Common head and neck cancer treatment pathways and associated costs in the U.S. commercial managed care population

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17001-e17001
Author(s):  
F. Camacho ◽  
C. D. Mullins ◽  
V. Joish ◽  
J. Choi
Keyword(s):  
Head And Neck Cancer ◽  
Managed Care ◽  
Head And Neck ◽  
Neck Cancer ◽  
Treatment Modalities ◽  
Current Guideline ◽  
Treatment Pathways ◽  
Average Patient ◽  
Single Modality ◽  
The U.S

e17001 Background: For the treatment of head and neck cancer (HNC), different modalities (chemotherapy, radiation, surgery, or chemoradiotherapy) can be used either independently or in combination with others. Information regarding real-world treatment pattern is limited. The purpose of this study was to identify common treatment pathways and associated costs. Methods: The study was performed using data from a large U.S. commercial managed care claims database. Adult subjects (≥18) diagnosed with HNC between January 1, 2006, to December 31, 2006, (index-period) were identified based on a pre-selected ICD-9-CM codes. All subjects were HNC diagnosis-naïve 12 months prior to their index dates (first date of HNC diagnosis) and followed for 12 months post index date. Treatment modalities were identified based on the Healthcare Common Procedure Coding System used in the U.S. Pathways were constructed by reflecting time of and between modality administration claims. Results: 6,570 subjects were identified. The average age was 61 years (±14.9) and 44% (n = 2869) were female. Midwest (31%) and east (31%) region had a higher (p < 0.01) representation, compared to south (20%) and west (18%). Only 2,257 subjects (34%) received some type of treatment modality and were categorized into 20 mutually exclusive treatment pathways. Of these, 82% (n = 1,843) received single modality, 18% (n = 398) received a combination of 2, and 0.7% (n = 16) received a combination of 3 modalities. Among single modality pathways, radiation (34%; n = 619) was most common, however, cheomoradiotherapy (26%; n = 485) had the highest average patient cost ($98,440). Within double modalities, radiation followed by chemotherapy (24%; n = 95) was most common, however, chemoradiotherapy followed by surgery (4%; n = 16) had the highest average cost ($146,374). Within triple modalities, surgery followed by radiation then chemotherapy (50%; n = 8) was most common and costly ($95,868). Conclusions: The most common treatment pathways one year post HNC diagnosis used a single modality; however, the average patient costs within multiple modalities were higher. Further study is required to investigate if these patterns are comparable to current guideline recommendation. [Table: see text]

scholarly journals Medical Gas Plasma Treatment in Head and Neck Cancer—Challenges and Opportunities

2020 ◽  
Vol 10 (6) ◽  
pp. 1944
Author(s):  
Julia Berner ◽  
Christian Seebauer ◽  
Sanjeev Kumar Sagwal ◽  
Lars Boeckmann ◽  
Steffen Emmert ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Plasma Treatment ◽  
Head And Neck ◽  
Neck Cancer ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Novel Treatment ◽  
Gas Plasma ◽  
Medical Gas ◽  
Physical Plasma

Despite progress in oncotherapy, cancer is still among the deadliest diseases in the Western world, emphasizing the demand for novel treatment avenues. Cold physical plasma has shown antitumor activity in experimental models of, e.g., glioblastoma, colorectal cancer, breast carcinoma, osteosarcoma, bladder cancer, and melanoma in vitro and in vivo. In addition, clinical case reports have demonstrated that physical plasma reduces the microbial contamination of severely infected tumor wounds and ulcerations, as is often seen with head and neck cancer patients. These antimicrobial and antitumor killing properties make physical plasma a promising tool for the treatment of head and neck cancer. Moreover, this type of cancer is easily accessible from the outside, facilitating the possibility of several rounds of topical gas plasma treatment of the same patient. Gas plasma treatment of head and neck cancer induces diverse effects via the deposition of a plethora of reactive oxygen and nitrogen species that mediate redox-biochemical processes, and ultimately, selective cancer cell death. The main advantage of medical gas plasma treatment in oncology is the lack of adverse events and significant side effects compared to other treatment modalities, such as surgical approaches, chemotherapeutics, and radiotherapy, making plasma treatment an attractive strategy for the adjuvant and palliative treatment of head and neck cancer. This review outlines the state of the art and progress in investigating physical plasma as a novel treatment modality in the therapy of head and neck squamous cell carcinoma.

