Predictors of gastrostomy tube dependence in surgically managed oropharyngeal squamous cell carcinoma

Varma, Vivek; Eskander, Antoine; Kang, Stephen Y.; Kumar, Bhavna; Brown, Nicole V.; Zhao, Songzhu; Brock, Guy; Agrawal, Amit; Carrau, Ricardo L.; Old, Matthew; Özer, Enver; Rocco, James W.; Schuller, David E.; Dziegielewski, Peter T.; Cipolla, Michael J.; Teknos, Theodoros N.

doi:10.1002/lary.27290

Cited by 13 publications

(21 citation statements)

References 31 publications

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“…Unlike HPV‐negative OPC, HPV‐mediated OPC tends to affect a healthier, younger population with significantly improved survival; as such, potential overtreatment and toxicities play an increased role in treatment decisions, especially for early‐stage disease. With improved survival, functional outcomes such as swallowing function, quality‐of‐life measures, and decreased gastrostomy or tracheostomy dependence are increasingly emphasized . The ideal treatment strategy that optimizes survival and minimizes toxicity is controversial because HPV‐negative OPC treatment paradigms persist as the standard of care.…”

Section: Introductionmentioning

confidence: 99%

“…With improved survival, functional outcomes such as swallowing function, quality-of-life measures, and decreased gastrostomy or tracheostomy dependence are increasingly emphasized. 4,5 The ideal treatment strategy that optimizes survival and minimizes toxicity is controversial because HPV-negative OPC treatment paradigms persist as the standard of care. Previous National Cancer Data Base (NCDB) studies not limited to HPV-specific OPC have shown that the use of upfront surgical treatment for OPC has either stayed stable or increased with time.…”

Section: Introductionmentioning

confidence: 99%

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National treatment trends in human papillomavirus–positive oropharyngeal squamous cell carcinoma

Zhan

Puram

et al. 2019

Cancer

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Background Human papillomavirus (HPV)–mediated oropharyngeal cancer (OPC) is associated with dramatically improved survival in comparison with HPV‐negative OPC and can be successfully treated with surgical and nonsurgical approaches. National treatment trends for OPC were investigated with the National Cancer Data Base (NCDB). Methods The NCDB was reviewed for primary HPV‐mediated OPC in 2010‐2014. Multivariable regression was used to identify predictors of both nonsurgical therapy and receipt of adjuvant chemoradiation (CRT). Results There were 13,363 patients identified with a median age at diagnosis of 58 years. The incidence of triple‐modality treatment (surgery with adjuvant chemotherapy) decreased from 23.7% in 2010 to 16.9% in 2014 (R2 = 0.96), whereas the incidence of nonsurgical treatment increased from 63.9% to 68.7% (R2 = 0.89). Hospitals in the top treatment volume quartile (quartile 1 [Q1]; n = 29) had a lower rate of positive margins (16.3%) than bottom‐quartile centers (n = 741; rate of positive margins, 36.4%; P < .001); Q1 hospitals used surgical therapy significantly more. Independent predictors of nonsurgical therapy included older age, advanced disease, lower hospital volume, and living closer to the hospital or outside the Pacific United States. In surgically treated patients, younger age, lower hospital volume, nodal disease, positive surgical margins, and extranodal extension (ENE) also predicted more adjuvant CRT use. Conclusions The use of upfront surgical treatment decreased from 2010 to 2014. Hospital volume shows a strong, inverse correlation with the rate of positive surgical margins. The upfront treatment strategy is predicted not only by staging but also by patient‐, geographic‐, and hospital‐specific factors. Lower hospital volume remains independently associated with increased triple‐modality therapy after adjustments for positive margins, ENE, and pathologic staging.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

National treatment trends in human papillomavirus–positive oropharyngeal squamous cell carcinoma

Zhan

Puram

et al. 2019

Cancer

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“…As such we chose to describe its use in this population which typically requires a relatively low rate of G-tube insertion. Our data does add value to the literature in that there is less reporting of G-tube use in oral cavity cancer patients compared to oropharynx cancer [ 24 , 24 – 26 , 12 ].…”

