Kara M. Christopher

Surgical margins and primary site resection in achieving local control in oral cancer resections

Evaluate effectiveness of resection of oral cavity cancer with a standardized approach for margin evaluation. Primary end points were local control and survival.

Using dissemination research to identify optimal community settings for tailored breast cancer information kiosks.

OBJECTIVE Selecting appropriate community channels or settings for delivering evidence-based health promotion programs can be critical to successful dissemination. This article describes how five criteria--accessibility, opportunity, appropriateness, reach, and specificity--were applied in identifying and comparing seven community settings as host sites for a tailored breast cancer education computer kiosk for African American women. METHODS Data were gathered from 10,306 kiosk uses in 92 beauty salons, churches, neighborhood health centers, laundromats, social service agencies, health fairs, and public libraries between June 2003 and March 2007. FINDINGS Of the seven settings, only laundromats were found to provide both high reach (ie, frequent kiosk use) and high specificity (ie, a large proportion of users with no health insurance, unaware of where to get a mammogram, reporting no recent mammogram and barriers to getting one, and having little knowledge about breast cancer and mammography). CONCLUSIONS Systematic, data-based evaluations of potential dissemination channels can help identify optimal settings for cancer control interventions.

Competing causes of death in the head and neck cancer population.

PURPOSE/OBJECTIVES The increasing survivorship of head and neck squamous cell carcinoma (HNSCC) comes with a risk of death from other causes, known as competing causes. The demographics of HNSCC are also evolving with increasing incidence of Human Papillomavirus (HPV) associated tumors. This study describes competing causes of death for the HNSCC population compared to the general population and identifies associated risk factors. METHODS Adult patients with first mucosal HNSCC (2004-2011) were identified from the Surveillance, Epidemiology and End Result database. Competing causes of death were compared to reference populations using proportion of deaths and Standardized Mortality Ratios (SMR). A multivariable competing risk survival analysis yielded subdistribution hazard ratios (HR) for competing mortality. RESULTS Of 64,598 HNSCC patients, 24,602 (38.1%) were deceased including 7142 deaths (29.0%) from competing causes. The most common were cardiovascular disease, lung cancer, and other cancers. All relative mortality rates were elevated, especially liver disease (SMR 38.7; 95% CI: 29.4-49.3), suicide (SMR 37.1; 95% CI: 26.1-48.6), and subsequent primary cancers (SMR 7.5; 95% CI: 6.78-8.32). Demographic and tumor factors independently increased risk of competing mortality, including age (HR per 5years 1.24; 95% CI: 1.22-1.25), sex (male HR 1.23; 95% CI: 1.16-1.32), race (Black HR 1.17; 95% CI: 1.09-1.26), insurance (uninsured HR 1.28; 95% CI: 1.09-1.50), and marital status (single HR 1.29; 95% CI: 1.21-1.37). CONCLUSION Nearly one in three HNSCC patients died from competing causes. When developing long term survivorship regimens for HNSCC patients, clinicians should be familiar with this populations specific risks.

The Neighborhood Voice: evaluating a mobile research vehicle for recruiting African Americans to participate in cancer control studies.

The Neighborhood Voice is a vehicle customized for conducting health research in community settings. It brings research studies into neighborhoods affected most by health disparities and reaches groups often underrepresented in research samples. This paper reports on the experience and satisfaction of 599 African American women who participated in research on board the Neighborhood Voice. Using bivariate, psychometric, and logistic regression analyses, we examined responses to a brief post-research survey. Most women (71%) reported that they had never previously participated in research, and two-thirds (68%) rated their Neighborhood Voice experience as excellent. Satisfaction scores were highest among first-time research participants (p < .05). Women’s ratings of the Neighborhood Voice on Comfort (OR = 4.9; 95% CI = 3.0, 7.9) and Convenience (OR = 1.8; 95% CI = 1.2, 2.9) significantly predicted having an excellent experience. Mobile research facilities may increase participation among disadvantaged and minority populations. Our brief survey instrument is a model for evaluating such outreach.

Predictors of stage at presentation and outcomes of head and neck cancers in a university hospital setting.

To increase early detection of head and neck cancers, it is important that disparities associated with access to care are addressed.