Patterns of head and neck cancer incidence, mortality, and survival in the U.S. Hispanic population.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13084-e13084
Author(s):  
Melissa S. Oh ◽  
Renjian Jiang ◽  
Yuan Liu ◽  
Xiting Zhu ◽  
Nabil F. Saba ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Oral Cavity ◽  
Head And Neck ◽  
Neck Cancer ◽  
Hispanic Population ◽  
Annual Percent Change ◽  
Kaplan Meier ◽  
Incidence And Mortality ◽  
Ethnic Subgroups ◽  
The U.S

e13084 Background: To compare the incidence, mortality, and survival of head and neck cancer (HNCA) in the U.S. Hispanic population to other racial/ethnic groups. Methods: Using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, we compared the incidence and mortality of cancer of the oral cavity, pharynx, and larynx between the U.S. Hispanic population versus other racial and ethnic subgroups, as well as the annual percent change between 2000-2013. A comparative analysis for different groups stratified by age and sex was performed. Survival analysis was performed using Kaplan-Meier estimate and logistic regression analysis. Results: The incidence of oral cavity, pharyngeal, and laryngeal cancers were significantly lower in Hispanics compared to Non-Hispanics (p < 0.05). The incidence of laryngeal cancer decreased significantly at a rate of 2.5% annually (p < 0.05), while incidence of oral cavity and pharyngeal cancers remained unchanged in U.S. Hispanics. The mortality rate for oral cavity, pharyngeal, and laryngeal cancers in the U.S. Hispanic population were 1.4 per 100,000, 1.1 per 100,000, and 1.2 per 100,000 respectively. Mortality rates in Hispanics were significantly lower compared to Non-Hispanics (p < 0.05). Non-Hispanics Blacks had the highest HNCA-related mortality among all the compared groups. The mortality of HNCA was significantly declining annually in the U.S. Hispanic population (p < 0.05). Conclusions: The incidence and mortality of HNCA in the U.S. Hispanic population appears to be declining and is significantly lower compared to Non-Hispanics.

Viral gene therapy for head and neck cancer

2015 ◽  
Vol 129 (4) ◽  
pp. 314-320 ◽  
Author(s):  
J P Hughes ◽  
G Alusi ◽  
Y Wang
Keyword(s):  
Gene Therapy ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Relevant Literature ◽  
P53 Gene ◽  
Oncolytic Viruses ◽  
Treatment Modalities ◽  
Viral Gene ◽  
Viral Gene Therapy

AbstractBackground:Viral gene therapy is a promising new treatment modality for head and neck cancer. This paper provides the reader with a review of the relevant literature in this field.Results:There are government licensed viral gene therapy products currently in use for head and neck cancer, utilised in conjunction with established treatment modalities. The viruses target tumour-associated genes, with the first licensed virus replacing p53 gene function, which is frequently lost in tumourigenesis. Oncolytic viruses selectively destroy cancer cells through viral replication and can be armed with therapeutic transgenes.Conclusion:Despite considerable advances in this field over the last 40 years, further research is needed to improve the overall efficacy of the viruses and allow their widespread utilisation in the management of head and neck cancer.

scholarly journals Less is Enough: Outcome of Bimodality Definitive Concurrent Chemoradiation does not Differ from that of Trimodality Upfront Neck Dissection Followed by Adjuvant Treatment for >6 cm Bulky Lymph Node (N3) Head and Neck Cancer

2019 ◽  
Author(s):  
Wan-Yu Chen ◽  
Tseng-Cheng Chen ◽  
Shih-Fan Lai ◽  
Tony Hsiang-Kuang Liang ◽  
Bing-Shen Huang ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Dissection ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Primary Tumor ◽  
Treatment Modalities ◽  
Recurrence Free Survival ◽  
Tumor Treatment ◽  
Free Survival

Currently, data regarding optimal treatment modality, response, and outcome specifically for N3 head and neck cancer are lacking. This study aimed to compare the treatment outcomes between definitive concurrent chemoradiotherapy (CCRT) to the neck and upfront neck dissection followed by adjuvant CCRT. 93 N3 squamous cell carcinoma head and neck cancer patients were included. Primary tumor treatment was divided to definitive CCRT (CCRT group) or curative surgery followed by adjuvant CCRT (surgery group). Neck treatment was also classified into two treatment modalities: definitive CCRT to the neck (CCRT group) or curative neck dissection followed by adjuvant CCRT (neck dissection group). Overall, the 2-year overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS) were 51.8%, 47.3%, 45.6%, and 43.6%, respectively. In both oropharyngeal cancer and nonoropharyngeal cancer patients, in terms of OS, LRFS, RRFS or DMFS no difference was noted regarding primary tumor treatment (CCRT vs. surgery) or neck treatment (CCRT vs. neck dissection). In summary, N3 neck patients treated with definitive CCRT can achieve similar outcomes to those treated with upfront neck dissection followed by adjuvant CCRT. Cautions should be made to avoid overtreatment for this group of patients.

