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Treatment trends in head and neck cancer: Surveillance, Epidemiology, and End Results (SEER) Patterns of Care analysis

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Abstract

Purpose

Recent advances in head and neck cancer (HNC) treatment, such as increased use of organ-preserving advanced radiation treatments, the approval of cetuximab for HNC treatment, and the increase in human papillomavirus (HPV)-related HNC, have changed clinical approaches to HNC management. We sought to identify treatment trends in a population-based cohort of HNC patients.

Methods

The Surveillance, Epidemiology, and End Results Patterns of Care program collected additional treatment and HPV testing information on stratified random samples of HNC patients diagnosed in 1997 (n = 473), 2004 (n = 1,317), and 2009 (n = 1,128). Rao–Scott Chi-square tests were used to examine unadjusted associations between year of diagnosis and patient sociodemographic, tumor, and treatment characteristics. Cochran–Armitage tests for trend were used to examine the hypothesis that certain treatments were used increasingly (or decreasingly) over the time period, while logistic regression was used to examine factors associated with particular treatments.

Results

Use of radiation and chemotherapy without surgery significantly increased for all HNC sites between 1997 and 2009. Cetuximab and taxane use also showed a significantly increasing trend. Lack of insurance was associated with not receiving treatment in multivariate models. The majority (64%) of cases undergoing radiation in 2009 received an advanced treatment, with 55% receiving intensity modulated. The majority of oropharyngeal cases with known HPV status received chemotherapy and radiation only (62%) and nearly all were insured and had one or fewer comorbidities.

Conclusions

Treatment patterns have changed for HNC, leading to increased incorporation of systemic therapy and newer radiation techniques. HPV testing should be targeted for more widespread use, especially in traditionally underserved groups.

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References

  1. National Cancer Institute (2018) Oropharyngeal Cancer Treatment (Adult) (PDQ®)–Health Professional Version. https://www.cancer.gov/types/head-and-neck/hp/adult/oropharyngeal-treatment-pdq. Accessed 17 Sept 2018

  2. Allal AS, Nicoucar K, Mach N, Dulguerov P (2003) Quality of life in patients with oropharynx carcinomas: assessment after accelerated radiotherapy with or without chemotherapy versus radical surgery and postoperative radiotherapy. Head Neck 25:833–839

    Article  PubMed  Google Scholar 

  3. Argiris A, Karamouzis MV, Raben D, Ferris RL (2008) Head and neck cancer. Lancet 371:1695–1709

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Eisbruch A, Harris J, Garden AS, Chao CK, Straube W, Harari PM, Sanguineti G, Jones CU, Bosch WR, Ang KK (2010) Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys 76:1333–1338

    Article  PubMed  Google Scholar 

  5. Ryzek DF, Mantsopoulos K, Kunzel J, Grundtner P, Zenk J, Iro H, Psychogios G (2014) Early stage oropharyngeal carcinomas: comparing quality of life for different treatment modalities. Biomed Res Int 2014: Article ID 421964, 7 pages

  6. Weber RS, Gidley P, Morrison WH, Peters LJ, Hankins P, Wolf P, Guillamondegui O (1990) Treatment selection for carcinoma of the base of the tongue. Am J Surg 160:415–419

    Article  CAS  PubMed  Google Scholar 

  7. Chambers MS, Garden AS, Kies MS, Martin JW (2004) Radiation-induced xerostomia in patients with head and neck cancer: pathogenesis, impact on quality of life, and management. Head Neck 26:796–807

    Article  PubMed  Google Scholar 

  8. Chambers MS, Rosenthal DI, Weber RS (2007) Radiation-induced xerostomia. Head Neck 29:58–63

    Article  PubMed  Google Scholar 

  9. Epstein JB, Robertson M, Emerton S, Phillips N, Stevenson-Moore P (2001) Quality of life and oral function in patients treated with radiation therapy for head and neck cancer. Head Neck 23:389–398

    Article  CAS  PubMed  Google Scholar 

  10. Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ (2008) Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol 26:3770–3776

    Article  PubMed  Google Scholar 

  11. Webb S (2001) Intensity-modulated radiation therapy. CRC Press, Taylor & Francis Group, Abingdon

    Book  Google Scholar 

  12. Intensity Modulated Radiation Therapy Collaborative Working Group (2001) Intensity-modulated radiotherapy: current status and issues of interest. Int J Radiat Oncol Biol Phys 51:880–914

