Evaluation of the head and neck cancer patient population and the incidence of hospitalization at an academic medical center

Purpose Patients with head and neck cancer are at risk for disease- and treatment-related toxicities that may be severe enough to require hospitalization. The risk factors associated with hospitalization in these patients are not well defined. Methods We conducted a single-center, retrospective observational study of patients with head and neck cancer receiving chemotherapy at an academic medical center infusion clinic in a one-year period. The primary objective was to characterize the head and neck cancer population at an academic medical center. Secondary objectives included describing the clinical and social factors associated with hospitalization. Results There were 109 patients with head and neck cancer included in the analysis. Of these patients, 38 (35%) were hospitalized. The factors that were significantly associated with hospitalization on univariable logistic regression were former alcohol abuse, being on a nonstandard of care chemotherapy regimen, and having a chemotherapy agent discontinued. On multivariable logistic regression, the factor that was significantly associated with hospitalization was having a chemotherapy agent discontinued. The most common reasons for hospitalization included shortness of breath/respiratory failure, fever/neutropenic fever, and infection. The most common new supportive care medications prescribed at discharge were stool softeners or laxatives and opioids. Conclusion This study identified several factors which may be useful to identify patients as high risk for hospitalization and the next steps will be to determine and study the role of the pharmacist in preventing hospitalization of these patients. Further studies are needed to assess the impact of adding a pharmacist to the head and neck cancer multidisciplinary team.

Download Full-text

Times to Diagnosis, Staging, and Treatment of Head and Neck Cancer Before and During COVID-19

OTO Open ◽

10.1177/2473974x211059429 ◽

2021 ◽

Vol 5 (4) ◽

pp. 2473974X2110594

Author(s):

Peter Yao ◽

Victoria Cooley ◽

William Kuhel ◽

Andrew Tassler ◽

Victoria Banuchi ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Medical Center ◽

Academic Medical Center ◽

Head And Neck Cancers ◽

Newly Diagnosed ◽

Time To Treatment ◽

Time To Diagnosis ◽

The Times

Objective The coronavirus disease 2019 (COVID-19) pandemic has reduced the demand for, and supply of, head and neck cancer services. This study compares the times to diagnosis, staging, and treatment of head and neck cancers before and during the COVID-19 pandemic. Study Design Retrospective cohort study. Setting Tertiary academic medical center in New York City (NYC). Methods The times to diagnosis, staging, and treatment of head and neck cancer for patients presenting to the clinics of 4 head and neck oncology surgeons with newly diagnosed head and neck cancers were compared between pre–COVID-19 and COVID-19 periods. Results Sixty-eight patients in the pre–COVID-19 period and 26 patients in the COVID-19 period presented with newly diagnosed head and neck cancer. Patients in the COVID-19 group had a significantly longer time to diagnosis than the pre–COVID-19 group after adjustment for age and cancer diagnosis ( P = .02; hazard ratio [HR], 0.54; 95% CI, 0.32-0.92). Patients in the pre–COVID-19 and COVID-19 groups had no statistically significant differences in time to staging ( P > .9; HR, 1.01; 95% CI, 0.58-1.74) or time to treatment ( P = .12; HR, 1.55; 95% CI, 0.89-2.72). Conclusion This study found that time to diagnosis for head and neck cancers was delayed during a COVID-19 period compared to a pre–COVID-19 period. However, there was no evidence of delays in time to staging and time to treatment during the COVID-19 period. Our results prompt further investigations into the factors contributing to diagnostic delays but provide reassurance that despite COVID-19, patients were receiving timely staging and treatment for head and neck cancers.

Download Full-text

Evaluation of tumor oxygenation by color duplex sonography: A new approach

Otolaryngology ◽

10.1016/j.otohns.2005.01.033 ◽

2005 ◽

Vol 132 (5) ◽

pp. 765-769 ◽

Cited By ~ 8

Author(s):

Ercole F.N. Di Martino ◽

Bernd Gagel ◽

Oliver Schramm ◽

Payam Maneschi ◽

Martin Westhofen

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Medical Center ◽

Academic Medical Center ◽

Duplex Sonography ◽

Tumor Oxygenation ◽

Controlled Study ◽

Color Duplex Sonography ◽

New Approach

OBJECTIVE: Description of a new noninvasive method for the evaluation of tissue oxygenation in head and neck cancer. STUDY DESIGN AND SETTING: Prospective nonrandomized controlled study in an academic medical center on 20 patients with neck metastases of head and neck cancer. Metastases were investigated using color duplex sonography and pO2 histography. The vascularization in sonography was quantitatively evaluated by color pixel density and compared to the pO2 values of the same nodes. RESULTS: The correlation between vascularization and flow velocity was 0.71. For the mean/median pO2-values and for the pO2 readings < 10.0 mmHg correlations were r = 0.65/0.76 and 0.71. CONCLUSION: This sonographic method allows a safe and reliable evaluation of oxygenation in metastases of head and neck cancer. SIGNIFICANCE: The new approach is an alternative to pO2 histography and may play a future role in the planning of radiotherapy in the neck. (Otolaryngol Head Neck Surg 2005;132:765-9.)

