherapy as Medicaid (41.7% vs. 42.3%, p=0.36) but less likely than privately insured (41.7% vs. 43.9%, p<0.001). Non-insured were more likely to receive no treatment than privately insured (20.8% vs. 11.7%, p<0.001) and Medicaid (20.8% vs. 16.8%, p <0.001) but less likely than Medicare (20. 8% vs. 24.6%, p<0.001). Tri-modality treatment was given less often to non-insured patients than privately insured (4.6% vs. 10.2%, p<0.001) and Medicaid (4.6% vs. 6.2%, p<0.001) but more often than Medicare patients (4.6% vs. 3.7%, p<0.001). Conclusions: Stage III NSCLC was most often given chemotherapy/radiation regardless of insurance status. Non-insured patients received this treatment as often as Medicaid but less often than privately insured. Non-insured patients also received no treatment more often than Medicaid and privately insured and less often than Medicare. Future studies could examine if average age among the populations impacted these findings. [Table: see text]

scholarly journals Treatment patterns and survival outcomes of advanced hypopharyngeal squamous cell carcinoma

2020 ◽  
Author(s):  
Yao-Te Tsai ◽  
Wen-Cheng Chen ◽  
Chih-Yen Chien ◽  
Cheng-Ming Hsu ◽  
Yi-Chan Lee ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Primary Treatment ◽  
Hypopharyngeal Squamous Cell Carcinoma ◽  
Primary Surgery ◽  
Kaplan Meier ◽  
Primary Treatment Modality

Abstract Background: This study evaluated the treatment outcomes of the primary surgery (PS) or concurrent chemoradiotherapy (CCRT) as the initial treatment for hypopharyngeal squamous cell carcinoma (HPSCC).Methods: This retrospective cohort study included patients with stage III-IV HPSCC from four tertiary referral centers consecutively enrolled from 2003 to 2012; of them, 213 (32.6%) and 439 (67.4%) had received PS and CCRT as their primary treatments, respectively. The 5-year overall survival (OS) and disease-free survival (DFS) rates were analyzed using the Kaplan-Meier method and Cox regression models.Results: In patients undergoing PS and CCRT, OS rates were 45.0% and 33.1% (p < 0.001), respectively, and DFS rates were 36.2% and 28.9% (p = 0.003), respectively. In subgroup analysis, in patients with stage IVA HPSCC, PS was associated with higher OS rate (p = 0.002), particularly in those with T4 or N2 classification (p = 0.021 and 0.002, respectively). Multivariate analysis indicated that stages IVA HPSCC, stage IVB HPSCC, and CCRT were independent adverse prognostic factors for OS rate (p = 0.004, <0.001, and 0.014, respectively). Furthermore, in patients with stage IVA HPSCC aged ≥ 65 years and with N2 classification, CCRT was significantly associated with lower OS rates than was PS (p = 0.027 and 0.010, respectively).Conclusions: In patients with advanced HPSCC, PS was significantly associated with better prognosis than CCRT. PS could be a favorable primary treatment modality for the management of patients with stage IVA HPSCC, particularly those aged ≥ 65 years and with T4 and N2 classification.

Factors Influencing Squamous Cell Carcinoma In Situ Recurrence and Implications for Treatment Choice

2018 ◽  
Vol 44 (5) ◽  
pp. 613-620 ◽  
Author(s):  
Andrew J. Matsumoto ◽  
Adam R. Schmitt ◽  
Logan M. Skelley ◽  
Christian L. Baum
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Carcinoma In Situ ◽  
Treatment Choice ◽  
Factors Influencing

Extranodal Extension as an Indicator for Sinonasal Squamous Cell Carcinoma Prognosis

2021 ◽  
pp. 019459982098746
Author(s):  
Christopher C. Tseng ◽  
Jeff Gao ◽  
Gregory L. Barinsky ◽  
Christina H. Fang ◽  
Jordon G. Grube ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Multivariate Regression ◽  
Multivariate Analyses ◽  
National Cancer Database ◽  
Extranodal Extension ◽  
Survival Difference ◽  
Survival Differences ◽  
Retrospective Database

