Head and Neck Cancer Patients Benefit in Multidisciplinary Clinics

Source: Journal of Clinical Oncology Head and neck cancer (HNC) is a multidisciplinary condition. Multi-modality treatment is standard, especially the use of chemoradiation. Proper imaging (CT, MRI and PET), more accurate pathologic assessment and thoroughly tailored treatment plans that limits radiation fields and doses and take into consideration surgical options that minimize morbidity (endoscopic and robotic procedures) are essential. Furthermore, dental, swallowing, speech, nutritional, financial and social support are also cornerstones in this comprehensive approach. However, the most important function might be the role of the nurse navigator in order to offer true coordinated care for our patients. Within William Beaumont Oncology Network we initiated multi-disciplinary clinics for HNC in January 2010 in which our specialists meet the patients together after discussion at the tumor board to streamline management. Methods: In this initial analysis we studied 15 randomly chosen patients’ way through our health care system in 2009, and compared with 15 randomly chosen patients in 2010, after the initiation of the Multi-Disciplinary Clinic. All patients had biopsy verified HNC, the vast majority being squamous cell carcinomas, and were stage III or stage IV. The radiation techniques were unchanged during study and treating physicians remained the same as well. Results: The first group of patients that did not go through our multi-disciplinary clinic had a mean time of 59 days (range 4-156) from pathologic diagnosis to start of radiation. Corresponding mean time for patients going through the multi-disciplinary clinics was 33 days (range 18-86), a decrease of 44%. Conclusions: Coordinated [...]

New Legislation may Weaken FDA’s Regulation of Cigarettes

Source: The Los Angeles Times The U.S. Food and Drug Administration barely had time to start regulating cigarettes before legislation was introduced to weaken its authority. The Family Smoking Prevention and Tobacco Control Act was passed in 2009 with sweeping majorities in both houses; its primary goal was to reduce the terrible toll that smoking takes on Americans' health, especially by discouraging young people from taking up the habit. The law gave the FDA the authority to regulate the advertising and packaging of cigarettes, along with ingredients such as nicotine and flavorings that affect how easily the public is drawn into smoking and how addictive the habit is once started. As required in the law, for example, the FDA banned candy flavorings in cigarettes, which make the product more appealing to underage smokers and young adults. But now that the agency is taking meaningful steps against smoking, Rep. Denny Rehberg (R-Montana) has added an amendment to the agriculture appropriations bill that would restrict the FDA's authority over cigarettes and a host of other matters. Currently, the FDA is considering whether to ban one of the most popular and profitable ingredients — menthol — but Rehberg's amendment would keep it from taking that action. No longer would the FDA be able to consider a substance's tendency to attract smokers or make cigarettes more addictive. Rather, the FDA could only ban or limit ingredients that are found to make the cigarette physically more harmful than existing products. Menthol has not been found [...]

New Strategies used to Identify Changes in Head and Neck Cancers

Source: GenomeWeb Daily News By Andrea Anderson CHICAGO– Researchers are making progress using high-throughput strategies to find previously unappreciated genetic and epigenetic quirks in head and neck cancer — including changes that may prove useful for diagnosing and tracking disease. Johns Hopkins University head and neck cancer research director David Sidransky described some of the work during an education session on molecular biology, targets, and pathways involved in head and neck cancer at the American Society of Clinical Oncology annual meeting here yesterday. Speaking during the same session, JHU oncologist Christine Chung and the University of Chicago's Ezra Cohen touched on strategies for targeting the types of mutations previously reported in head and neck cancer and the rationale behind targeted therapeutics already being tested or considered for the disease, respectively. Past studies have uncovered muted DNA methylation across the genomes of several cancer types, Sidransky explained, though methylation is also bumped up at specific sites in certain tumor types. Consequently, he said, researchers are using strategies such as real-time quantitative methylation-specific PCR (real-time QMSP) to look at methylation shifts in head and neck squamous cell carcinoma. In particular, he described work comparing methylation patterns in saliva and serum samples from individuals with HNSCC to those in samples from more than 800 apparently healthy individuals who are considered 'at-risk' of the disease because of smoking status and other exposures. At least two genes — KIF1A and EDNRB — seem to be more highly methylated in samples from those with HNSCC than [...]

