survival

BMS gets US breakthrough status for head & neck cancer

Source: pharmatimes.com
Author: Selina McKee

US regulators have awarded Bristol-Myers Squibb’s immunotherapy Opdivo a breakthrough designation for the potential indication of recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN). The move, which should help expedite the drug’s development and review, comes after preliminary clinical evidence indicated it could offer a substantial survival benefit to patients with the condition who have already received platinum-based therapy.

A first look at the data from the Phase III CheckMate-141 trial, stopped early in January 2016 after meeting its primary endpoint of overall survival, showed that patients treated with Opdivo (nivolumab) experienced a 30 percent reduction in the risk of death compared to the investigator’s choice of therapy (methotrexate, docetaxel, or cetuximab), with a median overall survival of 7.5 months versus to 5.1 months.

Safety signals were also looking good, with treatment-related adverse events (TRAEs) of any grade occurring in 58.9 percent of patients on Opdivo versus 77.5 percent of patients on investigator’s choice. Grade 3-4 TRAEs were reported in 13.1 percent of patients on Opdivo compared to 35.1 percent taking the investigator’s choice, while two drug-related deaths were reported as related to Opdivo (pneumonitis and hypercalcaemia), and one Grade 5 event of lung infection in the comparator arm.

The findings are particularly pertinent given the particularly bleak outlook for patients whose disease has progressed after platinum therapy and lack of systemic therapies to improve survival, and thus significant unmet medical need for new options.

Head and neck cancer is the seventh most common cancer globally, with an estimated 400,000 to 600,000 new cases per year and 223,000 to 300,000 deaths per year. The five-year survival rate is reported as less than 4% for metastatic Stage IV disease.

Opdivo is already available in the US to treat certain forms of melanoma, non-small cell lung cancer and renal cell carcinoma. This marks its fifth breakthrough designation from the FDA, and follows that for classical Hodgkin lymphoma issued just days ago.

April, 2016|Oral Cancer News|

Chemotherapy + radiation may improve survival for some elderly

Source: journals.lww.com
Author: Carlson, Robert H., Oncology Times

Because the toxicity of concurrent chemoradiation is greater than radiation therapy alone for definitive head and neck cancer treatment, many clinicians have reservations about offering chemoradiotherapy for elderly head and neck cancer patients.

But a new study shows that combining chemotherapy with radiation therapy improves survival rates for those head and neck cancer patients ages 71 to 79 years who have low comorbidity scores and advanced disease stage, with survival rates similar to that of younger patients.

The study, which used data from the National Cancer Data Base (NCDB), suggests elderly patients are being underrepresented in prospective clinical trials that have defined standards of care for head and neck cancer.

“In the era of improved radiation techniques, improved systemic therapy, and better supportive care, we found that chemoradiotherapy does, in fact, improve survival for a large segment of this population,” said Sana Karam, MD, PhD, Assistant Professor of Radiation Oncology at the University of Colorado School of Medicine in Aurora, and senior author on the study.“

“These findings challenge historical data demonstrating no benefit of chemoradiotherapy for patients older than 70 years,” Karam said.

The study was presented at the 2016 Multidisciplinary Head & Neck Cancer Symposium, sponsored by the American Society for Radiation Oncology (ASTRO) and the American Society of Clinical Oncology (ASCO). First author is Arya Amini, MD, a fourth-year resident in the Department of Radiation Oncology at the University of Colorado School of Medicine.

Before the meeting, Karam discussed the study in an online audio preview for the press.

She said current guidelines for treatment of elderly head and neck cancer are based on trials that are included in the MACH-NC meta-analysis of 16,485 patients in 87 randomized trials (Radiotherapy and Oncology 2009;92:4-14).

While the meta-analysis confirmed a benefit of concomitant chemotherapy in locally-advanced head and neck cancer greater than the benefit with induction chemotherapy, it showed those benefits decreasing with age with no overall survival benefit for patients age 71 and above.

“But only 4 percent of the patients in this meta-analysis were age 71 and above, compared with 9 percent of the 2010 U.S. Census,” Karam pointed out. “The meta-analysis was underpowered, yet it has set our clinical practice guidelines.”

