Oropharyngeal squamous cell carcinoma in the veteran population: Association with traditional carcinogen exposure and poor clinical outcomes

Sandulache, Vlad C.; Hamblin, John; Lai, Syeling; Pezzi, Todd A.; Skinner, Heath D.; Khan, Numan; Dioun, Shayan; Hartman, Christine M.; Kramer, Jennifer R.; Chiao, Elizabeth Y.; Zhou, Xiaodong; Zevallos, José P.

doi:10.1002/hed.23740

Cited by 44 publications

(102 citation statements)

References 22 publications

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“…Most patients underwent radiation based treatment, consistent with national trends (Table ) . Chemotherapy was added to radiation in the definitive setting in 152 of 262 patients and in the adjuvant setting in 13 of 55 patients.…”

Section: Resultsmentioning

confidence: 55%

“…Our previous publications detail compliance with NCCN guidelines as it relates to treatment selection . A majority of patients underwent external beam radiotherapy (EBRT) in the primary or adjuvant setting (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…The US Veterans Affairs medical system provides a vertically and horizontally integrated medical system that services a large, diverse patient population across the entire geographical landscape of the United States. As such, it provides a unique opportunity to study, and potentially improve, care delivery patterns for patients with HNSCC, particularly in an understudied patient population . To our knowledge, this is the largest single institution veteran cohort to undergo this type of analysis in the modern era.…”

Section: Discussionmentioning

confidence: 99%

“…It is well established by our group and others that incomplete treatment for HNSCC is associated with poor oncologic outcomes . Patients who experienced treatment breaks or missed radiation sessions were included in the analysis, since this is an unwanted but realistic feature of HNSCC treatment in the non‐clinical trial setting .…”

Section: Methodsmentioning

confidence: 99%

“…We recently published oncologic outcomes for patients with laryngeal and oropharyngeal squamous cell carcinoma (SCC) treated at one of the largest VHA cancer centers in the country . Our results demonstrate that outcomes for veterans with laryngeal and oropharyngeal SCC are comparable to published series from other tertiary centers and prospective clinical trials . Here we sought to evaluate treatment patterns associated with multi‐disciplinary treatment delivery for laryngeal and oropharyngeal cancer.…”

Section: Introductionmentioning

confidence: 99%

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Treatment Patterns in Veterans with Laryngeal and Oropharyngeal Cancer and Impact on Survival

Richardson

Kansara

Chen

et al. 2018

Laryngoscope Investig Oto

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ObjectivesVeterans with laryngeal and oropharyngeal cancer remain an understudied patient population despite a high incidence of disease and decreased survival compared to the general population. Our objective was to evaluate treatment patterns for laryngeal and oropharyngeal cancer in patients treated at one of the Veterans Health Administration's busiest cancer centers in order to generate some basic benchmarks for treatment delivery in the veteran population.MethodsWe reviewed 338 patients treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2000 and 2012.ResultsOropharyngeal site and advanced age were associated with worse overall and disease‐free survival. Treatment periods (mean) were as follows: 1) referral‐diagnosis, 26 days; 2) diagnosis‐surgery, 29 days; and 3) diagnosis‐radiation, 58 days. Adjuvant radiation was initiated within 6 weeks of surgery in 42% of patients and 68% of patients had a total treatment package time ≤100 days. Time from diagnosis to treatment initiation, surgery to adjuvant radiation interval and total treatment package time did not impact survival.ConclusionsThis study establishes basic benchmarks for laryngeal and oropharyngeal cancer treatment delivery in veterans. Additional efforts are warranted to improve consistency and provide treatment in line with NCCN recommendations and literature consensus.Level of Evidence2b

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Section: Resultsmentioning

confidence: 55%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment Patterns in Veterans with Laryngeal and Oropharyngeal Cancer and Impact on Survival

Richardson

Kansara

Chen

et al. 2018

Laryngoscope Investig Oto

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Risk of Cardiovascular Events Among Patients With Head and Neck Cancer