    Article  Google Scholar 

  13. Guadagnolo BA, Liu CC, Cormier JN, Du XL (2010) Evaluation of trends in the use of intensity-modulated radiotherapy for head and neck cancer from 2000 through 2005: socioeconomic disparity and geographic variation in a large population-based cohort. Cancer 116:3505–3512

    Article  PubMed  Google Scholar 

  14. Sher DJ, Neville BA, Chen AB, Schrag D (2011) Predictors of IMRT and conformal radiotherapy use in head and neck squamous cell carcinoma: a SEER-Medicare analysis. Int J Radiat Oncol Biol Phys 81:e197–206

    Article  PubMed  Google Scholar 

  15. Beadle BM, Liao KP, Elting LS, Buchholz TA, Ang KK, Garden AS, Guadagnolo BA (2014) Improved survival using intensity-modulated radiation therapy in head and neck cancers: a SEER-Medicare analysis. Cancer 120:702–710

    Article  PubMed  Google Scholar 

  16. Beitler JJ, Zhang Q, Fu KK, Trotti A, Spencer SA, Jones CU, Garden AS, Shenouda G, Harris J, Ang KK (2014) Final results of local-regional control and late toxicity of RTOG 9003: a randomized trial of altered fractionation radiation for locally advanced head and neck cancer. Int J Radiat Oncol Biol Phys 89:13–20

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bourhis J, Overgaard J, Audry H, Ang KK, Saunders M, Bernier J, Horiot J-C, Le Maître A, Pajak TF, Poulsen MG (2006) Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis. Lancet 368:843–854

    Article  PubMed  Google Scholar 

  18. Balukrishna S, Pilaka VK, Michael RC, Samuel P, Ravindran PB (2015) Hyper-fractionated Intensity Modulated Radiation Therapy (HF-IMRT) in Head and Neck Cancer: the technical feasibility and results of a short clinical series. J Clin Diagn Res 9:XR01–XR04

    PubMed  PubMed Central  Google Scholar 

  19. Kao J, Genden EM, Gupta V, Policarpio EL, Burri RJ, Rivera M, Gurudutt V, Som PM, Teng M, Packer SH (2011) Phase 2 trial of concurrent 5-fluorouracil, hydroxyurea, cetuximab, and hyperfractionated intensity-modulated radiation therapy for locally advanced head and neck cancer. Cancer 117:318–326

    Article  CAS  PubMed  Google Scholar 

  20. Lee VH, Kwong DL, Leung TW, Ng SC, Lam KO, Tong CC, Sze CK (2017) Hyperfractionation compared to standard fractionation in intensity-modulated radiation therapy for patients with locally advanced recurrent nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 274:1067–1078

    Article  PubMed  Google Scholar 

  21. Cohen EE, Lingen MW, Vokes EE (2004) The expanding role of systemic therapy in head and neck cancer. J Clin Oncol 22:1743–1752

    Article  PubMed  Google Scholar 

  22. NCCN Guidelines Version 2.2018 Panel Members: Head and Neck Cancers (2018) NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers, Version 2.2018—June 20, 2018. National Comprehensive Cancer Network. https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed 17 Sept 2018

  23. Pfister DG, Ang K-K, Brizel DM et al (2011) Head and neck cancers, clinical practice guidelines in oncology. JNCCN 9:596–650

    PubMed  Google Scholar 

  24. Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, Sur R, Raben D, Jassem J (2006) Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 354:567–578

    Article  CAS  PubMed  Google Scholar 

  25. Kreeger K (2006) News: cetuximab approved by FDA for treatment of head and neck squamous cell cancer. Cancer Biol Ther 5:340–342

    Google Scholar 

  26. Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, Erfan J, Zabolotnyy D, Kienzer H-R, Cupissol D (2008) Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 359:1116–1127

    Article  CAS  PubMed  Google Scholar 

  27. Dansky Ullmann C, Harlan LC, Shavers VL, Stevens JL (2012) A population-based study of therapy and survival for patients with head and neck cancer treated in the community. Cancer 118:4452–4461

