Stephen F. Hall

The impact of comorbidity on the survival of patients with squamous cell carcinoma of the head and neck

In North America, cigarette smoking and/or alcohol consumption not only cause head and neck cancer, they also cause many of the other diseases, illnesses, and conditions, also known as comorbidities, frequently found in our patients. Comorbidities can influence treatment decision making and treatment outcome. The aim of this study is to quantify the increased risk of comorbidity in our patients.

Measuring comorbidity in patients with head and neck cancer

Background Comorbidities are diseases or conditions that coexist with a disease of interest. The importance of comorbidities is that they can alter treatment decisions, change resource utilization, and confound the results of survival analysis.

The Natural History of Patients With Squamous Cell Carcinoma of the Hypopharynx

Objectives/Hypothesis: To provide the baseline information on the natural history of patients with squamous cell carcinoma of the hypopharynx to help clinicians, researchers, and patients assess the relative effectiveness of treatment options when the best treatment is not known and newer treatments are being proposed.

Increasing Detection and Increasing Incidence in Thyroid Cancer

BackgroundIt has been proposed that the increasing incidence of thyroid cancer is due to increasing detection.MethodsUsing administrative data, we compare by year from 1993 to 2006, the rates of diagnostic imaging tests of the neck (computed axial tomography—CT, magnetic resonance imaging—MRI, and non-obstetrical ultrasound—US) to the incidence of thyroid cancer for the population of the Province of Ontario Canada.ResultsWomen and men have different rates of tests, and those rates reflect the rates of new diagnoses of thyroid cancer.ConclusionsThe rising incidence of thyroid disease in women is associated with increasing numbers of diagnostic imaging tests.

Using TNM staging to predict survival in patients with squamous cell carcinoma of head & neck†

There is a need for a classification system for prognosis based on the TNM system for patients with squamous cell carcinoma of the head and neck such that patient groupings are homogeneous within and heterogeneous between.

A comparison of published head and neck stage groupings in carcinomas of the tonsillar region

The combination of T, N, and M classifications into stage groupings was designed to facilitate a number of activities including: the estimation of prognosis and the comparison of therapeutic interventions among similar groups of cases. The authors tested the UICC/AJCC 5th edition stage grouping and seven other TNM‐based groupings proposed for head and neck cancer to determine their ability to meet these expectations in a specific site: carcinoma of the tonsillar region.

Volume–outcome associations in head and neck cancer treatment: A systematic review and meta-analysis

Because of the relative rarity of head and neck malignancies and their complex treatment, some groups have advocated for regionalized care. Studies comparing high‐ and low‐volume centers have demonstrated mixed results.

Diagnostic delay and disease stage in head and neck cancer: a systematic review.

The objective of this study was to examine the evidence for an association between patient and/or provider‐related diagnostic delay and late stage at diagnosis.

Access, excess, and overdiagnosis: the case for thyroid cancer

The incidence of thyroid cancer in women is increasing at an epidemic rate. Numerous studies have proposed that the cause is increasing detection due to availability and use of medical diagnostic ultrasound. Our objective was to compare rates of diagnosis across different health‐care regions to rates of diagnostic tests and to features of both health and access of the regional populations. This is a population‐based retrospective ecological observational study of 12,959 patients with thyroid cancer between January 1, 2000 and December 31, 2008 in Ontario Canada based on the health‐care utilization regions (Local Health Integration Networks) of the province of Ontario Canada. We found that some regions of Ontario had four times the rates of diagnosis of thyroid cancer compared to other regions. The regions with the highest use of discretionary medical tests (pelvic ultrasound, abdominal ultrasound, neck ultrasound, echocardiogram, resting electrocardiogram, cardiac nuclear perfusion tests, and bone scan), highest population density, and better education had the highest rates of thyroid cancer diagnoses. Differences in the rates of the ordering of discretionary diagnostic medical tests, such as diagnostic ultrasound, in different geographic regions of Ontario lead to differences in the rates of diagnosis of thyroid cancer.

A population-based study of factors associated with early versus late stage oral cavity cancer diagnoses

Oral cavity cancers can be detected early yet many are diagnosed with advanced disease. We assessed risk factors for advanced stage disease in a population-based study. Study population was all Ontario patients with anterior tongue or floor of mouth cancers diagnosed between 1991 and 2000 (n=2033). Data are from a retrospective chart review. Risk factors included: demographic characteristics, co-morbidity, precancerous lesions, dental status, smoking, alcohol use, and social marginalization. Multivariate regression analyses assessed independent associations while controlling for disease grade and site. Forty percent had advanced disease. Eighty-nine percent presented with symptoms and 66% were referred by a family physician. Risk factors in the tongue group were being: age ≥80 (RR 1.47), widowed (RR 1.34), social marginalized (RR 1.69), a current smoker (RR 1.26), or a smoker-heavy drinker (RR 1.73). Risk factors in the floor of mouth group were being: age ≥70 (70-79: RR 1.24 and ≥80: RR 1.43), and socially marginalized (RR 1.22). Having a pre-cancerous lesion (RR 0.44) or a regular dentist (RR 0.84) was protective in the floor of mouth group. Risk factors for those with co-morbid illnesses were being: age ≥70 (70-79: RR 1.28 and ≥80: RR 1.55), separated/divorced (RR 1.26), socially marginalized (RR 1.37), or a smoker-heavy drinker (RR 1.44); while having a regular dentist was protective (RR 0.83). Targeted education to alert those at risk about oral cancer warning signs and better training coupled with opportunistic oral cavity exams by family physicians could reduce the burden of this disease.