Objectives 1) Investigate the use of optical reflectance spectroscopy to differentiate malignant and non-malignant tissues in head and neck lesions; 2) Characterize corresponding oxygen tissue biomarkers that are associated with pathologic diagnosis Study Design Prospective non-randomized clinical study Setting Tertiary VA Medical Center Subjects and Methods All patients undergoing panendoscopy with biopsy for suspected head and neck cancer were eligible. Prior to taking tissue samples, the optical probe was placed at three locations to collect diffuse reflectance data. These locations were labeled “tumor”, “immediately adjacent”, and “distant normal tissue”. Biopsies were taken of each of these respective sites. The diffuse reflectance spectra were analyzed, and biomarker specific absorption data was extracted using an inverse Monte Carlo algorithm for malignant and non-malignant tissues. Histopathological analysis was performed and used as the gold standard to analyze the optical biomarker data. Results 21 patients with mucosal squamous cell carcinoma of the head and neck were identified and selected to participate in the study. Statistically significant differences in oxygen saturation (p = 0.004) and oxygenated hemoglobin (p = 0.02) were identified between malignant and non-malignant tissues. Conclusion Our study established proof of principle that optical spectroscopy can be used in the head and neck areas to detect malignant tissue. Furthermore, tissue biomarkers were correlated with a diagnosis of malignancy.

Otolaryngology physicians have significantly different values in end-of-life care than cancer patients and their caregivers. This information is important for efficient allocation of scarce Medicare resources and for effective end-of-life discussions, both of which are key for developing appropriate health policy.

SUMMARY Objectives We propose the use of morphological optical biomarkers for rapid detection of human head and neck squamous cell carcinoma (HNSCC) by leveraging the underlying tissue characteristics in aerodigestive tracts. Materials and Methods Diffuse reflectance spectra were obtained from malignant and contra-lateral normal tissues of 57 patients undergoing panendoscopy and biopsy. Oxygen saturation, total hemoglobin concentration, and the reduced scattering coefficient were extracted. Differences in malignant and normal tissues were examined based on two different groupings: anatomical site and morphological tissue type. Results and Conclusions Measurements were acquired from 252 sites, of which 51 were pathologically classified as SCC. Optical biomarkers exhibited statistical differences between malignant and normal samples. Contrast was enhanced when parsing tissues by morphological classification rather than anatomical subtype for unpaired comparisons. Corresponding linear discriminant models using multiple optical biomarkers showed improved predictive ability when accounting for morphological classification, particularly in node-positive lesions. The false-positive rate was retrospectively found to decrease by 34.2% in morphologically- vs. anatomically-derived predictive models. In glottic tissue, the surgeon exhibited a false-positive rate of 45.7% while the device showed a lower false-positive rate of 12.4%. Additionally, comparisons of optical parameters were made to further understand the physiology of tumor staging and potential causes of high surgeon false-positive rates. Optical spectroscopy is a user-friendly, non-invasive tool capable of providing quantitative information to discriminate malignant from normal head and neck tissues. Predictive models demonstrated promising results for real-time diagnostics. Furthermore, the strategy described appears to be well suited to reduce the clinical false-positive rate.

Otolaryngology-head and neck surgery physician perspectives on end-of-life care differ significantly from cancer patient/caregiver perspectives, even when physicians take a patient's perspective when allocating resources. This demonstrates the challenges inherent in end-of-life discussions.

IMPORTANCE Physicians must participate in end-of-life discussions, but they understand poorly their patients’ end-of-life values and preferences. A better understanding of these preferences and the effect of baseline attitudes will improve end-of-life discussions. OBJECTIVE To determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation. DESIGN, SETTING, AND PARTICIPANTS Otolaryngology–head and neck surgery (OHNS) physicians were recruited to use a validated online tool to create a Medicare health plan for advanced cancer patients. During the exercise, participants allocated a limited pool of resources among 15 benefit categories. These data were compared with preliminary data from patients with cancer and their caregivers obtained from a separate study using the same tool. Attitudes toward quality vs quantity of life were assessed for both physicians and patients and caregivers. INTERVENTIONS Participation in online assessment exercise. MAIN OUTCOMES AND MEASURES Medicare resource allocation. RESULTS Of 9120 OHNS physicians e-mailed, 767 participated. Data collected from this group were compared with data collected from 146 patients and 114 caregivers. Compared with patients and caregivers, OHNS physician allocations differed significantly in all 15 benefit categories except home care. When stratified by answers to 3 questions about baseline attitudes toward quality vs quantity of life, there were 3 categories in which allocations of patients and caregivers differed significantly from the group with the opposite attitude for at least 2 questions: other medical care (question 1, P < .001; question 2, P = .005), palliative care (question 1, P = .008; question 2, P = .006; question 3, P = .009), and treatment for cancer (questions 1 and 2, P < .001). In contrast, physician preferences showed significant differences in only 1, nonmatching category for each attitude question: cash (question 1, P = .02), drugs (question 2, P = .03), and home care (question 3, P = .048). CONCLUSIONS AND RELEVANCE Patients with cancer and their caregivers have different preferences from physicians. These preferences are, for these patients and their caregivers, affected by their baseline health attitudes, but physician preferences are not. Understanding the effect of baseline attitudes is important for effective end-of-life discussions.

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Objectives: 1) Assess how physician perspective affects Medicare resource allocation for advanced cancer patients. 2) Compare how physician allocations differ from advanced cancer patients and their caregivers.

squamous cell carcinomas (HNSCC) is yet undefined. We therefore sought to: 1) Investigate clinical and histopathologic characteristics of Snail-positive HNSCC. 2) Understand the link between Snail and other commonly utilized HNSCC tumor markers. METHOD: Retrospective case-control study in a large-scale academic center. Of 51 consecutive HNSCC, 42 surgical resections were included. Two separate pathologists performed standard histopathologic reviews along with immunohistochemistries (Snail, E-cadherin, p16, EGFR) and in-situ hybridization (HPV). Medical review for all cases was performed. RESULTS: 22 of 42 (52%) cases stained 4ϩ Snail (Ͼ75% staining). The remaining 20 cases were considered negative. Snail was strongly inversely related to E-cadherin expression ( ϭ Յ0.69, pϽ0.001), but statistically independent from HPV, p16, or EGFR expression. Snail-(ϩ) tumors were equally represented from each anatomic subsite. Snail-(ϩ) tumors were strongly associated with poor differentiation (pϽ0.001) and basaloid classification (pϭ0.004). Snail-(ϩ) tumors were also strongly associated with lymphovascular invasion (pϭ0.02), but not perineural invasion. Ultimately, 11/22 (50%) of Snail-(ϩ) tumors demonstrated positive nodal metastasis and 11/14 (79%) node-positive cases were Snail-(ϩ) (pϭ0.02). CONCLUSION: This pilot study provides promising evidence of Snail's role as a molecular prognostic marker for HNSCC. Snail positivity is significantly predictive of poorly differentiated, lymphovascular invasive, as well as regionally metastatic tumors. As Snail positivity appears independent of HPV, p16, and EGFR expression, Snail may prove to improve upon these markers' predictive limitations.