Matthew C. Simpson

40-year incidence trends for oropharyngeal squamous cell carcinoma in the United States

OBJECTIVES To determine differences in oropharyngeal squamous cell carcinoma (OPSCC) incidence between 1975 and 2014 stratified by race, sex, and age. MATERIALS AND METHODS We obtained age-adjusted OPSCC incidence rates for race and sex groups from 1975 to 2014 using the Surveillance, Epidemiology, and End Results 9 database. We defined OPSCC as cancers of the base of tongue, lingual/palatine tonsil, oropharynx, soft palate, uvula, and Waldeyers ring. We used Joinpoint analyses to determine incidence trends for race/sex/age groupings. RESULTS There were 38,624 oropharyngeal primary tumors in the analyses. Males accounted for 74% of sample population, and whites accounted for 84% of tumors. Overall, there was a 57.3% increase in incidence of oropharyngeal between 1975 and 2014. For blacks and whites, average incidence was lower for females than males. Rates for black males aged ≥50years was highest for most of the follow-up time but decreased sharply around 1988 and were surpassed by the significant increase in incidence in white males aged 50-59 (1995-2014 APC=4.07, p<0.001) and ≥60years (2002-2014 APC=4.25, p<0.001). For males aged ≥60, whites had higher rates than blacks starting in 2010. OPSCC incidence in White males (10.99 per 100,000 person-years) surpassed rates in Blacks (10.14 per 100,000 person-years) beginning in 2008. CONCLUSION OPSCC has significantly increased in the United States in the last 40 years. This overall increase in OPSCC can primarily be attributed to white males. OPSCC prevention and early detection efforts could target these demographic factors to decrease rising OPSCC incidence.

Primary Cancer vs Competing Causes of Death in Survivors of Head and Neck Cancer

that by releasing panelists’ names they would be subject to lobbying by numerous entities. This proposed legislation and the California Association of Health Plans’ response highlight the concern and complexity around OCP transparency. Collaboration with industry is key to innovation; however, to ensure patient and clinician trust and maintain their momentum in the value space, pathway developers will need to be transparent about FCOI and how those interests are managed. Many vendors have begun this process, and 1 suggestion would be to take guidance from the Institute of Medicine’s recommendations for groups charged with clinical practice guideline development.6

Radiation and Second Primary Thyroid Cancer Following Index Head and Neck Cancer: Thyroid Cancer After Index HNC

Radiation is thought to increase risk of developing second primary thyroid cancer (SPTC). This study estimated the rate of SPTC following index head and neck cancer (HNC) and determined whether radiation treatment among HNC survivors increased SPTC risk.

Survival differences in nasopharyngeal carcinoma among racial and ethnic minority groups in the United States: A retrospective cohort study

The literature on nasopharyngeal carcinoma survival in the United States has focused mostly on Whites or Asians and not much is known about survivorship in other minority racial and ethnic groups. We aimed to determine the disease‐specific survival rate and prognostic factors for nasopharyngeal carcinoma survival across the minority United States population.

Abstract A33: Head and neck squamous cell carcinoma in adolescents and young adults: Survivorship patterns and disparities

Introduction: Head and neck squamous cell carcinoma (HNSCC) incidence and survivorship has been thoroughly described in the literature. Most of the literature has mainly focused on older adults. However, there are documented cases of early-onset HNSCC, typically in adolescents and young adults (AYA) aged 15-39 years. In fact, 12% of all pediatric cancers are in the head and neck region. As individuals live longer in the general population, it will become more important to track AYA cancer cases due to the potential for treatment effects, late toxicities, and comorbidities after cancer survivorship. Additionally, the emergence of the human papillomavirus (HPV)-associated oropharyngeal cancer as a dominant head and neck cancer means that more HNSCC patients are diagnosed at a younger age than previously known. These patients with HPV-associated oropharyngeal cancer are likely to live longer since HPV-associated HNSCC typically has better prognosis than other HNSCC. While numerous studies have investigated HNSCC survivorship in older adults and the elderly, limited research exists describing the incidence and survivorship in adolescents and young adults. The aim of this study is to characterize survivorship of HNSCC in the AYA population. Methods: In this retrospective study, we utilized a patient cohort of 3,366 first primary HNSCC cases from the Surveillance, Epidemiology, and End Results (SEER) 18 database diagnosed between ages 15-39 and the years 2000-2014. Actuarial survival curves stratified by age group (15-29, 30-34, 35-39) indicated differences in HNSCC survival among groups with a log-rank test. Patient characteristics including age, sex, race/ethnicity, HNSCC site, stage, and treatment modality were utilized in a Fine and Gray competing risk proportional hazard model to examine their impact on HNSCC death in this cohort. Results: The cohort was mostly male (65.1%) with an average age of 33.6. There was no significant HNSCC survival difference between the age-stratified survival curves (log-rank p=0.83). The Fine and Gray model also did not find a significant effect for age. All race/ethnicity groups had a significantly increased hazard of HNSCC death compared with non-Hispanic whites, with non-Hispanic American Indians/Alaska Natives having the highest increased hazard (aHR=4.01, 95% CI: 2.18, 7.38). Each increasing year of diagnosis was associated with a 5% decrease in hazard of death from HNSCC (aHR=0.95, 95% CI: 0.93, 0.97). Regional (aHR=3.90, 95% CI: 3.13, 4.86) and distant (aHR=6.77, 95% CI: 5.27, 8.70) stage had a higher HNSCC death hazard compared with localized stage. Patients who did not receive surgery had a 93% (aHR=1.93, 95% CI: 1.60, 2.33) increased hazard of HNSCC death compared with those who received surgery. Compared with oropharyngeal cancer, hypopharyngeal, oral cavity, and sinonasal cancers were associated with significantly increased hazard of HNSCC death, while nasopharynx was associated with a decreased hazard (aHR=0.68, 95% CI 0.52, 0.90). Conclusions: We found no survival differences between adolescents and young adults based on age at diagnosis; however, minorities, especially American Indians/Alaskan Natives, had the worst survival outcomes. Also, patients who did not have the definite treatment of surgery and had regional or distant stage faced increased death from HNSCC. More research needs to be done to understand the mechanisms underlying the survival disparities noted among minorities, especially American Indians/Alaskan Natives. Efforts should also focus on establishing risk factor awareness and educational interventions, earlier screening measures, and patient navigator programs to improve prognosis of HNSCC in the American Indian/Alaskan Natives and other high-risk populations. Citation Format: Sai D. Challapalli, Eric Adjei Boakye, Matthew C. Simpson, Nosayaba Osazuwa-Peters. Head and neck squamous cell carcinoma in adolescents and young adults: Survivorship patterns and disparities [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 A33.

