BACKGROUND: Cancer survivors face psychosocial issues that increase their risk of suicide. This study examined the risk of suicide across cancer sites, with a focus on survivors of head and neck cancer (HNC). METHODS: The Surveillance, Epidemiology, and End Results 18-registry database (from 2000 to 2014) was queried for the top 20 cancer sites in the database, including HNC. The outcome of interest was suicide as a cause of death. The mortality rate from suicide was estimated for HNC sites and was compared with rates for 19 other cancer sites that were included in the study. Poisson regression was used to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) for 1) HNC versus non-HNC sites (the other 19 cancer sites combined), and 2) HNC versus each individual cancer site. Models were stratified by sex, controlling for race, marital status, age, year, and stage at diagnosis. RESULTS: There were 404 suicides among 151,167 HNC survivors from 2000 to 2014, yielding a suicide rate of 63.4 suicides per 100,000 person-years. In this timeframe, there were 4493 suicides observed among 4219,097 cancer survivors in the study sample, yielding an incidence rate of 23.6 suicides per 100,000 person-years. Compared with survivors of other cancers, survivors of HNC were almost 2 times more likely to die from suicide (aRR, 1.97; 95% CI,). There was a 27% increase in the risk of suicide among HNC survivors during the period from 2010 to 2014 (aRR, 1.27; 95% CI, 1.16-1.38) compared with the period from 2000 to 2004. CONCLUSIONS: Although survival rates in cancer have improved because of improved treatments, the risk of death by suicide remains a problem for cancer survivors, particularly those with HNC. Cancer 2018;124:4072-4079.

Background Cancer survivors face psychosocial issues that increase their risk of suicide. This study examined the risk of suicide across cancer sites, with a focus on survivors of head and neck cancer (HNC). Methods The Surveillance, Epidemiology, and End Results 18‐registry database (from 2000 to 2014) was queried for the top 20 cancer sites in the database, including HNC. The outcome of interest was suicide as a cause of death. The mortality rate from suicide was estimated for HNC sites and was compared with rates for 19 other cancer sites that were included in the study. Poisson regression was used to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) for 1) HNC versus non‐HNC sites (the other 19 cancer sites combined), and 2) HNC versus each individual cancer site. Models were stratified by sex, controlling for race, marital status, age, year, and stage at diagnosis. Results There were 404 suicides among 151,167 HNC survivors from 2000 to 2014, yielding a suicide rate of 63.4 suicides per 100,000 person‐years. In this timeframe, there were 4493 suicides observed among 4219,097 cancer survivors in the study sample, yielding an incidence rate of 23.6 suicides per 100,000 person‐years. Compared with survivors of other cancers, survivors of HNC were almost 2 times more likely to die from suicide (aRR, 1.97; 95% CI, 1.77‐2.19). There was a 27% increase in the risk of suicide among HNC survivors during the period from 2010 to 2014 (aRR, 1.27; 95% CI, 1.16‐1.38) compared with the period from 2000 to 2004. Conclusions Although survival rates in cancer have improved because of improved treatments, the risk of death by suicide remains a problem for cancer survivors, particularly those with HNC.

Objective The COVID-19 pandemic in the U.S. has exhibited a distinct multiwave pattern beginning in March 2020. Paradoxically, most counties do not exhibit this same multiwave pattern. We aim to answer three research questions: (1) How many distinct clusters of counties exhibit similar COVID-19 patterns in the time-series of daily confirmed cases? (2) What is the geographic distribution of the counties within each cluster? and (3) Are county-level demographic, socioeconomic and political variables associated with the COVID-19 case patterns? Materials and methods We analyzed data from counties in the U.S. from March 1, 2020 to January 2, 2021. Time series clustering identified clusters in the daily confirmed cases of COVID-19. An explanatory model was used to identify demographic, socioeconomic and political variables associated with the outbreak patterns. Results Three patterns were identified from the cluster solution including counties in which cases are still increasing, those that peaked in the late fall, and those with low case counts to date. Several county-level demographic, socioeconomic, and political variables showed significant associations with the identified clusters. Discussion The pattern of the outbreak is related both to the geographic location within the U.S. and several variables including population density and government response. Conclusion The reported pattern of cases in the U.S. is observed through aggregation of the daily confirmed COVID-19 cases, suggesting that local trends may be more informative. The pattern of the outbreak varies by county, and is associated with important demographic, socioeconomic, political and geographic factors.

