A Patient-Centered Approach to Counseling Patients With Head and Neck Cancer Undergoing Human Papillomavirus Testing: A Clinician's Guide

Abstract

Institute have acknowledged human papillomavirus (HPV)-16 as an independent risk factor for oropharyngeal cancer (OPC). HPV-positive oropharyngeal cancer (HPVOPC) is a sexually transmitted entity that is on the rise; within the next 10 years, the annual number of HPV-associated OPC cases is projected to exceed the annual number of cervical cancer cases in the United States. Recognition of HPV status in OPC has broad implications beyond the traditional oncological concerns of timely diagnosis, accurate staging, and appropriate treatment of cancer patients. The National Comprehensive Cancer Network recommends testing the tumor site for HPV-status during OPC management; it is likely this will become a standard component of care for patients with high-probability tumors of the oropharynx.As the practice of HPV testing becomes more common, it behooves providers to be able to adequately address the concerns of patients with HPVOPC. Although there are currently few relevant studies focusing on this population, existing literature on HPV-infected women and patients with cervical cancer strongly supports the concept that patients with HPVOPC need education to optimally address concerns such as selfblame, guilt, intimacy, and interpersonal relationships. When HPV testing is done, it should be accompanied by evidencedriven and patient-centered counseling to best minimize negative psychosocial outcomes and ensure optimum health promotion. Based on the current state of the literature, this article is intended to be a reference for physicians to effectively manage psychosocial outcomes when diagnosing patients with HPV-associated OPC. The Oncologist 2013;18:180 -189 Implications for Practice: HPV testing for individuals with high-probability tumors of the tonsil and base of tongue is an emerging standard of care. This article provides physicians with guidelines on how to provide optimal patient-centered counseling for individuals receiving the concurrent diagnoses of a sexually transmitted cancer, with the understanding that with HPV testing brings the responsibility for physicians to provide education, address patient concerns in an evidence-driven manner, screen for emotional distress, and make referrals to psychosocial care when needed.

Survivorship Challenges and Information Needs after Radiotherapy for Oral Cancer

“…Given that increased symptom burden is associated with more cancer-related worry [33], OC survivors may have been anxious because side effects were not resolving as fast as expected. Their anxiety may have also been due to OC-specific challenges such as uncertainty surrounding transmission of the human papilloma virus (HPV) and the increased risk of recurrence for OC relative to other cancers [34, 35]. Future studies should determine the prevalence and causes of fear of recurrence in an effort to design psychosocial interventions to alleviate anxiety in this population.…”

Detection of human papillomavirus and expression of osteopontin in cervical cancer specimens

“…Furthermore, HPV-associated cervical cancer exhibits a trend of onset in a younger age-group than other types of cancer (14). Cervical cancer poses a significant threat to the lives of females, in part because there is no accurate detection index available for predicting the occurrence and progression of the disease (15). It has been generally accepted that persistent HrHPV infection is a significant contributing factor in the development of cervical cancer; the degree of its correlation with the occurrence of cervical cancer is markedly higher than the degree of correlation between smoking and the occurrence of lung cancer (16) .…”

Counseling the Patient with Potentially HPV-Related Newly Diagnosed Head and Neck Cancer

“…While little literature addresses the need for counseling directly in the subset of patients with HPV-HNC, we may consider relevant examples from similarly affected populations (reviewed comprehensively in [68]). In patients with HPV-unrelated HNC, disease-related anxiety and emotional distress are both common and known to negatively affect quality of life [69, 70].…”