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.

Survival of human papillomavirus-associated cancers: Filling in the gaps: HPV-Associated Cancer Survival

Nearly 80 million individuals are currently infected with human papillomavirus (HPV) in the United States, making it the most common sexually transmitted infection. The oncogenic strains of HPV are associated with virtually all cases of cervical cancer (including cancer in situ), 91% of anal cancer, 75% of vaginal cancer, 70% of oropharyngeal cancer, 69% of vulvar cancer, and 63% of penile cancer. In the last decade, it has been demonstrated that several rectal cancers could be associated with HPV because of the proximity of the anus and the rectum. Together, these HPV-associated cancers cost 7.5 million years of potential life lost and

Suicide risk among cancer survivors: Head and neck versus other cancers: Suicide Risks in Patients With Cancer

3.7 billion in lost productivity. Currently, there are an estimated 38,793 new cases of HPV-associated cancers in the United States, which comprises approximately 2.3% of all new cancer cases in the United States. These cancers also contribute about 9% to the cancer mortality burden. These statistics are troubling, given that most of these malignancies are preventable. Also concerning is the finding that the survival of patients with HPV-associated tumors varies greatly between demographic groups. These disparities are among the focus of the Healthy People 2020 initiative, but mitigation efforts first require characterization of the disparities. In this issue of Cancer, the study by Razzaghi and colleagues provides up-to-date data quantifying the problem of HPV-associated cancer survival. Several studies have described incidence trends of most HPV-associated cancers as well as preventive strategies. However, the literature on HPV-associated cancer survivorship have been overwhelmingly dominated by studies focusing on either cervical or oropharyngeal cancers. Thus, this novel effort by Razzaghi et al has filled a major gap in knowledge about the survival of patients with HPV-associated cancers. The authors describe how survival of cervical and oropharyngeal cancers compare with the other less studied, rarer HPV-associated cancers, including anal, vulvar, vaginal, and rectal cancers. They also highlight racial disparities in survivorship across HPV-associated cancers. In their study sample of almost one-quarter of a million diagnosed HPV-associated cancer cases across a decade (20012011), Razzaghi and colleagues observed survival rates as low as 47% for penile cancer and as high as 66% for vulvar cancer. They report that blacks consistently had lower survival rates than whites independent of which HPV-associated cancer was considered. In the context of health inequities and disparities, this finding of worse survival outcomes for blacks versus whites merits further discussion. Previous studies have attempted to describe differences in tumors based on race/ethnicity and have suggested biology as a potential basis for the survival differences observed in patients with cancer. However, there has been overwhelming evidence that the issues affecting cancer survivors are usually related to disease stage at presentation and access to care, with biology playing no more a significant role than these nonbiologic factors. Without universal access to care, underserved racial/ethnic groups will likely continue to suffer worse outcomes from many cancers, including those associated with HPV, such as oropharyngeal cancer. The landmark article by Chaturvedi et al in 2011 described a 225% increase in HPV-associated oropharyngeal cancer incidence in the last 3 decades. Oropharyngeal cancer was projected to surpass cervical cancer as the leading HPVassociated cancer in the United States by 2020. However, the report by Razzaghi and colleagues and another recent study demonstrate that HPV-associated oropharyngeal cancer incidence may already have overtaken cervical cancer as the leading HPV-associated cancer. The incidence of oropharyngeal cancers even may be underestimated, since misclassification of these as tumors of the oral cavity is known to occur in some cancer databases. Meanwhile, cervical cancer

Differences in Risks of Synchronous and Metachronous Second Primary Cancers Among Head and Neck Cancer Patients

Cancer survivors face psychosocial issues that increase their risk of suicide. This study examined the risk of suicide across cancer sites, with a focus on survivors of head and neck cancer (HNC).