Background: In the era of deintensification, little data is available regarding patients' treatment preferences. This study evaluates treatment-related priorities, concerns and regret among head and neck squamous cell cancer (HNSCC) patients.Methods: Patients with HNSCC (n=150) ranked the importance of ten non-oncologic treatment goals, relative to the oncologic goals cure and survival. Level of concern regarding 11 issues and decision regret was recorded. Median rank was reported overall, and factors associated with odds of rank as a top three priority were modeled using logistic regression.Results: Among the treatment effects analyzed, odds of being a top three priority was especially high for cure (odds 9.17, 95% CI 5.05-16.63), followed by survival and swallow (1.26, 95% CI 0.88-1.80 and 0.85, 95% CI 0.59-1.21, respectively). Prioritization of cure, survival and swallow was similar by human papillomavirus (HPV) tumor status. By increasing decade of age, older participants were significantly less likely than younger to prioritize survival (odds ratio, 0.72; 95%CI, 0.52-1.00). Concern regarding mortality (p=0.04

BACKGROUND: Case-control studies from the early 2000s demonstrated that human papillomavirus-related oropharyngeal cancer (HPV-OPC) is a distinct entity associated with number of oral sex partners. Using contemporary data, we investigated novel risk factors (sexual debut behaviors, exposure intensity, and relationship dynamics) and serological markers on odds of HPV-OPC. METHODS: HPV-OPC patients and frequency-matched controls were enrolled in a multicenter study from 2013 to 2018. Participants completed a behavioral survey. Characteristics were compared using a chi-square test for categorical variables and a t test for continuous variables. Adjusted odds ratios (aOR) were calculated using logistic regression. RESULTS: A total of 163 HPV-OPC patients and 345 controls were included. Lifetime number of oral sex partners was associated with significantly increased odds of HPV-OPC (>10 partners: odds ratio [OR], 4.3 [95% CI, 2.8-6.7]). After adjustment for number of oral sex partners and smoking, younger age at first oral sex (<18 vs >20 years: aOR, 1.8 [95% CI, 1.1-3.2]) and oral sex intensity (>5 sex-years: aOR, 2.8 [95% CI, 1.1-7.5]) remained associated with significantly increased odds of HPV-OPC. Type of sexual partner such as older partners when a case was younger (OR, 1.7 [95% CI, 1.1-2.6]) or having a partner who had extramarital sex (OR, 1.6 [95% CI, 1.1-2.4]) was associated with HPV-OPC. Seropositivity for antibodies to HPV16 E6 (OR, 286 [95% CI, 122-670]) and any HPV16 E protein (E1, E2, E6, E7; OR, 163 [95% CI, 70-378]) was associated with increased odds of HPV-OPC. CONCLUSION: Number of oral sex partners remains a strong risk factor for HPV-OPC; however, timing and intensity of oral sex are novel independent risk factors. These behaviors suggest additional nuances of how and why some individuals develop HPV-OPC.

Performance of commercially available human papillomavirus (HPV) assays (approved for cervical HPV detection) is unknown for detecting HPV-related oropharyngeal cancer (HPV-OPC). Assays for detection of HPV DNA [ELISA (DEIA) and Cobas], and RNA (Aptima) in oral rinse samples, and serum HPV oncogene antibodies were evaluated. Sensitivity and specificity of each test was explored among HPV-OPC cases and controls. Biomarker prevalence was evaluated among 294 "at-risk" people (screening) and 133 "high-risk" people [known to previously have oral oncogenic HPV (oncHPV) DNA and/or HPV16 E6/E7 antibodies detected]. HPV16 E6 antibodies had the best overall test performance with sensitivity of 88%, compared with oral HPV16 DNA sensitivity of 51% by DEIA and 43% by Cobas (each P < 0.001). Specificity was comparable in each of these tests (!98%). When positivity for any oncHPV type was compared with HPV16 for the same test, sensitivity was comparable (60% vs. 51%, 40% vs. 43%, and 92% vs. 88% for DEIA, Cobas, and E6 antibodies, respectively), but specificity was reduced (93%-97%). Aptima had poor sensitivity (23%). Sensitivity decreased when cotesting HPV16 oral rinse DNA and E6 antibodies (37%-48%), or multiple E antibodies (69%-72%). HPV16 DNA were detected in $2% of the at-risk by either DEIA or Cobas and up to 15% of the high-risk population. HPV16 E6 seroprevalence was 2.3% and 2.4% in the at-risk and high-risk populations, respectively. Oral rinse HPV testing had moderate-to-poor sensitivity for HPV-OPC, suggesting many true positives would be missed in a potential screening scenario. HPV16 E6 serum antibody was the most promising biomarker evaluated.

Background HPV-related oropharyngeal cancer (HPV-OPC) incidence is increasing but the natural history of the precursor, oral HPV, has not been well described. Methods This observational cohort study of people living with HIV and at-risk HIV uninfected people evaluated participants semi-annually using 30-second oral rinse/gargle specimens over 7 years. Initially, 447 subjects were followed for four years as part of the POPS Study, and a subset of 128 showing persistent infections at the last POPS visit had an additional visit, as part of MOUTH Study, on average 2.5 years later. Extracted DNA from oral rinse/gargle specimens were amplified using PCR and type-specification of 13 oncogenic HPV types. Risk factors for oncogenic oral HPV clearance were evaluated using Cox models. Results The majority of oncogenic oral HPV infections cleared quickly with median time to clearance of 1.4 years [IQR=0.5-3.9]. After 7 years of follow-up, 97% of incident and 71% of prevalent infections had cleared. Lower HPV16 viral load was statistically significantly associated with clearance (Per 10-fold decrease in copy number: adjusted hazard ratio [HR]=2.51, 95% confidence interval [CI]=1.20-5.26, p=.01) Adjusted analyses showed oncogenic oral HPV clearance was lower among prevalent than incident detected infections (aHR=0.44, 95%CI=0.35-0.55), among men than women (aHR=0.74, 95%CI=0.60-0.91), for older participants (aHR per 10 years increasing age=0.81, 95%CI=0.74-0.89), and among people living with HIV (aHR=0.76, 95% CI = 0.60-0.95). One participant who had oral HPV16 consistently detected at 10 study visits over 4.5 years was subsequently diagnosed with HPV-OPC. Conclusions This prospective study of oncogenic oral HPV infection is the longest and largest quantification of oral HPV16 infections to date.