Postoperative Radiation Therapy Refusal in Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Carcinoma

Abstract

Objectives/Hypothesis: Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a distinct clinical entity with good prognosis, unique demographics, and a trend toward treatment deintensification. Patients with this disease may opt out of recommended postoperative radiation therapy (PORT) for a variety of reasons. The aim of this paper was to examine factors that predict patient refusal of recommended PORT in HPV-associated OPSCC, and the association of refusal with overall survival.Study Design: Retrospective population-based cohort study of patients in the National Cancer Database.Methods: We conducted a retrospective cohort study of patients in the National Cancer Database diagnosed with OPSCC between January 2010 and December 2015. We primarily assessed overall survival and the odds of refusing PORT based on demographic, socioeconomic, and clinical factors. Analysis was conducted using multivariable logistic regression and multivariable Cox proportional hazards model.Results: A total of 4229 patients were included in the final analysis, with 156 (3.7%) patients opting out of recommended PORT. On multivariable analysis, patient refusal of PORT was independently associated with a variety of socioeconomic factors such as race, insurance status, comorbidity, treatment at a single facility, and margin status. Lastly, PORT refusal was associated with significantly lower overall survival compared to receipt of recommended PORT (hazard ratio 1.69, confidence interval 1.02-2.82).Conclusions: Patient refusal of recommended PORT in HPV-associated OPSCC is rare and associated with variety of disease and socioeconomic factors. PORT refusal may decrease overall survival in this population. Our findings may help clinicians when counseling patients and identifying those who may be more likely to opt out of recommended adjuvant therapy.

Determinants of Patient Refusal of Postoperative Radiation Therapy in Sinonasal Squamous Cell Carcinoma

“…In their analysis of the NCDB, Prasad et al found Black patients with HPV-associated oropharyngeal SCC were more likely to refuse PORT. 11 Similarly, Hamidi et al found that in their patient population black patients were approximately 30% more likely to refuse radiation therapy. 14 While the reasons for this discrepancy are likely multifactorial, black patients have been noted to have the lowest survival rate and highest death rate of any group.…”

“…Contrary to previous studies, we did not find a statistically significant difference in survival between patients who received and refused PORT. 11,14,15,19 There are multiple studies demonstrating the survival benefit of PORT. 20,21 Given the robust data in favor of radiation therapy, it is likely that the relatively small sample size of patients refusing PORT (n ¼ 73) precluded a significant difference in survival in our study.…”

“…Previous studies have identified advanced age, low educational status, and higher comorbidities as factors correlated with refusal of cancer treatment. 8 9 10 11…”

“…Previous studies have identified advanced age, low educational status, and higher comorbidities as factors correlated with refusal of cancer treatment. [8][9][10][11] To date, there has been a lack of research looking at patient factors associated with treatment refusal in sinonasal malignancies. One factor limiting research is the rarity of sinonasal tumors making prospective studies difficult.…”

Nodal metastasis in surgically treated laryngeal squamous cell carcinoma

“…These variables have been defined in previous studies. 18,19 Due to the study period, all patients were staged with either the 6th or 7th edition of the AJCC staging criteria. 20 The differences between these staging criteria and the current 8th criteria for laryngeal SCCa are negligible.…”