The researchers examined records from the NCDB for patients older than between 1998 and 2011. From 1998-2011, 23 percent of patients in the database were over age 70. Cases for these elderly patients were stratified by whether or not they received chemotherapy concurrent with radiotherapy.

All patients received definitive radiotherapy (66.0-81.6 Gy in 1.2-2.0 Gy fractions). Concurrent chemoradiation was defined as beginning a course of chemotherapy 14 days before or after the start of radiotherapy.

Karam said 68 percent of the patients received radiotherapy alone, and 32 percent received chemoradiotherapy.

Five-Year Survival Improved If Comorbidity Low
The study showed that five-year survival in head and neck cancer patients ages 71 to 79 years was 30.3 percent with concomitant chemotherapy and radiotherapy, versus 15.2 percent for radiotherapy alone.

“Our results showed clearly a significant overall survival benefit with the addition of chemotherapy to radiation therapy,” Karam said.

Chemoradiotherapy was associated with improved survival when patients had comorbidity scores of zero or one, and advanced disease stage.

The researchers also found an overall survival benefit of chemoradiotherapy for patients treated with intensity modulated radiotherapy.

But patients who did not see an overall survival benefit from chemoradiotherapy tended to be ages 79 or older, had a comorbidity score of two or greater, or presented with T-I or T-II disease.

The trend toward worse overall survival for patients with multiple comorbidities was only marginally significant, Karam added.

“These findings may aid clinicians in discussing treatment options with their elderly head and neck cancer patients, and they could guide future prospective trials to confirm the benefit of multimodality treatment in elderly patients, not only for head and neck cancer, but for other cancer sites as well,” Karam said.

Comorbidity, Not Age
In an online audio preview of the meeting for the press, moderator Christine G. Gourin, MD, Associate Professor of Narratology-Head and Neck Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, said, “These data show us that the key factor is not age, but comorbidity. As we age, we collect comorbidities, and that’s what is probably more significant.”

Gourin commented on the MACH-NC meta-analysis, “that we all know is used by our colleagues in Europe to support not using chemotherapy in elderly patients.

She said her own research using the SEER (Surveillance, Epidemiology and End Results) Medicare database found survival results can differ by tumor site—chemoradiation is superior to radiation in oropharyngeal cancer in terms of survival, she said; but in larynx cancer, overall survival is actually worse for chemoradiation.

Those differences were due to late toxicity of treatment, aspiration pneumonia, and dyspepsia.

Karam said her research also found differences between those two tumor sites, but that chemoradiotherapy improved overall survival for both subsets nonetheless.

“There are many differences in the data sets between the NCDB and SEER Medicare databases, including the historic staging analysis. The patient populations are a little different; our reviewers picked up on that when we were submitting the manuscript.”

“Unfortunately, we don’t have a clear cut variable for toxicity, but we did look at time to completion of radiotherapy. We found that patients who got concurrent chemoradiation had a longer time to completion of radiotherapy, suggesting perhaps more treatment breaks.”

“But even after controlling for treatment breaks, we still saw an overall survival advantage regardless of the subset, except for the very elderly and those with multiple comorbidities,” Karam said.

Source:
Oncology Times: 25 April 2016 – Volume 38 – Issue 8 – p 27
doi: 10.1097/01.COT.0000482924.27883.03

April, 2016|Oral Cancer News|

Having a partner increases cancer survival rates: Australian study

Source: www.theaustralian.com.au
Author: Sean Parnell

People diagnosed with cancer are more likely to die if they do not have a partner, according to a new Australian study.

Researchers from Cancer Council Queensland and Queensland University of Technology examined 176,050 cases of the 10 most common cancers in Queensland, diagnosed between 1996 and 2012. They found the chance of death was 26 per cent higher for men who did not have a partner compared to those who did, and 20 per cent higher for women who did not have a partner, across all cancers.

“The reasons for higher survival in partnered patients still remains unclear, but are likely to include economic, psychosocial, environmental, and structural factors,” CCQ professor Jeff Dunn said yesterday.