Section: Discussionmentioning

confidence: 63%

A preliminary assessment of guideline adherence and clinical variation in oral cancer treatment: a MarketScan database study

et al. 2021

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Background To assess variations in adherence to guideline-recommended processes of care for oral cavity cancer patients. Methods Retrospective study using a U.S. healthcare research database (MarketScan). Index diagnoses were considered from 2010 to 2012 with follow-up from 2013 to 2014. Diagnostic and procedure codes were utilized to identify oral cavity patients with a defined treatment modality. Compliance with guideline-recommended processes of care, which included pre-treatment imaging, thyroid-function testing (TFTs), multidisciplinary consultation and gastrostomy-tube insertion rates, were assessed. Results A total of 2752 patients were identified. Surgery alone was the most common treatment (60.8%), followed by surgery with adjuvant chemoradiotherapy (20.4%) and surgery with adjuvant radiotherapy (18.8%). Head/neck and chest imaging were obtained in 60% and 62.5% of patients respectively. Significant geographical differences in head and neck imaging were observed between North-central (64%), South (58.4%) and West (56.1%) regions (p = 0.026). Differences in chest imaging were also present between North-east (65%) and West (56.8%; p = 0.007). TFTs were obtained in 54.4% of the patients after radiation treatment, and 18.6% of patients had multidisciplinary consultation during the 6 months before and 3 months after initiation of treatment. During the year after treatment initiation, 21.2% of patients underwent G-tube placement, with significantly higher rates in patients receiving triple modality treatment (58%) when compared to surgery plus radiation (27%) and surgery alone (15%; p < 0.01). Conclusion Adherence to evidence-based practices was low based on the database coding. These data suggest a potential to improve adherence and increase the routine use of practices delineated in national clinical practice guidelines. Clinical relevance This study reflects a suboptimal adherence to guidelines based on the database employed. This study should be considered by healthcare providers and efforts should be maximized to follow the processes of care which have proven to impact on patient's outcomes.

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“…However, these studies are focused primarily on deescalation regimens for "low-risk" patients 23 and patients with surgically managed OPSCC. 24,25 Veterans with OPSCC demonstrate significant differences from the general OPSCC population. The incidence of tobacco exposure in veterans with OPSCC is essentially identical to that of veterans with laryngeal squamous cell carcinoma, surpassing 80%.…”

Section: Introductionmentioning

confidence: 98%

“…However, these studies are focused primarily on deescalation regimens for “low-risk” patients 23 and patients with surgically managed OPSCC. 24,25…”

Section: Introductionmentioning

confidence: 99%

Swallowing Function in Survivors of Oropharyngeal Cancer Is Associated With Advanced T Classification

Harms

Kansara

Stach

et al. 2019

Ann Otol Rhinol Laryngol

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Objectives: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rapidly increasing in the United States. The aim of this study was to characterize the functional status of OPSCC survivors to identify predictors of swallowing dysfunction in this patient population. Methods: OPSCC survivors (n = 81) treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2005 and 2015 with at least 2 years of clinical follow-up were reviewed. Functional status was ascertained using (1) gastrostomy and tracheostomy placement and retention, (2) gastrostomy use at last follow-up, (3) patient-reported diet, and (4) modified barium swallow. Results: Median follow-up duration was 5.6 years; 67% of patients had ≥10-pack-year tobacco exposure; 96% of tumors for which p16 data were available were p16 positive. At last follow-up, 82% of patients reported a regular diet, and only 9 patients required gastrostomy use. Gastrostomy use at last follow-up was higher in patients with T3 and T4 tumors compared with those with T1 and T2 tumors ( P = .01). The relationship between T classification and gastrostomy use persisted even when the analysis was limited to p16+ tumors and p16+ tumors with ≥10-pack-year history of tobacco exposure. Conclusions: Advanced T classification at presentation is a critical predictor of gastrostomy use in long-term OPSCC survivors irrespective of p16 status or tobacco exposure history. Level of Evidence: 2b

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Predictors of gastrostomy tube dependence in surgically managed oropharyngeal squamous cell carcinoma

Abstract: 4. Laryngoscope, 2018.

Cited by 13 publications

References 31 publications

National treatment trends in human papillomavirus–positive oropharyngeal squamous cell carcinoma

National treatment trends in human papillomavirus–positive oropharyngeal squamous cell carcinoma

A preliminary assessment of guideline adherence and clinical variation in oral cancer treatment: a MarketScan database study

Swallowing Function in Survivors of Oropharyngeal Cancer Is Associated With Advanced T Classification

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