Objective Although extranodal extension (ENE) is a known indicator of poor prognosis for head and neck malignancies, its value as an indicator for sinonasal squamous cell carcinoma (SCC) has not been well characterized. This study seeks to assess the usefulness of ENE as a prognostic marker for sinonasal SCC. Study Design Retrospective database review. Setting National Cancer Database from 2010 to 2015. Methods The National Cancer Database was queried from 2010 to 2015 for all patients with sinonasal SCC with available ENE status (n = 355). These cases were divided into those with pathologically confirmed ENE (n = 146) and those without ENE (n = 209). Univariate and multivariate analyses were used to examine survival differences and predictors of ENE status. Results Most patients with ENE were ≥60 years old (61.7%), male (61.6%), and white (83.6%). Patients aged 60 to 69 and 80+ years were more likely to have ENE than those under 60 years ( P < .05). Patients with ENE had worse 1-year overall survival than those without ENE (58.2% vs 70.8%, log-rank P = .008). After multivariate regression, however, there was no survival difference detected between ENE-positive and ENE-negative cases (hazard ratio, 1.14 [0.775-1.672], P = .508). Conclusion ENE status did not have a significant effect on survival in patients with sinonasal SCC. Thus, ENE alone may not necessarily be a helpful indicator for sinonasal SCC prognosis.

Disparities in sinonasal squamous cell carcinoma short- and long-term outcomes: Analysis from the national cancer database

2017 ◽  
Vol 128 (3) ◽  
pp. 560-567 ◽  
Author(s):  
Ryan M. Carey ◽  
Arjun K. Parasher ◽  
Alan D. Workman ◽  
Carol H. Yan ◽  
Jordan T. Glicksman ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
National Cancer Database ◽  
Long Term Outcomes ◽  
Outcomes Analysis ◽  
Short And Long Term

Patient Choice of Nonsurgical Treatment Contributes to Disparities in Head and Neck Squamous Cell Carcinoma

2018 ◽  
Vol 158 (6) ◽  
pp. 1057-1064 ◽  
Author(s):  
Harman S. Parhar ◽  
Donald W. Anderson ◽  
Arif S. Janjua ◽  
J. Scott Durham ◽  
Eitan Prisman
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Patient Choice ◽  
Nonsurgical Treatment ◽  
Neck Squamous Cell Carcinoma ◽  
Primary Surgery ◽  
Increased Risk ◽  
Risk Of Cancer

Objectives There are well-established outcome disparities among different demographic groups with head and neck squamous cell carcinoma (HNSCC). We aimed to investigate the potential contribution of patient choice of nonsurgical treatment to these disparities by estimating the rate of this phenomenon, identifying its predictors, and estimating the effect on cancer-specific survival. Study Design Retrospective nationwide analysis. Settings Surveillance, Epidemiology, and End Results Database (2004-2014). Subjects and Methods Patients with HNSCC, who were recommended for primary surgery, were included. Multivariable logistic regression was used to identify demographic and clinical factors associated with patient choice of nonsurgical treatment, and Kaplan Meier/Cox regression was used to analyze survival. Results Of 114,506 patients with HNSCC, 58,816 (51.4%) were recommended for primary surgery, and of those, 1550 (2.7%) chose nonsurgical treatment. Those who chose nonsurgical treatment were more likely to be older (67.1 ± 12.6 vs 63.6 ± 13.1, P < .01), were of Black (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.28-1.74) or Asian (OR = 1.79; 95% CI, 1.46-2.20) ethnicity, were unmarried (OR married, 0.50; 95% CI, 0.44-0.58), had an advanced tumor, and had a hypopharyngeal or laryngeal primary. Choice of nonsurgical treatment imparted a 2.16-fold (95% CI, 2.02-2.30) increased risk of cancer-specific death. Conclusion Of the patients, 2.7% chose nonsurgical treatment despite a provider recommendation that impairs survival. Choice of nonsurgical treatment is associated with older age, having Black or Asian ethnicity, being unmarried, having an advanced stage tumor, and having a primary site in the hypopharynx or larynx. Knowledge of these disparities may help providers counsel patients and help patients make informed decisions.