Growth in head and neck cancer clinical research in the NCRN and NCRI: Expanding opportunities for patients across the United Kingdom.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16007-e16007
Author(s):  
Matthew T. Seymour ◽  
Rachel Moser ◽  
Matthew Cooper ◽  
Sheila Fisher ◽  
Karen Poole ◽  
...  
Keyword(s):  
Cancer Research ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Clinical Studies ◽  
Network Activity ◽  
Research Network ◽  
Treatment Modalities ◽  
Research Networks ◽  
Incident Cases

e16007 Background: The National Institute for Health Research Cancer Research Network (NCRN) was established in 2001 to benefit patients by improving the coordination, integration and speed of cancer research. Networks were established in England (NCRN), Scotland, Wales and Northern Ireland, supporting recruitment to a national portfolio across the NHS. In a decade recruitment to cancer studies has increased five fold in England to 20% of new incident cases. Head and Neck cancers affect basic functions including breathing and eating; particularly devastating for patients. The NCRI Head and Neck Cancer Clinical Studies Group is one of 23 Groups funded by NCRI members with a UK wide remit to develop a national portfolio of clinical studies. All CSGs include patients and carers as members resulting in active patient involvement in trial design, patient information and strategic direction of the portfolio. Methods: The last decade has seen unprecedented growth in the Head and Neck portfolio, which now includes 43 studies from only three studies in 2003/4. By 2010/11, 95% of UK Cancer Local Research Networks (37 networks) were recruiting to Head and Neck studies from only 2 networks in 2001/2, expanding trial access for patients and developing Head and Neck research expertise in new sites and with new investigators. Results: Numbers of patients participating in Head and Neck studies has grown exponentially. Since 2006/7 UK patient recruitment has risen 15-fold from 126 to 1890, representing almost 25% new incident cases of Head and Neck cancer. Conclusions: Rapid portfolio growth and associated network activity has expanded opportunities for patients with Head and Neck cancer; providing access to new therapeutic agents and treatment modalities, including NIHR CRN-adopted commercial trials and studies in a surgical setting. Participation in studies demonstrating the effectiveness of Intensity Modulated Radiotherapy in reducing xerostomia (including PARSPORT), has supported integration of this technique into cancer service.

scholarly journals Clinical Factors Associated With Cost in Head and Neck Cancer: Implications for a Bundled Payment Model

2019 ◽  
Vol 15 (6) ◽  
pp. e560-e567
Author(s):  
Martin C. Tom ◽  
Richard B. Ross ◽  
Shlomo A. Koyfman ◽  
David J. Adelstein ◽  
Robert R. Lorenz ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Treatment Modalities ◽  
Trimodality Therapy ◽  
Payment Model ◽  
Bundled Payment ◽  
Number Of Treatment

PURPOSE: To determine which factors influence cost in head and neck cancer (HNC) to inform the development of a bundled payment model (BPM). METHODS: Patients with stages 0 to IVB (by American Joint Commission on Cancer, 7th edition) HNC of various sites and histology treated definitively at a single tertiary care center during 2013 were included. Clinical variables and direct cost data were obtained, and their associations were investigated using χ2, t, Wilcoxon rank sum, and analysis of variance testing. Results were used to develop a BPM. RESULTS: One hundred fifty patients were included; 87% were white, 74% were men, 48% had oropharyngeal cancer, and 58% had stage IVA disease. Treatment consisted of surgery alone (17%), radiation alone (11%), surgery plus radiation (14%), chemoradiation (45%), and surgery plus chemoradiation (13%). On multivariable analysis, both increasing group stage and number of treatment modalities used were significantly associated with higher cost. Given that stage often dictates treatment, we developed three cost tiers that were based on overall treatment modality. Tier A, the least costly, consisted of single-modality therapy with either surgery alone or radiation alone (median cost divided by the median overall cost of treatment, 0.54; 25th to 75th percentile range, 0.29 to 1.02), followed by tier B, which consisted of bimodality therapy with either chemoradiation or surgery plus radiation (1.03; range, 0.81 to 1.35), followed by tier C, which consisted of trimodality therapy with surgery plus chemoradiation (1.43; range, 1.10 to 1.96). CONCLUSION: The number of treatment modalities required is the primary driver of cost in HNC. These data can simplify development of a comprehensive HNC BPM.

scholarly journals HEAD AND NECK CANCER STEM CELL PROTEOMICS

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Saira Saleem ◽  
Sahrish Tariq
Keyword(s):  
Stem Cells ◽  
Head And Neck Cancer ◽  
Cancer Stem Cells ◽  
Head And Neck ◽  
Neck Cancer ◽  
Drug Targets ◽  
Treatment Modalities ◽  
Cell Of Origin ◽  
Novel Drug ◽  
Novel Drug Targets

It is critical to identify the cell of origin of cancer and the genes/proteins/transcriptional/epigenetic factors of that cell. Here, we review studies on head and neck cancer stem cells (CSC) in the hope of developing better understanding of their role highlighting their importance as novel drug targets. CSC model has introduced a hierarchical conceptual framework for the interpretation of intratumour heterogeneity within tumour. This, in turn, has culminated in a major paradigm shift in terms of how different types of cancers can be targeted for treatment. Several malignancies conform to the CSC model of tumour growth yet identification of CSC markers remains a profound challenge.Key words: Chemo- and radio-resistance, head and neck cancer stem cells, proteomics, treatment modalities

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