“Having a partner has been linked to a healthier lifestyle, greater financial resources and increased practical or social support while undergoing treatment.

“Support from a partner can also influence treatment choices and increase social support to help manage the psychosocial effects of cancer.”

The increased risk varied depending on the type of cancer. For men without a partner, it ranged from 2 per cent for lung cancer to 30 per cent for head and neck cancer, while for women without a partner it ranged from 2 per cent for kidney and lung cancer to 41 per cent for uterine cancer.

“Health professionals managing cancer patients should be aware of the increased mortality risk among unpartnered patients, and tailor follow-up treatment accordingly,” Professor Dunn said.

Of the 176,050 patients analysed for the study, 68 per cent had a partner, which included those who were married or in a de facto relationship. The researchers published their findings in the journal Cancer Epidemiology and suggested a better understanding of the relationship factor might help improve cancer management and outcomes.

March, 2016|Oral Cancer News|

Depressed Head and Neck Cancer Patients Have Lower Survival and Higher Recurrence Risk

Source: www.OncologyNurseAdvisor.com
Author: Kathy Boltz, PhD
 

Depression is a significant predictor of 5-year survival and recurrence in patients with head and neck cancer, according to a new study published in Pyschosomatic Medicine (doi: 10.1097/PSY.0000000000000256). These findings represent one of the largest studies to report on the impact of depression on cancer survival.

Although depression can have obvious detrimental effects on a person’s quality of life, its impact on cancer patients is more apparent, explained lead author Eileen Shinn, PhD, assistant professor of Behavioral Science at The University of Texas MD Anderson Cancer Center, in Houston. Increasing evidence shows modest associations between elevated symptoms of depression and greater risk for mortality among patients with lung, breast, ovarian, and kidney cancers.

The research team sought to clarify the influence of depression on survival, focusing their analysis on a single cancer type. By limiting the sample set and adjusting for factors known to affect outcome, such as age, tumor size, and previous chemotherapy, they were able to uncover a more profound impact of depression.

The researchers followed 130 patients at MD Anderson with newly diagnosed oropharyngeal squamous cell carcinoma (OSCC), a type of cancer in which the tumor originates at the back of the throat and base of the tongue.

At the beginning of their radiation therapy, Patients completed a validated questionnaire at the beginning of their radiation therapy to identify symptoms of clinical depression. Researchers monitored the participants, all of whom completed treatment, until their last clinic visit or death, a median period of 5 years.

“The results of this study were quite intriguing, showing depression was a significant factor predicting survival at 5 years, even after controlling for commonly accepted prognostic factors,” said senior author Adam Garden, MD, professor, Radiation Oncology. Furthermore, depression was the only factor shown to have a significant impact on survival.

Patients who scored as depressed on the questionnaire were 3.5 times less likely to have survived to the 5-year interval compared with those who did not score as depressed. The degree of depression was also found to be significant, as every unit increase on this scale indicated a 10% higher risk for reduced survival.

The results were replicated with a different psychological health survey and were not influenced by how soon following diagnosis the depression assessment was done.

OSCC is diagnosed in 10 000 to 15 000 Americans each year. Major risk factors known to be associated with OSCC include smoking and tobacco use, alcohol consumption, and human papillomavirus (HPV) infection. Incidence of OSCC has doubled in the last 20 years due to increasing HPV infection rates, noted Shinn.

Neither alcohol nor tobacco use, also surveyed in this group, had a significant impact on survival. HPV infection status, when available, also did not appear correlated.

Despite a high cure rate, normally 60% to 80%, recurrence rate of disease is unusually high in these patients (approximately 30%). The researchers also investigated a potential link between depression and disease recurrence.

