Assessment of Oropharyngeal and Laryngeal Cancer Treatment Delay in a Private and Safety Net Hospital System

Objective Advanced laryngeal squamous cell carcinoma remains associated with approximately 50% mortality at 5 years. Delivery of multimodality treatment remains critical to maximizing survival for this disease, but achieving this at a national level remains a difficult undertaking, particularly in under- and uninsured patients as well as minority patients. We sought to evaluate laryngeal cancer treatment delivery and clinical outcomes in a predominantly minority and underserved cohort of largely under- and uninsured patients in a county hospital. Study Design Retrospective cohort study. Setting Tertiary care county hospital in Houston, Texas. Subjects and Methods Patients (N = 210) with a new diagnosis of laryngeal squamous cell carcinoma treated between 2005 and 2015 were included in a retrospective analysis of patient demographics, tumor and treatment characteristics, and oncologic outcomes. Results The majority of patients presented with advanced disease (T4 = 43%, N>0 = 45%). Treatment selection was compliant with National Comprehensive Cancer Network guidelines in 81% of cases, but 76% of patients who required adjuvant radiotherapy were unable to start it within 6 weeks postsurgery. Overall survival and disease-free survival were 52% and 63% for the entire cohort, respectively. Supraglottic subsite and nodal metastases were significantly associated with decreased overall survival and disease-free survival. Race/ethnicity and insurance status were not associated with worse oncologic outcomes. Conclusion Under- and uninsured patients often present with advanced laryngeal cancer. Oncologic outcomes in this cohort of patients is similar to that of other published series. Moreover, tumor characteristics rather than demographic variables drive oncologic outcomes for the predominantly minority and underserved patients seeking care in our tertiary care county hospital.

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“…In parallel, we consider it critical that appropriate institutional resources be dedicated to achieving such benchmarks. 28…”

Section: Discussionmentioning

confidence: 99%

Demographic and Tumor Characteristic Impact on Laryngeal Cancer Outcomes in a Minority Underserved Patient Population

Fullmer

Wilde

Shi

et al. 2020

Otolaryngol.--head neck surg.

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“…In addition, HPV-negative patients had a greater incidence of higher T classification and a greater likelihood of being of lower income status and publicly insured, which may reduce access to care. 19 There are several limitations to this study. First, use of the SEER classification of death introduces the possibility of error.…”

Section: Discussionmentioning

confidence: 94%

“…This may be caused by selection bias because HPV‐negative patients have higher rates of comorbidities and negative prognostic indicators and may be less likely to be offered therapy. In addition, HPV‐negative patients had a greater incidence of higher T classification and a greater likelihood of being of lower income status and publicly insured, which may reduce access to care …”

Section: Discussionmentioning

confidence: 99%

Short‐term mortality risks among patients with oropharynx cancer by human papillomavirus status

Fullerton

Butler

Mahal

et al. 2020

Cancer

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Background There is substantial variation in head and neck cancer (HNC) mortality and competing mortality among patients with HNC. In this study, the authors characterize the causes and risks of short‐term mortality among patients with oropharynx cancer (OPC) and how these risks differ by human papillomavirus (HPV) status. Methods A custom Surveillance, Epidemiology, and End Results (SEER) data set with HPV status was used to identify 4930 patients with OPC who were diagnosed with nonmetastatic (M0) disease from 2013 to 2014, including 3560 (72.2%) HPV‐positive patients and 1370 HPV‐negative patients. Causes of death and cumulative incidence estimates for HNC‐specific mortality, competing mortality, second‐cancer mortality, and noncancer mortality were analyzed by HPV status. Risk factors for mortality events were determined using multivariable competing risk regression models. Results Compared with HPV‐negative patients, HPV‐positive patients had a lower risk of 2‐year cumulative incidence of all‐cause mortality (10.4% vs 33.3%; P < .0001) and a lower risk of both HNC‐specific mortality (4.8% vs 16.2%; P < .0001) and competing‐cause mortality (5.6% vs 16.8%; P < .0001). Second‐cancer mortality was the most common cause of non‐HNC mortality among HPV‐negative patients. Both second‐cancer mortality and noncancer mortality were significantly higher among patients who had HPV‐negative OPC (10.8% and 6.1%, respectively) compared with those who had HPV‐positive OPC (2.4% and 3.2%, respectively; both P < .0001). The median follow‐up was 11 months (range 1‐23 months) in this cohort with known HPV‐status. Conclusions Patients with HPV‐positive and HPV‐negative OPC have significantly different rates of both HNC mortality and competing mortality. HPV‐negative patients are at substantial risk of competing mortality, even within 2 years of cancer diagnosis. These differences can inform power calculations for clinical trials and patient management in the acute and survivorship settings.

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“…The high rate of smoking recidivism may be due to this patient population’s high degree of stress related to their cancer diagnosis, their high level of addiction as indicated by their baseline characteristics, or the variety of socioeconomic pressures faced by patients treated at this safety-net hospital. 15 Anecdotally, many patients reported a significant life stressor in addition to their cancer diagnosis, which ultimately led to their relapse.…”

Section: Discussionmentioning

confidence: 99%

Smoking Cessation at a Safety-Net Hospital: A Radiation Oncology Resident-Led Quality Improvement Initiative

Ramey

Silver

Diaz

et al. 2020

Advances in Radiation Oncology

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Purpose Continued smoking among patients with cancer has been associated with increased toxicities, resistance to treatment, and recurrence. This resident-led quality improvement study attempted to increase smoking cessation by providing free smoking cessation medications in the radiation oncology clinic. Methods and Materials Twenty currently smoking patients with nonmetastatic cancer were prospectively enrolled. First line treatment was protocol-standardized combined nicotine replacement therapy (patches and lozenges). Therapy was initiated before radiation therapy and given for 12 weeks. Patient self-reported tobacco use was assessed at midtreatment, end of 12-week treatment, 3-month follow-up, 6-month follow-up, and 12-month follow-up. Results Within the initial cohort of 20 patients, average years smoked was 36.3 years (median = 37.5). In addition, 85% had attempted to quit previously. Among patients initially enrolled, 3 did not initiate radiation therapy, and 4 were removed from the study by midtreatment due to noncompliance. Midway through treatment, patients had cut self-reported cigarette use to 31% of baseline. However, 75% or more of patients had smoked within the last week at all timepoints assessed. With further follow-up, the number of cigarettes smoked daily continued to rise, reaching 61% of baseline by the 12-month follow-up. Conclusions Patients reduced cigarette consumption, but all patients eventually resumed smoking during the 12-month follow-up. Although it is unfortunate that this study did not result in long-term smoking cessation, the results demonstrate the difficulties faced in helping patients with cancer quit, particularly patients seen at a safety-net hospital. Future efforts could be directed at intensified smoking cessation programs, likely incorporating a more standardized counseling component.

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Assessment of Oropharyngeal and Laryngeal Cancer Treatment Delay in a Private and Safety Net Hospital System

Cited by 13 publications

References 27 publications

Demographic and Tumor Characteristic Impact on Laryngeal Cancer Outcomes in a Minority Underserved Patient Population

Demographic and Tumor Characteristic Impact on Laryngeal Cancer Outcomes in a Minority Underserved Patient Population

Short‐term mortality risks among patients with oropharynx cancer by human papillomavirus status

Smoking Cessation at a Safety-Net Hospital: A Radiation Oncology Resident-Led Quality Improvement Initiative

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