Lauren M. Cass

Dynamic vs. fixed bag filling: Impact on cardiac output rebreathing protocol

The purpose of this study was to compare the repeatability (2.77 multiplied by the within-subject SD)between two different rebreathing protocols on cardiac output ( ˙Q ), pulmonary diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO), and pulmonary capillary blood volume (Vc). This study compared two bag volume protocols [Fixed Bag Volume (FBV) = bag volume fixed at 60% of forced vital capacity; Dynamic Bag Volume (DBV) = bag volume matched to tidal volume at each stage of exercise].Ten females (age = 27±8 yrs; ˙VO2, (peak)=2.5±0.6 L/min had measurements at rest (12%), 52%, 88%, and 100% of ˙VO2, (peak) on two study days. Neither the slope nor intercept of ˙Q vs. ˙VO2 were different between either bag volume protocols. The slope of DLCO vs. ˙Q was the same but the intercept was higher for the FBV protocol. The bag volume affected the slope and the intercept between DLNO vs. ˙Q (p < 0.05).The mean repeatability was similar between both protocols for ˙Q (2.0 vs. 2.3 L/min) and DLCO (3.8 vs.5.9 mL/min/mmHg), regardless of exercise intensity. Increasing exercise intensity made the measurement error worse for Vc and DLNO (p ≤ 0.06). Measurement error was lower for Vc when using the FBV protocol (p = 0.02). Also, the pattern of bag volume used during rebreathing maneuvers affected the relation between DLNO vs. ˙Q more than it affected DLCO vs. ˙Q , or Vc vs. ˙Q. Additionally, the FBV protocol provided less measurement error for Vc compared to the DBV protocol [corrected].

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.

Oncologic and functional outcomes of pretreatment tracheotomy in advanced laryngeal squamous cell carcinoma: A multi-institutional analysis

OBJECTIVES Describe the influence of pretreatment tracheotomy and treatment modality (surgical versus non-surgical) on oncologic and functional outcomes. MATERIALS AND METHODS Retrospective study of previously untreated advanced-stage laryngeal squamous cell carcinoma patients at two academic tertiary care institutions from 1995 to 2014. RESULTS Primary outcomes evaluated were disease-free survival, disease-specific survival, and overall survival of pretreatment tracheotomy versus no pretreatment tracheotomy cohorts. Functional status, measured by tracheotomy decannulation and gastrostomy tube placement/removal, was assessed. Of the 226 patients, 31.4% underwent pretreatment tracheotomy. Five-year disease-specific survival was 72.9%, and overall survival was 48.8% for entire cohort. There was a statistically significant decrease in overall survival (p = .03) and disease-free survival (p = .02) for the pretreatment tracheotomy group compared to no pretreatment tracheotomy, which was largely explained by primary tumor stage. Pretreatment tracheotomy was associated with gastrostomy tube placement and was an independent predictor of worse odds of gastrostomy tube removal. Disease stage, distant metastasis, and age independently conferred worse odds of gastrostomy tube removal. CONCLUSION Patients undergoing pretreatment tracheotomy for primary T4 laryngeal cancer had decreased overall survival compared to patients without pretreatment tracheotomy. There was no difference in local recurrence rates based on tracheotomy status. Organ preservation with chemotherapy and radiation did not result in better functional outcomes than surgery in the pretreatment tracheotomy group as nearly half of patients treated with organ preservation remained tracheotomy dependent. Based on this data, pretreatment tracheotomy may impact oncologic and functional outcomes in advanced disease, and it should be a consideration in an informed decision-making process.

Demographic predictors of head and neck cancer survival differ in the elderly: HNSCC Survival Predictors in the Elderly

Head and neck squamous cell carcinoma (HNSCC) prognosis strongly correlates with demographic factors. This study aimed to determine whether demographic predictors of HNSCC survival differ between age cohorts, with an emphasis on the growing elderly demographic.

Abstract A87: Which head and neck cancer patient benefits from being married: The man or the woman?

Introduction: Among the known nonclinical prognostic factors for head and neck squamous cell carcinoma (HNSCC) survivorship, there has been recent focus on the potential benefits of being married. Several studies have shown that marriage confers a survival advantage for HNSCC patients. However, anecdotal evidence suggests that there may be marked differences in this survival benefit based on the sex of the patient. To date, no study has described how sex differences influence head and neck cancer survivorship based on marital status. Our study aimed to determine whether marital status at diagnosis impacts survivorship of HNSCC differently based on sex. Methods: In this retrospective study, we utilized a patient cohort of 27,208 confirmed HNSCC cases from the Surveillance, Epidemiology, and End Results (SEER) 18 database (2004–2014) who received chemotherapy and radiotherapy. Actuarial survival curves stratified by marital status at diagnosis (married/partnered, never married, divorced/separated, widowed) indicated cancer-specific survival from HNSCC. Survival differences between marital status groups were first assessed by log-rank tests with Bonferroni adjustments. Second, patients9 demographic and clinical characteristics including sex, marital status, race/ethnicity, insurance status, HNSCC site, stage, age at diagnosis, year of diagnosis, and county-level poverty were utilized in Fine and Gray competing risk proportional hazard models to examine the potential interaction between sex and marital status and estimate adjusted hazard ratios (aHR) for death from HNSCC. Results: The cohort was mostly men (80.8%) and married/partnered (56.5%). Married/partnered patients had the best survival of any marital status group (log-rank and Bonferroni p Conclusions: Our study has shown for the first time in the head and neck cancer literature that while being married confers survival benefits in general, married men with HNSCC may benefit more than women. Unmarried men seemed to fare the worst compared with every marital status for both men and women. More research is needed to understand this differential marital status benefit based on sex. Additionally, efforts should focus on developing analogous support systems for men and women who are head and neck cancer patients that could improve their survival, especially unmarried men and widowed men and women. Citation Format: Nosayaba Osazuwa-Peters, Matthew C. Simpson, Lauren M. Cass, Sai Deepika Challapalli, Zisansha S. Zahirsha, Eric Adjei Boakye, Sean T. Massa. Which head and neck cancer patient benefits from being married: The man or the woman? [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A87.