“When we controlled for all variables, depression was linked with a nearly 4 times higher risk of recurrence,” said Shinn. In addition, never smokers had a 73% lower chance of recurrence, compared with current smokers. Those were the only two factors associated with cancer recurrence.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

December, 2015|Oral Cancer News|

Depression and smoking linked to worse prognosis in oral cancer

Source: medicalresearch.com
Author: staff

MedicalResearch.com Interview with: Dr. Eileen H. Shinn PhD
Assistant Professor, Department of Behavioral Science
Cancer Prevention and Population Sciences, MD Anderson Cancer Center

Medical Research:
What is the background for this study? What are the main findings?

Dr. Shinn:
Recent studies with leukemia, breast, lung, renal and liver cancer patients have shown that patients with depression have worsened survival. These effect sizes are small, but independent of any of the traditional factors that are known to impact survival, such as extent of cancer, types of treatment administered and baseline health and age of the patient. The current thinking is that cancer patients who are depressed have chronically heightened responses to stress; the constant release of stress hormones trigger changes in the tumor itself (such as noradrenergically-driven tumor angiogenesis) or may weakens the body’s immune function and ability to resist tumor growth.

When we measured depression in newly diagnosed patients with oropharyngeal cancer (cancer of the base of tongue and tonsil), we found that those patients who scored as depressed were 3.5 times more likely to have died within the five year period after their diagnosis, compared to non-depressed patients. We also found that patients who were depressed were also 3.8 times more likely to have their cancer recur within the first five years after diagnosis. We also found that patients who continued to smoke after diagnosis were more likely to recur within the first five years. These effect sizes were larger than those typically found in recent studies. We believe that the larger effect size may be due to the tight eligibility criteria ( e.g., we did not include patients who already had recurrent disease, we only included patients with one specific type of head and neck cancer, oropharyngeal) and also due to controlling other known factors (all patients completed individualized treatment regimens of radiation/ chemoradiation at a comprehensive cancer center and patients with more advanced disease stage were more likely to have received treatment intensification compared to patients with early stage disease). In all, we had 130 patients, one of the largest prospective studies with oropharyngeal cancer to examine the effect of depression on cancer outcome.

Medical Research:
What should clinicians and patients take away from your report?

Dr. Shinn:
With important factors, such as careful diagnosis, staging and individualized multidisciplinary treatment plans, being equal, depression status may impact patient recurrence and survival in oropharyngeal cancer.

Medical Research:
What recommendations do you have for future research as a result of this study?

Dr. Shinn:
These results need to be replicated in a larger study, with particular attention paid to repeated measures of depression as well as possible bio-behavioral markers of tumor growth and chronic stress.

December, 2015|Oral Cancer News|

Factors linked with better survival in oral cancer identified

Source: www.cancertherapyadvisor.com
Author: staff

Factors associated with improved survival in oral cavity squamous cell cancer (OCSCC) include neck dissection and treatment at academic or research institutions, according to a study published in JAMA Otolaryngology-Head & Neck Surgery.

Alexander L. Luryi, from the Yale University School of Medicine in New Haven, Conn., and colleagues analyzed correlations between treatment variables and survival in patients with stages I and II OCSCC. Data were included for 6,830 patients.

The researchers found that five-year survival was 69.7 percent. Treatment factors that correlated with improved survival on univariate analysis included treatment at academic or research institutions, no radiation therapy, no chemotherapy, and negative margins (all P < 0.001).

Improved survival was also seen in association with neck dissection (P = 0.001). Treatment at academic or research institutions correlated with increased likelihood of receiving neck dissection and decreased likelihood of receiving radiation therapy or having positive margins.

Neck dissection and treatment at academic or research institutions correlated with improved survival on multivariate analysis (hazard ratios, 0.85 and 0.88, respectively), while compromised survival was seen for positive margins, insurance through Medicare, and adjuvant radiation therapy or chemotherapy (hazard ratios, 1.27, 1.45, 1.31, and 1.34, respectively).

“Overall survival for early OCSCC varies with demographic and tumor characteristics but also varies with treatment and system factors, which may represent targets for improving outcomes in this disease,” the authors write.

Reference
Luryi, Alexander L., BS, et al. “Treatment Factors Associated With Survival in Early-Stage Oral Cavity Cancer: Analysis of 6830 Cases From the National Cancer Data Base.” JAMA Otolaryngology – Head & Neck Surgery. doi:10.1001/jamaoto.2015.0719. [epub ahead of print]. May 14, 2015.