Sun

Brody

Candelieri

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceCardiovascular (CV) disease is a substantial cause of morbidity and mortality in cancer due to shared risk factors and exposure to potentially cardiotoxic cancer therapy. However, our understanding of CV risk in patients with head and neck squamous cell carcinoma (HNSCC) is limited.ObjectiveTo define CV risk profiles, incident stroke, myocardial infarction (MI), and mortality in patients with HNSCC.Design, Setting, ParticipantsThis retrospective, population-based cohort study included 35 897 US veterans with newly diagnosed HNSCC from January 1, 2000, to December 31, 2020. Data were analyzed from May 2022 to January 2023.ExposuresDemographic, cancer-specific, and treatment characteristicsMain OutcomesPrevalence of CV risk factors, medication use, and control at HNSCC diagnosis; cumulative incidence of stroke and MI; and all-cause death.ResultsOf 35 857 US veterans with HNSCC (median [IQR] age, 63 [58-69] years; 176 [0.5%] American Indian or Alaska Native, 57 [0.2%] Asian, 5321 [16.6%] Black, 207 [0.6%] Native Hawaiian or Other Pacific Islander, and 26 277 [82.0%] White individuals), there were high rates of former or current smoking (16 341 [83%]), hypertension (24 023 [67%]), diabetes (7988 [22%]), and hyperlipidemia (18 421 [51%]). Although most patients were taking risk-lowering medications, 15 941 (47%) had at least 1 uncontrolled CV risk factor. Black race was associated with increased risk of having uncontrolled CV risk factor(s) (relative risk, 1.06; 95% CI, 1.03-1.09), and patients with larynx cancer had higher rates of prevalent and uncontrolled risk factors compared with other cancer subsites. Considering death as a competing risk, the 10-year cumulative incidence of stroke and MI was 12.5% and 8.3%, respectively. In cause-specific hazards models, hypertension, diabetes, carotid artery stenosis, coronary artery disease, and presence of uncontrolled CV risk factor(s) were significantly associated with stroke and MI. In extended Cox models, incident stroke and MI were associated with a 47% (95% CI, 41%-54%) and 71% (95% CI, 63%-81%) increased risk of all-cause death, respectively.ConclusionThe results of this cohort study suggest that in HNSCC, the burden of suboptimally controlled CV risk factors and incident risk of stroke and MI are substantial. Modifiable CV risk factors are associated with risk of adverse CV events, and these events are associated with a higher risk of death. These findings identify populations at risk and potentially underscore the importance of modifiable CV risk factor control and motivate strategies to reduce CV risk in HNSCC survivorship care.

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Association of race and health care system with disease stage and survival in veterans with larynx cancer

Voora

Kotha

Kumar

et al. 2021

Cancer

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Background Black patients with laryngeal squamous cell carcinoma (LSCC) historically have inferior outcomes in comparison with White patients. The authors investigated these racial disparities within the Veterans Health Administration (VHA), an equal‐access system, and within the Surveillance, Epidemiology, and End Results (SEER) program, which is representative of the US hybrid‐payer system. Methods Patients with invasive (T1 or greater) LSCC were included from SEER (2004‐2015) and the VHA (2000‐2017). The primary outcomes of overall survival (OS) and larynx cancer–specific survival (LCS) were evaluated in Cox and Fine‐Gray models. Results In the SEER cohort (7122 patients: 82.6% White and 17.4% Black), Black patients were more likely to present with advanced disease and had inferior OS (hazard ratio [HR], 1.37; 95% CI, 1.26‐1.50; P < .0001) in a multivariable analysis. Black LCS was worse in a univariable analysis (HR, 1.42; 95% CI, 1.27‐1.58; P < .0001), but this effect was attenuated by 83% when the authors controlled for the TNM category and was found to be insignificant in a multivariable analysis (HR, 1.05; 95% CI, 0.93‐1.18; P = .42). In the VHA cohort (9248 patients: 79.7% White and 20.3% Black), the 2 racial cohorts presented with similar tumor characteristics and similar OS (HR, 0.95; 95% CI, 0.89‐1.02; P = .14). Black LCS was similar in univariable (HR, 1.10; 95% CI, 1.00‐1.22; P = .05) and multivariable analyses (HR, 1.02; 95% CI, 0.92‐1.14; P = .67). Conclusions Black patients with LSCC had a tumor burden at diagnosis and survival outcomes comparable to those of White patients within the VHA; this was counter to what was observed in the SEER analysis and prior national trends. This study's findings point toward the notable role of health care access in contributing to racial health disparities in the realm of larynx cancer.

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Oropharyngeal squamous cell carcinoma in the veteran population: Association with traditional carcinogen exposure and poor clinical outcomes

Cited by 44 publications

References 22 publications

Treatment Patterns in Veterans with Laryngeal and Oropharyngeal Cancer and Impact on Survival

Treatment Patterns in Veterans with Laryngeal and Oropharyngeal Cancer and Impact on Survival

Risk of Cardiovascular Events Among Patients With Head and Neck Cancer

Association of race and health care system with disease stage and survival in veterans with larynx cancer

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