ObjectiveTo evaluate the impact of persistent precarious employment (lasting 12+ months) on the health of working age adults, compared with more stable employment. Persistent precarity reflects a shift towards less secure forms of employment and may be particularly important for health.MethodsNine databases were systematically searched to identify quantitative studies that assessed the relationship between persistent precarious employment and health outcomes. Risk of bias (RoB) was assessed using an adaptation of the Effective Public Health Practice Project tool. Narrative synthesis and random effects meta-analysis were conducted. Certainty of evidence was assessed using the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ResultsOf 12 940 records screened, 50 studies met the inclusion criteria and 29 were included in meta-analyses. RoB was generally high (n=18). The most reported outcome domain was mental health; with evidence also reported relating to general health, physical health,and health behaviours. Of GRADE assessed outcomes, persistent precarious employment was associated with increased risk of poor self-rated health (OR 1.53, 95% CI 1.09 to 2.14, I2=80%) and mental health symptoms (OR 1.44, 95% CI 1.23 to 1.70, I2=65%). The association with all-cause mortality was imprecisely estimated (OR 1.10, 5% CI 0.91 to 1.33, I2=73%). There was very low GRADE certainty across all outcomes.ConclusionsPersistent precarious employment is associated with poorer health, particularly for outcomes with short time lags, though associations are small and causality is highly uncertain. Further research using more robust methods is needed but given potential health harms of persistent precarious employment, exploration of precautionary labour regulations and employment policies is warranted.

Objectives To provide real-world performance data and identify clinical factors associated with survival outcomes for patients receiving first-line pembrolizumab-containing treatment for head and neck squamous cell carcinoma (HNSCC) in the palliative setting. Materials and Methods We analysed the electronic records of patients who initiated pembrolizumab-containing treatment between 01/03/2020-30/09/2021. Outcomes included overall survival (OS), progression-free survival (PFS), duration of response (DOR), disease control rate (DCR). Data were compared with the KEYNOTE-048 study and clinical factors were evaluated for association with survival. Results Our cohort included 91 patients (median follow-up 10.8 months). For patients receiving monotherapy (n=76), 12-month and 24-month OS was 45% and 27%, respectively, 12-month PFS was 22%, median DOR was 13.3 months, and DCR was 56.6%. For patients receiving pembrolizumab-chemotherapy (n=15), 12-month OS was 60%, 12-month PFS was 20%, median DOR was 7.3 months and DCR was 60.0%. Experiencing ≥1 irAE (versus no irAEs), of any grade, was associated with favourable OS and PFS for patients receiving monotherapy in both univariable log-rank analysis (median OS 17.4 months versus 8.6 months, respectively, P=0.0033; median PFS 10.9 months versus 3.0 months, respectively, P<0.0001) and multivariable analysis (Cox proportional hazards regression: OS HR: 0.31, P=0.0009; PFS HR: 0.17, P<0.0001). Conclusion Our real-world data, first from a European population, support the KEYNOTE-048 study findings. Additionally, our data is first to show irAEs are associated with better outcomes in this patient group, adding to the growing body of evidence showing irAEs are generally a positive marker of PD-L1 inhibitor response.

Objectives: This rapid review aims to evaluate the impact of the COVID-19 pandemic on incidence of head and neck cancer (HNC) and stage distribution at diagnosis. Design: Rapid Review and Meta-analysis Participants: comparative data for new HNC patients between a pre-pandemic cohort (before March 2020) and a pandemic cohort (after March 2020 during the lockdown period). Main Outcomes Measured: data on tumour stage, incidence, referral pathway (number of new patient referrals) or workload levels (number of HNC treatments). Data on stage were summarised as odds ratios (OR) with 95% confidence intervals (CI), data related to changes in numbers of diagnoses, referrals and workload levels were summarised as a narrative synthesis. Results: 31 reports were included in this review. Individually 16 out of 23 studies did not show a significant impact on stage relative to the pre-pandemic period. However, the meta-analysis revealed that patients diagnosed with HNC during the pandemic were 16% more likely to have nodal involvement (OR=1.16; 95% CI 1.00–1.35), 17% more likely to have a late overall stage (OR=1.17; 95% CI 1.01–1.36), and 32% more likely to present with advanced tumour extent (T3 and T4 stage) (OR=1.32; 95% CI 1.08–1.62). Data on incidence was extremely limited and not currently sufficient to assess trends in burden of disease. Conclusions: This review indicates that during the COVID-19 pandemic there was upstaging of HNC at diagnosis, suggesting the provision of care to HNC patients was significantly affected.