Download Full-text

The Impact of Smoking, Alcohol Use, Recurrent Disease, and Age on the Development of Neck Fibrosis in Head and Neck Cancer Patients Following Radiation Therapy

Frontiers in Oncology ◽

10.3389/fonc.2021.707418 ◽

2021 ◽

Vol 11 ◽

Author(s):

Connor L. Pratson ◽

Michael C. Larkins ◽

Brandon H. Karimian ◽

Caitrin M. Curtis ◽

Pamela A. Lepera ◽

...

Keyword(s):

Head And Neck Cancer ◽

Alcohol Use ◽

Head And Neck ◽

Neck Cancer ◽

Recurrent Disease ◽

Care Center ◽

Univariate Analysis ◽

Tertiary Care ◽

Factors Associated ◽

The Impact

There is a paucity of information regarding the demographic factors associated with the development of neck fibrosis in head and neck cancer (HNC) patients following radiotherapy. A retrospective review of all patients being treated for HNC at a tertiary care center between 2013 and 2017 was performed. Chi-squared and Mann-Whitney U tests were used to identify differences in incidence and grade of fibrosis, respectively, between populations. A total of 90 patients aged 19 to 99 years were included. Factors associated with an increased incidence of fibrosis included smoking during radiotherapy (p < 0.001), alcohol use (p = 0.026), recurrent disease (p = 0.042), and age less than 60 (p < 0.001) on univariate analysis. Factors associated with increased grade of fibrosis in HNC patients included recurrent HNC (p = 0.033), alcohol use (p = 0.013), patient age younger than 60 years (p = 0.018), smoking during radiotherapy (p < 0.001), and non-Caucasian race (p = 0.012). Identification and intervention directed at patients that possess risk factors associated with fibrosis prior to treatment has the potential to improve the long-term quality of life for HNC patients.

Download Full-text

Follow-Up Phone Interviews and Attendance Motivation From A Free Head and Neck Cancer Screening

Ear Nose & Throat Journal ◽

10.1177/0145561320940866 ◽

2020 ◽

pp. 014556132094086

Author(s):

Zachary D. Urdang ◽

David H. Rosales ◽

QiLiang Chen ◽

Ryan J. Li ◽

Peter E. Andersen ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Medical Center ◽

Academic Medical Center ◽

Significant Proportion ◽

Community Outreach ◽

Cancer Center ◽

Screening Programs

Introduction: Head and Neck Cancer Awareness and Screening Programs (HNCASP) are popular community outreach events hosted by academic and community otolaryngology departments. However, long-term follow-up of participants is lacking. Patients and Methods: Participants of a HNCASP held at an academic cancer center prospectively filled out demographic and risk factor surveys followed by HNC screening examination. A phone interview was conducted for participants between 2012 and 2016 with suspicious findings to assess outcomes. Results: Participants were largely Caucasian, female, and had health insurance, reflecting the setting at an academic medical center. Despite this, there were 156 (16.8%) positive screenings; 47 of these completed follow up interviews. Twelve (1.1% of all participants) cancer cases were confirmed. Discussion: A significant proportion of HNCASP participants benefited from this screening opportunity. Education regarding HNC is the primary benefit and motivational factor for attendance of HNCASPs, although a significant subset of patients was identified that needed follow-up, and several cancers were detected.

Download Full-text

Factors associated with psychological distress for couples facing Head and Neck Cancer: A systematic literature review

Psycho-Oncology ◽

10.1002/pon.5686 ◽

2021 ◽

Author(s):

Linda McCabe‐White ◽

Nima Moghaddam ◽

Anna Tickle ◽

Sanchia Biswas

Keyword(s):

Head And Neck Cancer ◽

Psychological Distress ◽

Literature Review ◽

Head And Neck ◽

Neck Cancer ◽

Systematic Literature Review ◽

Factors Associated

Download Full-text

The impact of coronavirus disease 2019 on suspected head and neck cancer two-week-wait referrals

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001717 ◽

2021 ◽

pp. 1-10

Author(s):

N Bhamra ◽

B Gorman ◽

W Arnold ◽

A Rajah ◽

K Jolly ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

The Impact

Download Full-text

Alcohol Hand Rub Significantly Reduces Overall Bacterial Bioburden on Stethoscopes in a Real-World Clinical Setting

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.620 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s114-s115

Author(s):

Alexandra Johnson ◽

Bobby Warren ◽

Deverick John Anderson ◽

Melissa Johnson ◽

Isabella Gamez ◽

...