Trends in HPV Testing for Patients With Sinonasal Squamous Cell Carcinoma: A National Analysis

2021 ◽  
pp. 019459982110675
Author(s):  
Christopher C. Tseng ◽  
Jeff Gao ◽  
Gregory L. Barinsky ◽  
Christina H. Fang ◽  
Wayne D. Hsueh ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Odds Ratio ◽  
Tumor Grade ◽  
Suburban Area ◽  
National Cancer Database ◽  
Hpv Testing ◽  
National Analysis

Objective The objective of this study was to analyze national trends in human papillomavirus (HPV) testing for patients diagnosed with sinonasal squamous cell carcinoma (SNSCC). Study Design Retrospective database study. Setting National Cancer Database (2010-2016). Methods Cases from 2010 to 2016 with a primary SNSCC diagnosis and known HPV testing status were extracted from the National Cancer Database. Univariate and multivariate analyses were then performed to assess differences in socioeconomic, hospital, and tumor characteristics between tested and nontested patients. Results A total of 2308 SNSCC cases were collected, with 1210 (52.4%) HPV tested and 1098 (47.6%) not tested. On univariate analyses, patient age, insurance, income quartile, population density, treatment facility location, and tumor grade were significantly associated with HPV testing status. After multivariate logistic regression modeling, living in a suburban area had lower odds of HPV testing as compared with living in urban areas (odds ratio, 0.74 [95% CI, 0.55-0.99]; P = .041), while tumor grade III/IV had higher odds than grade I (odds ratio, 1.73 [95% CI, 1.29-2.33]; P < .001). HPV-tested patients had a similar 5-year overall survival to nontested patients (48.3% vs 45.3%, log-rank P = .405). A sharp increase in HPV testing rates was observed after 2010 ( P < .001). Conclusion Among patients with SNSCC, those with high-grade tumors were more likely to be tested for HPV, while patients with a suburban area of residence were less likely. Additionally, there was no significant survival benefit to HPV testing, with tested and nontested groups having similar overall survival. Level of evidence 4.

Sequential methotrexate, 5-fluorouracil, and cisplatin in the treatment of recurrent squamous-cell carcinoma of the head and neck: failure of hypertonic saline to reduce the nephrotoxicity of cisplatin.

1986 ◽  
Vol 4 (11) ◽  
pp. 1670-1676 ◽  
Author(s):  
I W Dimery ◽  
S S Legha
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Hypertonic Saline ◽  
Squamous Cell ◽  
Renal Toxicity ◽  
Recurrent Squamous Cell Carcinoma ◽  
Duration Of Response ◽  
Median Cumulative Dose ◽  
To Receive

Fifty patients with histologically proven squamous-cell carcinoma of the head and neck, recurrent after surgery and/or radiation therapy, were treated with a triple-drug combination of methotrexate (MTX), 250 mg/m2 intravenously (IV) on day 1, followed by 5-fluorouracil (5-FU), 600 mg/m2 IV on days 1 and 2, followed by cisplatin, 50 to 60 mg/m2 IV on days 3 and 4. Patients were randomly assigned to receive cisplatin either in 300 mL of 3% saline or with standard mannitol diuresis along with appropriate hydration. The courses of treatment were repeated every 3 to 4 weeks. Among 47 evaluable patients, there were four complete responses (CRs) and 17 partial responses (PRs) (9% and 36%, respectively). The median duration of response was 23 weeks and the overall survival was 7 months. The median survival of responders v nonresponders was 12 months and 6 months, respectively. Nausea and vomiting was experienced by all patients and diarrhea was experienced by 36% of patients. Neutropenia occurred in 37 patients (79%) and resulted in fever or infection in 11 patients (23%) and death in two patients. Mild renal failure (persistent serum creatinine greater than 1.5 mg/ dL) was observed in ten patients (21%), six treated with 3% saline and four treated with mannitol. The median cumulative dose of cisplatin that lead to the development of renal impairment was 485 mg/m2 in the hypertonic saline arm and 550 mg/m2 in the mannitol arm (P = .40). The antitumor activity of this regimen was not superior to that of sequential MTX and 5-FU. The use of hypertonic saline was not effective in reducing the renal toxicity of cisplatin.

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