    Article  PubMed  Google Scholar 

  28. Ryerson AB, Peters ES, Coughlin SS, Chen VW, Gillison ML, Reichman ME, Wu X, Chaturvedi AK, Kawaoka K (2008) Burden of potentially human papillomavirus-associated cancers of the oropharynx and oral cavity in the US, 1998–2003. Cancer 113(10 Suppl):2901–2909

    Article  PubMed  Google Scholar 

  29. D’Souza G, Kreimer AR, Viscidi R, Pawlita M, Fakhry C, Koch WM, Westra WH, Gillison ML (2007) Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 356:1944–1956

    Article  PubMed  Google Scholar 

  30. Nguyen NP, Chi A, Nguyen LM, Ly BH, Karlsson U, Vinh-Hung V (2010) Human papillomavirus-associated oropharyngeal cancer: a new clinical entity. Q J Med 103:229–236

    Article  CAS  Google Scholar 

  31. Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tan PF, Westra WH, Chung CH, Jordan RC, Lu C et al (2010) Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 363:24–35

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Fakhry C, Westra WH, Li S, Cmelak A, Ridge JA, Pinto H, Forastiere A, Gillison ML (2008) Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst 100:261–269

    Article  CAS  PubMed  Google Scholar 

  33. Saraiya M, Unger ER, Thompson TD, Lynch CF, Hernandez BY, Lyu CW, Steinau M, Watson M, Wilkinson EJ, Hopenhayn C, Copeland G, Cozen W, Peters ES, Huang Y, Saber MS, Altekruse S, Goodman MT, HPV Typing of Cancers Workgroup (2015) US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J Natl Cancer Inst 107:djv086

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Pagedar NA, Chioreso C, Schlichting JA, Lynch CF, Charlton ME (2017) Treatment selection in oropharyngeal cancer: a Surveillance, Epidemiology, and End Results (SEER) patterns of care analysis. Cancer Causes Control 28:1085–1093

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kahl AR, Charlton ME, Pagedar NA, Sperry SM, Matt B, Platz C, Lynch CF (2018) Accuracy of the HPV status site-specific factor 10 (SSF-10) variable for patients with oropharyngeal cancers in the Iowa Cancer Registry, 2010–2014. Head Neck 40:2199–2209

    Article  PubMed  PubMed Central  Google Scholar 

  36. Maniakas A, Moubayed SP, Ayad T, Guertin L, Nguyen-Tan PF, Gologan O, Soulieres D, Christopoulos A (2014) North-American survey on HPV-DNA and p16 testing for head and neck squamous cell carcinoma. Oral Oncol 50:942–946

    Article  PubMed  Google Scholar 

  37. Chen AY, Schrag N, Hao Y, Stewart A, Ward E (2007) Changes in treatment of advanced oropharyngeal cancer, 1985–2001. Laryngoscope 117:16–21

    Article  PubMed  Google Scholar 

  38. Subramanian S, Chen A (2013) Treatment patterns and survival among low-income medicaid patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg 139:489–495

    Article  PubMed  Google Scholar 

  39. Choi SH, Terrell JE, Fowler KE, McLean SA, Ghanem T, Wolf GT, Bradford CR, Taylor J, Duffy SA (2016) Socioeconomic and other demographic disparities predicting survival among head and neck cancer patients. PLoS ONE 11:e0149886

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Walker BB, Schuurman N, Auluck A, Lear SA, Rosin M (2017) Socioeconomic disparities in head and neck cancer patients’ access to cancer treatment centers. Rural Remote Health 17:4210

    Article  PubMed  Google Scholar 

  41. National Cancer Institute, Division of Cancer Control & Population Sciences, Healthcare Delivery Research Program (2019) Patterns of care studies. https://healthcaredelivery.cancer.gov/poc/. Accessed 13 May 2019

  42. National Cancer Institute, Division of Cancer Control and Population Sciences and Division of Cancer Treatment and Diagnosis, Surveillance, Epidemiology, and End Results Program (1997, 2004, 2009) Head and Neck Cancer Data Set. POC Data Acquisition Manual

  43. Surveillance, Epidemiology, and End Results Program (2018) Overview of the SEER program. National Cancer Institute. https://seer.cancer.gov/about/overview.html. Accessed 17 Sept 2018