Keyword(s):

Real World ◽

Medical Center ◽

Academic Medical Center ◽

Randomized Study ◽

Healthcare Providers ◽

Clinical Workflow ◽

Provider Type ◽

Academic Medical ◽

Rn Students ◽

The Impact

Background: Stethoscopes are a known vector for microbial transmission; however, common strategies used to clean stethoscopes pose certain barriers that prevent routine cleaning after every use. We aimed to determine whether using readily available alcohol-based hand rub (ABHR) would effectively reduce bacterial bioburden on stethoscopes in a real-world setting. Methods: We performed a randomized study on inpatient wards of an academic medical center to assess the impact of using ABHR (AlcareExtra; ethyl alcohol, 80%) on the bacterial bioburden of stethoscopes. Stethoscopes were obtained from healthcare providers after routine use during an inpatient examination and were randomized to control (no intervention) or ABHR disinfection (2 pumps applied to tubing and bell or diaphragm by study personnel, then allowed to dry). Cultures of the tubing and bell or diaphragm were obtained with premoistened cellulose sponges. Sponges were combined with 1% Tween20-PBS and mixed in the Seward Stomacher. The homogenate was centrifuged and all but ~5 mL of the supernatant was discarded. Samples were plated on sheep’s blood agar and selective media for clinically important pathogens (CIPs) including S. aureus, Enterococcus spp, and gram-negative bacteria (GNB). CFU count was determined by counting the number of colonies on each plate and using dilution calculations to calculate the CFU of the original ~5 mL homogenate. Results: In total, 80 stethoscopes (40 disinfection, 40 control) were sampled from 46 physicians (MDs) and MD students (57.5%), 13 advanced practice providers (16.3%), and 21 nurses (RNs) and RN students (26.3%). The median CFU count was ~30-fold lower in the disinfection arm compared to control (106 [IQR, 50–381] vs 3,320 [986–4,834]; P < .0001). The effect was consistent across provider type, frequency of recent usual stethoscope cleaning, age, and status of pet ownership (Fig. 1). Overall, 26 of 80 (33%) of stethoscopes harbored CIP. The presence of CIP was lower but not significantly different for stethoscopes that underwent disinfection versus controls: S. aureus (25% vs 32.5%), Enterococcus (2.5% vs 10%), and GNB (2.5% vs 5%). Conclusions: Stethoscopes may serve as vectors for clean hands to become recontaminated immediately prior to performing patient care activities. Using ABHR to clean stethoscopes after every use is a practical and effective strategy to reduce overall bacterial contamination that can be easily incorporated into clinical workflow. Larger studies are needed to determine the efficacy of ABHR at removing CIP from stethoscopes as stethoscopes in both arms were frequently contaminated with CIP. Prior cleaning of stethoscopes on the study day did not seem to impact contamination rates, suggesting the impact of alcohol foam disinfection is short-lived and may need to be repeated frequently (ie, after each use).Funding: NoneDisclosures: NoneDisclosures: NoneFunding: None

Download Full-text

Increasing Mean Age of Head and Neck Cancer Patients at a German Tertiary Referral Center

Cancers ◽

10.3390/cancers13040832 ◽

2021 ◽

Vol 13 (4) ◽

pp. 832

Author(s):

Julius M. Vahl ◽

Marlene C. Wigand ◽

Michael Denkinger ◽

Dhayana Dallmeier ◽

Chiara Steiger ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Catchment Area ◽

Incidence Rates ◽

Cancer Center ◽

Tertiary Referral ◽

Tertiary Referral Center ◽

Referral Center ◽

The Impact

Background: The impact of demographic change on the age at diagnosis in German head and neck cancer (HNC) patients is unclear. Here we present an evaluation of aging trends in HNC at a tertiary referral center. Methods: Retrospective cohort study on aging trends at the initial diagnosis of newly diagnosed patients with HNC between 2004 and 2018 at the head and neck cancer center Ulm in relation to demographic data of the catchment area. Results: The study population consisted of 2450 individuals diagnosed with HNC with a mean age of 62.84 (±11.67) years. We observed a significant increase in annual incidence rates and mean age over time. Mean age among HNC patients increased significantly more than among the population in the catchment area. Whereas the incidence rate of patients <50 years did not change, the incidence of HNC patients aged ≥70 years increased the most. The mean patient age in the main tumor sites increased significantly. Surprisingly, HPV-positive patients were not younger than HPV-negative patients, but showed a non-significant trend towards a higher mean age (63.0 vs. 60.7 years). Conclusions: Increasing incidence rates in older patients pose a challenge for health care systems. A nationwide study is needed to assess the dynamics and impact of aging on the incidence of HNC.

Download Full-text