The human papillomavirus (HPV) vaccine was approved for females in 2006 and males in 2009 for the prevention of anogenital cancer and warts. The indications were expanded in 2020 to include the prevention of oropharyngeal cancer, which is more common in males. 1 The Advisory Committee on Immunization Practices recommends routine vaccination with 2 doses at age 11 to 12 years, with catch-up vaccination at age 13 to 26 years (limited to age 13-21 years from 2011 to 2019 for males). 2 If the first dose occurs after age 15 years, a 3-dose series is recommended. 2 HPV vaccination rates are closely tracked and monitored for adolescents (aged 13-17 years). 3 However, little is known about vaccination rates in young adults, who are more likely to make health care decisions for themselves but less likely to access preventive services or be insured. 4 Our objective was to assess HPV vaccination among young adults in the US.

PURPOSE: Financial hardship is a growing concern for patients with cancer. Patients with head and neck cancer (HNC) are particularly vulnerable, given that a third leave the workforce following treatment. The goal of our study was to characterize financial hardship in the psychologic response (response to increased expenses) and coping behaviors (behaviors patients adopt to manage their care in the setting of increased expenses) domains in patients with HNC compared with patients with other cancers. METHODS: This was a retrospective cohort study of nationally representative public survey data from 2013 to 2018 in the National Health Interviews Survey, an annual cross-sectional household survey. We included respondents age ≥ 18 years who reported a diagnosis of cancer and identified a subset of patients with HNC. Our main outcomes were financial hardship in the psychologic response and coping behaviors domains. RESULTS: Our sample included a weighted population of 357,052 patients with HNC and 21.4 million patients with other cancers. Compared with patients with other cancers, patients with HNC reported greater levels of coping behaviors hardship (31% v 23%, P = .015), but similar levels of psychologic financial hardship (73% v 72%, P = .787). Medicaid or uninsured patients more often reported coping behaviors hardship. On multivariable analysis, HNC (odds ratio, 1.51; 95% CI, 1.01 to 2.24) was independently associated with coping behaviors hardship. CONCLUSION: To our knowledge, this is the first study to evaluate financial hardship in patients with HNC compared with patients with other cancers that includes Medicaid and uninsured patients, who are more often to have financial hardship. Patients with HNC have greater levels of hardship in the coping behaviors domain compared with patients with other cancers, but similar levels in the psychologic response domain.

Objective To explore challenges and opportunities for supporting midcareer women otolaryngologists in the areas of negotiation and sponsorship. Study Design Qualitative approach using semistructured interviews. Setting Online multi-institutional interviews. Methods This study was performed from June to August 2021. Women otolaryngologists representing diverse subspecialties, training, and practice environments were recruited via a purposive criterion-based sampling approach. Semistructured interviews were transcribed, coded, and analyzed via an inductive-deductive approach to produce a thematic content analysis. Results Among the 12 women interviewees, who represented 7 subspecialties, the majority were Caucasian (58%) and in academic practice (50%). The median residency graduation year was 2002 (range, 1982-2013). Participants expressed several challenges that women otolaryngologists face with respect to negotiation, including the absence of systematic formal negotiation training, gendered expectations that women experience during negotiations, and a perceived lack of power in negotiations. Obstacles to effective sponsorship included difficulty in the identification of sponsors and the influence of gender and related systemic biases that hindered sponsorship opportunities. Conclusion Notable gender disparities exist for negotiation and sponsorship in the midcareer stage for women otolaryngologists. Women start at a disadvantage due to a lack of negotiation training and access to sponsors, which is exacerbated by systemic gender bias and power differentials as women advance in their careers. This study highlights opportunities to improve negotiation and sponsorship for women, with the goal of promoting a more diverse workforce.

Key Points Question What are older women’s perspectives on recommendations for treatment de-escalation for low-risk, early-stage hormone receptor–positive breast cancer? Findings In this qualitative study of 30 participants aged 70 years or older, women expressed skeptical views regarding age-based treatment guidelines, difficulty interpreting the rationale for reducing low-value care to be a favorable rather than poor prognosis, and perceived benefit of some low-value therapies for peace of mind. Meaning Emphasizing an overall favorable prognosis and improving patient education on the risks vs benefits of adjuvant therapies may help reduce overtreatment in older women with early-stage, hormone receptor–positive breast cancer.

Surveillance imaging and visits are costly and have not been shown to improve oncologic outcomes for patients with head and neck cancer (HNC). However, the benefit of surveillance visits may extend beyond recurrence detection. To better understand surveillance and potentially develop protocols to tailor current surveillance paradigms, it is important to elicit the perspectives of the clinicians who care for patients with HNC. OBJECTIVE To characterize current surveillance practices and explore clinician attitudes and beliefs on deintensifying surveillance for patients with HNC.DESIGN, SETTING, AND PARTICIPANTS This qualitative study was performed from January to March 2021. Guided by an interpretive description approach, interviews were analyzed to produce a thematic description. Data analysis was performed from March to April 2021. Otolaryngologists and radiation oncologists were recruited using purposive and snowball sampling strategies. MAIN OUTCOMES AND MEASURESThe main outcomes were current practice, attitudes, and beliefs about deintensifying surveillance and survivorship as well as patients' values and perspectives collected from interviews of participating physicians.RESULTS Twenty-one physicians (17 [81%] men) were interviewed, including 13 otolaryngologists and 8 radiation oncologists with a median of 8 years (IQR, 5-20 years) in practice. Twelve participants (57%) stated their practice comprised more than 75% of patients with HNC. Participants expressed that there was substantial variation in the interpretation of the surveillance guidelines. Participants were open to the potential for deintensification of surveillance or incorporating symptom-based surveillance protocols but had concerns that deintensification may increase patient anxiety and shift some of the burden of recurrence monitoring to patients. Patient and physician peace of mind, the importance of maintaining the patient-physician relationship, and the need for adequate survivorship and management of treatment-associated toxic effects were reported to be important barriers to deintensifying surveillance. CONCLUSIONS AND RELEVANCEIn this qualitative study, clinicians revealed a willingness to consider altering cancer surveillance but expressed a need to maintain patient and clinician peace of mind, maintain the patient-clinician relationship, and ensure adequate monitoring of treatment-associated toxic effects and other survivorship concerns. These findings may be useful in future research on the management of posttreatment surveillance.

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Objective Otolaryngology residency applicants often struggle to gauge their competitiveness at programs due to the lack of information available, resulting in a rising number of applications. We aimed to evaluate otolaryngology websites for information pertaining to prospective applicants. Study Design Systematic content analysis. Setting Web. Methods We reviewed 50 otolaryngology websites from June to July 2021. We searched for information pertaining to the application process, including requirements, screening and/or selection processes, and average interviewee or matched resident statistics. Results All websites had a page for prospective applicants. Under half (n = 24, 48%) explicitly listed required application components. Only 23 (46%) mentioned the desired number of letters of recommendation, and only 2 (4%) noted the need for a letter from the department chair. The majority (n = 35, 70%) provided no information regarding the number of applications received or interviews granted. Most (n = 35, 70%) did not mention how candidates are evaluated. A minority (n = 14, 30%) provided very general metrics on which candidates are scored or ranked. Almost all (n = 49, 98%) did not mention screening processes in place to select applicants for interview. None provided information about the academic characteristics or demographics of their interviewed applicants, and only 1 (2%) included this information for matched applicants. Conclusion Otolaryngology websites contain limited information pertaining to the residency application process for prospective applicants, making it difficult for candidates to discern their competitiveness at programs and potentially contributing to match inefficiency.