HPV related oral cancers continue to increase in the US

Source: International Medicine News CHICAGO – Human papillomavirus infection was firmly linked to the recent rise in oropharyngeal cancers in the United States, based on data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. If current trends continue, the incidence of HPV-related oral cancers will soon surpass that of cervical cancers, senior author Dr. Maura Gillison reported at the annual meeting of the American Society of Clinical Oncology. The incidence of HPV-positive oropharyngeal cancers increased 225% – from 0.8 per 100,000 to 2.8 per 100,000 – between 1988 and 2004, the researchers found. At the same time, the incidence rate for HPV-negative oropharyngeal cancers, which are strongly related to tobacco and alcohol use, declined by 50% – from 2.0 per 100,000 to 1.0 per 100,000. Consequently, the overall incidence of oropharyngeal cancers increased 28%. Even by the conservative estimate that 70% of oropharyngeal cancers in 2020 will be HPV positive, the annual number of HPV-positive oral squamous cell carcinomas (8,653 cases) is expected to surpass cervical cancers (7,726 cases). Further, the majority will occur among men (7,426 cases), said Dr. Gillison, a medical oncologist and the Jeg Coughlin Chair in Cancer Research at Ohio State University Comprehensive Cancer Center in Columbus. Changes in sexual behavior among recent birth cohorts and increased oral HPV exposure probably influenced the increases in incidence and prevalence, Dr. Gillison speculated. Having a high lifetime number of sexual partners is a known risk factor for HPV infection. Although the rise in oral cancers [...]

Cellular p16 localization and survival outcomes in head and neck cancer.

Source: ASCO.org Background: Head and neck squamous cell carcinoma (HNSCC) constitutes approximately 3-5 percent of all cancers. Recent data suggest an increasing incidence rate among younger people who are often non-smokers and non-drinkers, which are believed to be caused by human papillomavirus (HPV) infection. HPV positive tumors are typically found in the oropharynx and have better response to treatment and better disease outcome despite more advanced nodal stages. Therefore, HPV-positive HNSCCs represent a unique clinical subgroup with a separate tumor entity. Methods: Patients treated for HNSCC from 2002 to 2006 at UNC hospitals and had banked tissue available were eligible for this study. Tissue microarrays (TMA) were generated in triplicate. Immunohistochemical (IHC) staining for p16 was performed and scored separately for nuclear staining and cytoplasmic staining. Human papilloma virus (HPV) staining was also carried out using monoclonal antibody E6H4. P16 expression, HPV status and other clinical features were correlated with progression-free (PFS) and overall survival (OS). Results: 135 patients had sufficient sample for this analysis. Median age of diagnosis was 57 years (range 20-82), with 68.9% males, 8.9% never smokers and 32.6 % never drinkers. 3 year OS rate and PFS rate was 63.0% and 54.1% respectively. Based on the p16 staining score, patients were divided into three groups: high nuclear any cytoplasmic staining group (HNAC), low nuclear low cytoplasmic staining group (LNLC) and low nuclear high cytoplasmic staining group (LNHC). HNAC and LNLC groups had significantly better overall survival than LNHC groups with hazard ratios of 0.01 and 0.37 [...]

A new state approach to reducing tobacco use

Source: www.indystar.com Author: Dr. Gregory N. Larkin This week, Indiana joined the rest of the world in celebrating World No Tobacco Day. This global health observation was created to teach people about the dangers of tobacco use and highlight public health efforts in the fight against the tobacco epidemic. World No Tobacco Day is of particular importance to Hoosiers this year. Beginning July 1, two state government agencies critical to protecting the health of Hoosiers will be combined: the Indiana State Department of Health and Indiana Tobacco Prevention & Cessation. The General Assembly's move to put tobacco cessation within the health department provides additional tools for Indiana to catch up with other states in the race to lower smoking rates and tobacco-related illnesses. According to the Centers for Disease Control and Prevention, approximately 23 percent of Indiana adults smoke cigarettes, ranking us among the worst five states for adult smoking. Clearly, the adverse health effects of tobacco use continue to increase the rates of diseases as well as increase health costs. Combining efforts will reduce administrative redundancy and saving taxpayer dollars. Valuable ITPC programs, such as the community- and minority-based programs, the Indiana Tobacco Quitline, Quit Now Indiana and the VOICE youth program, will continue. Tobacco reduction and protection from secondhand smoke exposure will now be further integrated into many existing state health promotion programs, such as cancer prevention, oral health, asthma care, maternal/prenatal health, cardiovascular health, and minority, women's and children's health. I assure Hoosiers that by having the [...]

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