Abstract C54: Survival outcomes for head and neck patients with Medicaid: A health insurance paradox

Introduction: Although there are currently more than 430,000 head and neck cancer (HNC) survivors in the United States, it is accepted that many more patients would have survived longer if they presented at an earlier stage. Less than half of all head and neck cancer patients present with early-stage disease. One of the factors implicated in late stage of presentation for head and neck cancer patients is access to care, driven by health insurance status. While individuals with health insurance are known to present earlier, less is known about outcome differences for patients who are uninsured or who have Medicaid insurance. We have observed many head and neck cancer patients initially present without insurance despite qualifying for Medicaid, and so are assisted with obtaining insurance before discharge. This process blurs the line between uninsured and Medicaid patients. The aim of this study was to determine whether there are disparities in survival outcomes for HNC patients based on whether they are insured, uninsured, or have Medicaid insurance. Methods: A cohort of 49,524 patients aged 18-64 years with first primary HNC from the Surveillance, Epidemiology, and End Results (SEER) 18 database diagnosed from 2007-2014 was included. Actuarial survival curves stratified by insurance status (insured, Medicaid, and uninsured) were created to determine HNC-specific survival differences between the groups with a log-rank test. Patient characteristics including insurance, race/ethnicity, sex, county-level poverty, surgery, marital status, tumor site, stage, year of diagnosis, and age at diagnosis were utilized in a Fine and Gray competing risk proportional hazard model to compute adjusted hazard ratios (aHR) for cause-specific death from HNC. Multinomial logistic regression was also performed to determine characteristics of patients with each type of insurance by adjusted odds ratios (aOR). Results: The cohort was mostly male (75.6%) and insured (73.6%), with 18.6% on Medicaid and 7.8% uninsured. At the end of the 7-year follow-up period, HNC-specific survival rate was significantly lower for patients on Medicaid (49.5%) than uninsured (54.8%) and insured patients (74.2%) (log-rank p Conclusion: While patients with health insurance had better survival outcome in general, our study showed that patients with Medicaid did not have a better survival outcome than those without any insurance after adjusting for all other prognostic factors, including stage of presentation and treatment modality. Medicaid patients, in fact, had worse outcome than uninsured HNC patients. It could be that despite having insurance, Medicaid patients did not have adequate access to care and thus had delayed presentations. Our findings highlight the need to bridge the health insurance gap for HNC patients to increase survivorship. Citation Format: Nosayaba Osazuwa-Peters, Matthew C. Simpson, Sean T. Massa, Eric Adjei Boakye, Lauren M. Cass, Sai Deepika Challapalli, Rebecca L. Rohde, Mark A. Varvares. Survival outcomes for head and neck patients with Medicaid: A health insurance paradox [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C54.

Abstract 3472: Does being married independently predict survival in patients with head and neck cancer? Results from a single institution

Purpose/Objectives An important factor in cancer survivorship is social support, often coming from a spouse. There is an emerging literature on the role of spousal support in head and neck cancer (HNC) outcomes; however most are based on results from national databases. While more generalizable, these studies may not always capture the unique variation in different patient populations. This single institution study aimed to describe the association between marital status and outcomes of HNC; and to determine if marital status independently predicts survival in a local patient population. Materials/Methods We identified 460 patients aged 20 to 91 (59.31 ± 11.42) years diagnosed with squamous cell carcinoma of the head and neck at an academic tertiary referral center between 1997 and 2012 in this retrospective cohort study. Cox proportional hazards model assessed the effect of marital status on survival. Results are based on the final model constructed after accounting for covariates in the data. Results Our study population was made up of 73% males, and 82.2% Whites. We found an association between marital status and HNC survival. Unmarried HNC patients had a 66% increase in the hazard of death compared to married HNC patients (HR = 1.66, 95% CI = 1.23 - 2.23). This was after controlling for covariates, which included sociodemographic variables (age, race, sex, and health insurance status), social habits (tobacco and alcohol), primary anatomical subsite (oral cavity, oropharyngeal, laryngeal, and others), stage at presentation (early vs. late stage), and treatment modality (surgery, surgery with adjuvant therapies, other single modality therapy, and palliative care). Other factors found to be associated with an increased hazard of death were age (≥ 50 years), current tobacco use, late stage of presentation, palliative care, and laryngeal subsite. Conclusion Marital status is associated with head and neck cancer outcomes, and being married is an independent predictor of survival among patients. This result, found in previous national studies, held true in our local patient population. This underscores the need for the multidisciplinary HNC team to recognize this aspect of survivorship and to emphasize the need for social support among unmarried HNC patients. It could be that it is necessary to add social support to the clinical practical guidelines for managing head and neck cancer beyond palliative care. Citation Format: Nosayaba Osazuwa-Peters, Kara M. Christopher, Sean T. Massa, Lauren Cass, Ronald J. Walker, Mark A. Varvares. Does being married independently predict survival in patients with head and neck cancer? Results from a single institution. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3472.