Increase in head and neck cancer in younger patients due to human papillomavirus (HPV)

Oral and oropharyngeal cancer.

The demographics of squamous cell carcinoma of the head and neck (SCCHN) is marked by a growing number of patients aged 65 and over, which is in line with global projections for other cancer types. In developed countries, more than half of new SCCHN cases are diagnosed in older people and in 15 years from now, the proportion is expected to rise by more than 10%. Still, a high-level evidence-based consensus to guide the clinical decision process is strikingly lacking. The available data from retrospective studies and subset analyses of prospective trials suffer from a considerable underrepresentation of senior participants. The situation is even more challenging in the recurrent and/or metastatic setting, where usually only palliative measures are employed. Nevertheless, it is becoming clear that if treated irrespective of chronological age, fit elderly patients in a good general condition and with a low burden of comorbidities may derive a similar survival advantage as their younger counterparts. Despite that, under-treatment represents a widespread phenomenon and together with competing non-cancer mortality is suggested to be an important cause of the worse treatment outcomes observed in this population. Due to physiological changes in drug metabolism occurring with advancing age, the major concerns relate to chemotherapy administration. In locally advanced SCCHN, concurrent chemoradiotherapy in patients over 70 years remains a point of controversy owing to its possibly higher toxicity and questionable benefit. However, accumulating evidence suggests that it should, indeed, be considered in selected cases when biological age is taken into account. Results from a randomised trial conducted in lung cancer showed that treatment selection based on a comprehensive geriatric assessment (CGA) significantly reduced toxicity. However, a CGA is time-consuming and not necessary for all patients. To overcome this hurdle, geriatric screening tools have been introduced to decide who needs such a full evaluation. Among the various screening instruments, G8 and Flemish version of the Triage Risk Screening Tool were prospectively verified and found to have prognostic value. We therefore conclude that also in SCCHN, the application of elderly-specific prospective trials and integration of clinical practice-oriented assessment tools and predictive models should be promoted.

/pdf/treatment-of-elderly-patients-with-squamous-cell-carcinoma-4mlhhvn05l.pdf

Treatment of elderly Patients with Squamous Cell Carcinoma of the Head and Neck

HPV-positive oropharyngeal squamous cell carcinoma (HPV-OSCC) is associated with oral sexual behaviors. The sharp rise in incidence of HPV-OSCC in the USA has been attributed to changes in sexual norms over the past five decades, with lower age at sexual debut and higher numbers of sexual partners per individual. In addition, variations in HPV-OSCC prevalence by race, age cohort and gender may be attributable to differences in oral sexual behaviors among these groups. Oral HPV infection is the putative precursor to HPV-OSCC. Risk factors for oral HPV incidence, prevalence, clearance and persistence are crucial to understanding how, and in whom, oral HPV infection progresses to malignancy. Future investigation should focus on elucidating the natural history of oral HPV infection persistence and malignant transformation, developing effective screening tools and exploring opportunities for prevention such as vaccination and public health education.

/pdf/the-role-of-sexual-behavior-in-head-and-neck-cancer-3ck5y7rrb3.pdf

The role of sexual behavior in head and neck cancer: Implications for prevention and therapy

Objective To examine the effectiveness of smoking cessation interventions in improving cessation rates and smoking related behaviour in patients with head and neck cancer (HNC). Design A systematic review of randomised and non-randomised controlled trials. Methods We searched the following data sources: CENTRAL in the Cochrane Library, MEDLINE, EMBASE, PsycINFO and CINAHL up to February 2016. A search of reference lists of included studies and Google Scholar (first 200 citations published online between 2000 and February 2016) was also undertaken. The methodological quality of included studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). 2 study authors independently screened and extracted data with disagreements resolved via consensus. Results Of the 5167 studies identified, 3 were eligible and included in the review. Trial designs of included studies were 2 randomised controlled trials and 1 non-randomised controlled trial. 2 studies received a weak methodological rating and 1 received a moderate methodological rating. The trials examine the impact of the following interventions: (1) nurse delivered cognitive–behaviour therapy (CBT) via telephone and accompanied by a workbook, combined with pharmacotherapy; (2) nurse and physician brief advice to quit and information booklets combined with pharmacotherapy; and (3) surgeon delivered enhanced advice to quit smoking augmented by booster sessions. Only the trial of the nurse delivered CBT and pharmacotherapy reported significant increases in smoking cessation rates. 1 study measured quit attempts and the other assessed consumption of cigarettes per day and readiness to change. There was no significant improvement in quit attempts or cigarettes smoked per day among patients in the intervention groups, relative to control. Conclusions There are very few studies evaluating the effectiveness of smoking cessation interventions that report results specific to the HNC population. The 3 trials identified reported equivocal findings. Extended CBT counselling coupled with pharmacotherapy may be effective. Trial registration number CRD42016016421.

https://bmjopen.bmj.com/content/bmjopen/6/9/e012296.full.pdf

Smoking cessation care among patients with head and neck cancer: a systematic review

BACKGROUND

Use of tobacco products, excessive alcohol consumption, and high-risk sexual behaviors increase the risk of developing head and neck cancer and impacts treatment effectiveness after diagnosis. This study examined smoking and engagement in other modifiable behavioral risk factors and human papillomavirus (HPV) status in patients with head and neck cancer in order to facilitate identification and foster development of targeted interventions in high-risk patients.



METHODS

Participants were 102 patients with head and neck cancer at a large urban cancer center who completed a self-report background and health questionnaire and provided a saliva sample for determination of the long-acting nicotine metabolite cotinine.



RESULTS

Compared with former and never-smokers, current smokers were less educated, less likely to be married or living with a partner, and consumed more alcohol. Cotinine analysis indicated that 4 of 16 (25%) patients who denied past-month cigarette use misrepresented their true smoking status. Of patients with oropharyngeal cancer, 74% were confirmed as HPV-positive, and compared with HPV-negative patients, they were younger, more likely to be married/partnered and of Caucasian race, and reported more past vaginal and oral sexual partners. Only one-third of HPV-positive patients were aware of their HPV disease status.



CONCLUSIONS

Cigarette smoking is associated with engagement in other modifiable risk factors in patients with head and neck cancer. Self-report measures of smoking may not accurately depict true smoking status. HPV-positive cancer patients were more likely to endorse a history of multiple sexual partners. Regular screening and targeted interventions for these distinct risk factors are warranted. Cancer 2013;119:2419-2426. © 2013 American Cancer Society.

Modifiable risk behaviors in patients with head and neck cancer

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Modifiable risk behaviors in patients with head and neck cancer