In combination with IR, M3814 showed efficacy in all of the 6 mouse models of human cancer as demonstrated by a strong potentiation of the effect of IR. In all models, a dose of 2 Gy administered daily for 1 week in combination with M3814 induced statically significant tumor growth inhibition compared to IR alone. In 2 models, FaDu and NCI-H460, M3814 induced tumor regression. In the FaDu model, no tumor regrowth (duration of the experiment >100 days) was observed in the combination arm with IR (2 Gy per fractions, 6 weeks, 5 days per week: total dose 60 Gy) at the doses of 25 and 50 mg/Kg. In the IR only arm, no tumor responses were observed. These effects were a likely consequence of inhibiting DNA-PK activity, as shown by measuring the autophosphorylation of DNA-PK in FaDu tumor tissue. M3814, alone or in combination with IR, did not induce significant weight loss or visual signs of toxicity in the mice in any study. Conclusion: M3814 is active in nonclinical experiments in combination with IR. Strong antitumor activity was observed in several xenograft models with complete regressions of tumors upon application of the established clinical IR schedule of 2-Gy fractions for 6 weeks in the FaDu model (squamous cell carcinomas of the head and neck). Clinical evaluation of M3814 is ongoing.

Purpose: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. One in every four individuals-nearly 80 million-is infected. More than 38,000 new cases of HPV-associated cancers are diagnosed annually. However, factors related to HPV-associated cancer survivorship, based on primary anatomic site, remain understudied. The aim of this study was to assess sociodemographic factors related to survival following diagnosis of HPV-associated cancers in the United States. Methods: Patients ≥18 years diagnosed with first-primary HPV-associated cancer between 2007 and 2014 were identified from the Surveillance, Epidemiology, and End Results 18. HPV-associated cancers sites were defined as anal, cervical, oropharyngeal, penile, vaginal, and vulvar per the International Classification of Diseases for Oncology, third edition codes. Kaplan-Meier curves showing cancer-specific survival (CSS) from each HPV-associated cancer site stratified by sex with differences assessed by log-rank tests. Fine and Gray proportional hazards regression models for each HPV-associated site controlled for clinical covariates and estimated sociodemographic predictors of hazard of death from cancer. Results: A total of 63,329 patients with HPV-associated cancers were included in the analyses. The most common sites were cervix for females (58%) and oropharynx for males (78%). Overall 8-year survival at the end of follow-up was 56%. For males, anal cancer had the lowest CSS (62%) compared to oropharyngeal (69%) and penile (72%) cancer (p<0.01). For females, vaginal cancer had the lowest CSS (46%) compared to anal (71%), cervical (67%), oropharyngeal (57%), and vulvar (72%) cancer. Final adjusted model showed significant CSS differences based on sociodemographic factors, including sex, age, marital status, race/ethnicity, and insurance status. Males were more likely to die from anal cancer compared to females (aHR=1.53, 95% CI 1.39, 1.68), while less likely than females to die from oropharyngeal cancer (aHR=0.91, 95% CI 0.84, 0.98). Blacks were more likely to die from anal (aHR=1.33, 95% CI 1.16, 1.52), cervical (aHR=1.13, 95% CI 1.05, 1.22), and oropharyngeal cancer (aHR=1.54, 95% CI 1.41, 1.68) compared with Whites. Each increasing year of diagnosis was associated with a 1-3% increase in hazard of cancer-specific death for all cancers. Conclusions: There is marked variability in sociodemographic correlates among HPV-associated cancer survivors in the United States, based on sex, age, insurance and marital status, race/ethnicity, and cancer type. This has important implications for clinical decision making and identification of populations at greater risk of death from HPV-associated cancers. Citation Format: Nosayaba Osazuwa-Peters, Matthew C. Simpson, Eric Adjei Boakye, Kahee A. Mohammed, Longwen Zhao, Sai D. Challapalli, Rebecca L. Rohde, Vy T. Pham, Sean T. Massa, Mark A. Varvares. Differences in the sociodemographic correlates of HPV-associated cancer survival in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4255.