Product comparison model in otolaryngology: Equivalency analysis of absorbable hemostatic agents after endoscopic sinus surgery

Evidence‐based medicine in otolaryngology literature continues to be lacking, especially with regard to new products brought to market. The marketing of products often includes statements of benefit that have limited objective support in research or literature. To address this, and to adequately determine product equivalency/superiority, careful evaluation must be made. In order to establish standards for this process in rhinology products, we directly compare three different absorbable hemostatic agents in patients with chronic rhinosinusitis (CRS) after undergoing endoscopic sinus surgery (ESS), using both objective and subjective outcomes.

Societal and physician perspectives on sinonasal diagnosis and treatment.

Background Sinusitis is diagnosed in 31 million individuals annually and has a significant impact on health care expenditures. Otolaryngologists understand that patient expectations, health knowledge, and the use of therapeutic options by patients and primary care physicians (PCPs) vary greatly. The intent of this study was to elucidate differences in the perspectives of patients, PCPs and otolaryngologists regarding the diagnosis and treatment of sinonasal disease. Methods Three surveys were developed with questions targeting sinonasal infections: specifically, prevalence, diagnosis, physician prescribing patterns, treatment alternatives, and referral patterns to tertiary level physicians. Surveys were distributed to adult patients (n = 113) at general health fairs, whereas surveys for PCPs (n = 54) and otolaryngologists (n = 40) were obtained from teaching conferences and professional networking events. Results In a description of viral upper respiratory tract infections (URIs), 43% of patients attributed symptoms to allergic rhinitis, 28% to URIs, and 28% to sinus infections. Despite this, 37% of patients still expected anti-bacterial agents. In patients with acute rhinosinusitis (ARS), 44% of patients would wait <1 week to see a physician whereas 82% of otolaryngologists and 57% of PCPs felt waiting 1 week or more was appropriate. In an ambulatory care setting, 45% of PCPs would chose to treat patients with 5 days of ARS symptoms whereas 32% of otolaryngologists would treat patients (p = .22). For ARS, 70% of patients expected antibiotics. Seventy percent of PCPs stated that they would refer a patient to an otolaryngologist after a single episode of sinusitis. Conclusion Patients with sinonasal symptoms confuse URIs for sinusitis and expect unnecessary treatment with antibiotics. PCPs and otolaryngologists vary regarding indications for presentation to a physician, approaches to therapy, and indications for referral to a tertiary provider in their respective practices.

Efficacy of bone marrow cytologic evaluations in detecting occult cancellous invasion

Determine the accuracy of bone marrow cytologic evaluations in detecting occult cancellous invasion by squamous cell carcinomas (SCCa) beyond the original margins of bone resection that would have gone undetected without the use of intraoperative bone‐marrow margin analysis.

Impact of treatment modality on quality of life of head and neck cancer patients: Findings from an academic medical institution

PURPOSE The objective of this pilot study was to determine how different treatment modalities (surgery, radiation, and chemotherapy) impact quality of life (QOL) in a population of head and neck cancer (HNC) survivors. METHODS Fifty-nine newly diagnosed, biopsy-confirmed HNC patients were recruited between 2007-2012. They completed the EORTC Quality of Life Questionnaire and Head & Neck Module at 5 intervals pre- and post-treatment. Participants were grouped into four categories based on modality: surgery only, surgery/radiation, chemoradiation, or surgery/chemoradiation. Repeated measures ANOVA examined effect of treatment modality on QOL over time. RESULTS Xerostomia symptoms were significantly associated with chemoradiation (F(2.47, 59.27)=3.57, p=0.03), lowest at pretreatment and highest 6 months post-treatment. Time was significantly associated with head and neck pain, F(2.95,67.89)=3.39, p=0.02. CONCLUSIONS HNC survivors exhibit different QOL related symptoms depending on combined treatment modalities, and time post-treatment. It is important to understand QOL differences based upon treatment modalities when developing treatment plans for HNC patients.

Decreased cancer‐independent life expectancy in the head and neck cancer population

Aside from cancer mortality, patients with head and neck cancer have increased mortality risk. Identifying patients with the greatest loss of cancer‐independent life expectancy can guide comprehensive survivorship programs.