  44. Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin L, Parkin DM, Whelan S (eds) (2013) International classification of diseases for oncology, 3rd edn. World Health Organization, Geneva

    Google Scholar 

  45. Yu JB, Gross CP, Wilson LD, Smith BD (2009) NCI SEER public-use data: applications and limitations in oncology research. Oncology 23:288–295

    PubMed  Google Scholar 

  46. Lewis C, Nurgalieva Z, Lai S, Weber R (2014) Improving the quality of multidisciplinary care for head and neck cancer. J Clin Oncol 32:232

    Article  Google Scholar 

  47. Dogan V, Rieckmann T, Munscher A, Busch CJ (2018) Current studies of immunotherapy in head and neck cancer. Clin Otolaryngol 43:13–21

    Article  CAS  PubMed  Google Scholar 

  48. Cogliano V, Baan R, Straif K, Grosse Y, Secretan B, El Ghissassi F, World Health Organization International Agency for Research on Cancer Working Group on the Evaluation of Carcinogenic Risks to Humans (2005) Policy watch: carcinogenicity of human papillomaviruses. Lancet 6:204

    Article  Google Scholar 

  49. Fakhry C, Lacchetti C, Rooper LM, Jordan RC, Rischin D, Sturgis EM, Bell D, Lingen MW, Harichand-Herdt S, Thibo J et al (2018) Human papillomavirus testing in head and neck carcinomas: ASCO clinical practice guideline endorsement of the college of american pathologists guideline. J Clin Oncol 36:3152–3161

    Article  PubMed  Google Scholar 

  50. Bath C (2017) Deintensifiying treatment of HPV-positive oropharyngeal cancer could reduce toxicity while maintaining function and survival. The ASCO Post, American Society of Clinical Oncology. http://www.ascopost.com/issues/april-25-2017/deintensifiying-treatment-of-hpv-positive-oropharyngeal-cancer-could-reduce-toxicity-while-maintaining-function-and-survival/. Accessed 17 Sept 2018

  51. Daraei P, Moore CE (2015) Racial disparity among the head and neck cancer population. J Canc Educ 30:546–551

    Article  Google Scholar 

  52. Xu C, Chen YP, Liu X, Tang LL, Chen L, Mao YP, Zhang Y, Guo R, Zhou GQ, Li WF et al (2017) Socioeconomic factors and survival in patients with non-metastatic head and neck squamous cell carcinoma. Cancer Sci 108:1253–1262

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Gross AM, Cohen EE (2015) Towards a personalized treatment of head and neck cancer. Head and Neck Cancer, Am Soc Clin Oncol Educ Book 28–32

  54. Seiwert TY, Zuo Z, Keck MK, Khattri A, Pedamallu CS, Stricker T, Brown C, Pugh TJ, Stojanov P, Cho J et al (2015) Integrative and comparative genomic analysis of HPV-positive and HPV-negative head and neck squamous cell carcinomas. Clin Cancer Res 21:632–641

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported in part under NIH/NCI contract number HHSN26120130000201/HHSN26100006 with University of Iowa (MEC, CC, JAS). This work was also supported by the University of Iowa Holden Comprehensive Cancer Center, which is funded in part by NIH/NCI P30 CA086862.

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Authors and Affiliations

  1. Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside, Dr, Iowa City, IA, 52242, USA

    Jennifer A. Schlichting, Catherine Chioreso, Charles F. Lynch & Mary E. Charlton

  2. Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Iowa City, IA, USA

    Nitin A. Pagedar

  3. State Health Registry of Iowa, Iowa City, IA, USA

    Charles F. Lynch & Mary E. Charlton

Authors
  1. Jennifer A. Schlichting
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  2. Nitin A. Pagedar
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  3. Catherine Chioreso
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  4. Charles F. Lynch
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  5. Mary E. Charlton
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Correspondence to Mary E. Charlton.

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Schlichting, J.A., Pagedar, N.A., Chioreso, C. et al. Treatment trends in head and neck cancer: Surveillance, Epidemiology, and End Results (SEER) Patterns of Care analysis. Cancer Causes Control 30, 721–732 (2019). https://doi.org/10.1007/s10552-019-01185-z

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