effect sizes, population norms, profile health status instruments, quality of life measurement, WHOQOL-Brèf,

Human papillomavirus (HPV) is associated with a subset of head and neck squamous cell carcinoma (HNSCC). Between 15% and 35% of HNSCCs harbor HPV DNA. Demographic and exposure differences between HPV-positive (HPV + ) and negative (HPV À ) HNSCCs suggest that HPV + tumors may constitute a subclass with different biology, whereas clinical differences have also been observed. Gene expression profiles of HPV + and HPV À tumors were compared with further exploration of the biological effect of HPV in HNSCC. Thirty-six HNSCC tumors were analyzed using Affymetrix Human 133U Plus 2.0 GeneChip and for HPV by PCR and real-time PCR. Eight of 36 (22%) tumors were positive for HPV subtype 16. Statistical analysis using Significance Analysis of Microarrays based on HPV status as a supervising variable resulted in a list of 91genes that were differentially expressed with statistical significance. Results for a subset of these genes were verified by real-time PCR. Genes highly expressed in HPV + samples included cell cycle regulators (p16 INK4A , p18, and CDC7) and transcription factors (TAF7L, RFC4, RPA2, andTFDP2).The microarray data were also investigated by mapping genes by chromosomal location (DIGMAP). A large number of genes on chromosome 3q24-qter had high levels of expression in HPV + tumors. Further investigation of differentially expressed genes may reveal the unique pathways in HPV + tumors that may explain the different natural history and biological properties of these tumors. These properties may be exploited as a target of novel therapeutic agents in HNSCC treatment.Head and neck cancer remains one of the most devastating cancers in the United States. Development of the vast majority of these tumors has been attributed to use of tobacco and ethanol products, but a significant portion of these tumors are associated with human papillomavirus (HPV; refs. 1, 2). Infection with HPV is associated with malignant and premalignant lesions of the uterine, cervix, vulva, penis, conjunctiva, and upper aerodigestive tract (for review, see ref.3). Over 100 subtypes of HPV have been described in humans, with HPV type 8, 11, 16, and 18 being associated with the majority of human disease. In the cervix, a distinction is made between ''low-risk'' (types 8 and 11) and ''high-risk'' (types 16 and 18) HPV, depending on their association with premalignant and malignant lesions, respectively. Reports of the prevalence of HPV infection in head and neck squamous cell carcinoma (HNSCC) indicate that 15% to 35% of HNSCC may harbor HPV sequences, depending on the detection method used (4). DNA amplification by PCR remains the most sensitive technique to detect HPV, with almost 35% of HNSCCs yielding HPV-specific amplification products, although this result may be biased because of contamination problems associated with PCR. HPV is most commonly found in tonsillar tumors (45-100%; ref. 5) with HPV type 16 (HPV16) being found in the vast majority and HPV18 associated with most others (6).There INK4A alterations are common (50% and ...

The present study demonstrated a relatively high rate of CR programme attendance. Special attention needs to be directed towards males who are older, PCI patients, smokers, unemployed or non-drivers, and females who are older or inactive.

BackgroundHead and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, and of the survivors only 48% return to work. Consequently the economic burden of oral cavity, oral pharyngeal, and salivary gland cancer (OC/OP/SG) must be understood. The cost of these cancers in the U.S. has not been investigated.MethodsA retrospective analysis of administrative claims data for 6,812 OC/OP/SG cancer patients was undertaken. Total annual health care spending for OC/OP/SG cancer patients was compared to similar patients without OC/OP/SG cancer using propensity score matching for enrollees in commercial insurance, Medicare, and Medicaid. Indirect costs, as measured by short term disability days were compared for employed patients.ResultsTotal annual health care spending for OC/OP/SG patients during the year after the index diagnosis was $79,151 for the Commercial population. Health care costs were higher for OC/OP/SG cancer patients with Commercial Insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303) and Medicaid ($44,541, n = 585) than the comparison group (all p < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees (p < 0.01). Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of cost of care, from $96,520 in the Medicare population to $153,892 in the Commercial population.ConclusionsIn the U.S., the cost of OC/OP/SG cancer is significant and may be the most costly cancer to treat in the U.S. The results of this analysis provide useful information to health care providers and decision makers in understanding the economic burden of head and neck cancer. Additionally, this cost information will greatly assist in determining the cost-effectiveness of new technologies and early detection systems. Earlier identification of cancers by patients and providers may potentially decrease health care costs, morbidity and mortality.

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