Possibility of cure For HPV positive throat cancer patients—new research

Source: au.ibtimes.com
Author: Samantha Richardson

A new research conducted by Dr. Sophie Huang, assistant professor in the Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada revealed that throat cancer caused by the Human Papilloma virus (HPV+) can possibly be cured. The research is of utmost importance as it is the first to provide substantial evidence to prove that patients suffering from oropharynx cancer can be healed.

The disease also spreads to other parts of the body. The press release disclosed that the tumours remain passive and go undetected for over two years in most case, which makes it incurable. The research was presented at the 5th International Conference on Innovative Approaches in Head and Neck Oncology (ICHNO) on Friday. She states that cure is possible among patients suffering from oropharyngeal cancer is possible for the first time.

“Our research, the largest study to date to explore survival predictors for metastatic HPV+ and HPV- oropharyngeal cancer patients,” says Dr. Huang.

For the research, 934 patients suffering from HPV+ OPC were studied. All subjects were patients treated at the Princess Margaret Cancer Centre between 2000 and 2011. The researchers found two types of distinct metastases or tumours in other parts of the body away from the source in HPV+ patients: “explosive” and “indolent” metastases. The former grows and spreads quicker while the latter is slower and manifests itself as oligometastasis. However, they found the lung as the most common metastatic site in both HPV+ and HPV- patients. According to Dr. Huang, more aggressive treatments solely aimed at disease control resulted in a long term disease-free period, suggesting that some may be cured.

“In the HPV+ group with oligometases 25% were still alive after three years, whereas the percentage in the HPV- group was 15%,” the press release stated. The reason for higher survival rates among HPV+ patients is the younger age of the patients. In addition, the cancer is more sensitive to radiotherapy and chemotherapy. Those who receive treatment are at an advantage and can survive longer than those who do not undergo the process. Early detection of metastases and aggressive treatment can cure the patient.

Dr. Huang explained that they were aware of the correlation between the initial stages and the risk of a tumour on another site of the body. However, the degree by which they are related remains unknown. She highlights that identifying such relationships could help find an appropriate treatment at an early stage.

Professor Jean Bourhis, co-chair of the conference scientific committee, says that this is a very important research with respect to finding the cure of oropharynx cancer. He states that it provides hope in both the treatment and diagnosis of the patients.

February, 2015|Oral Cancer News|

Coupling head and neck cancer screening and lung cancer scans could improve early detection, survival

Source: www.medicalnewstoday.com
Author: staff

Adding head and neck cancer screenings to recommended lung cancer screenings would likely improve early detection and survival, according to a multidisciplinary team led by scientists affiliated with the University of Pittsburgh Cancer Institute (UPCI), a partner with UPMC CancerCenter.

In an analysis published in the journal Cancer and funded by the National Institutes of Health (NIH), the team provides a rationale for a national clinical trial to assess the effectiveness of adding examination of the head and neck to lung cancer screening programs. People most at risk for lung cancer are also those most at risk for head and neck cancer.

“When caught early, the five-year survival rate for head and neck cancer is over 83 percent,” said senior author Brenda Diergaarde, Ph.D., assistant professor of epidemiology at Pitt’s Graduate School of Public Health and member of the UPCI. “However, the majority of cases are diagnosed later when survival rates generally shrink below 50 percent. There is a strong need to develop strategies that will result in identification of the cancer when it can still be successfully treated.”

Screening patients for head and neck cancer and lung cancer could improve early detection and survival.

Screening patients for head and neck cancer and lung cancer could improve early detection and survival.

Head and neck cancer is the world’s sixth-most common type of cancer. Worldwide every year, 600,000 people are diagnosed with it and about 350,000 die. Tobacco use and alcohol consumption are the major risk factors for developing the cancer.

The early symptoms are typically a lump or sore in the mouth or throat, trouble swallowing or a voice change, which are often brushed off as a cold or something that will heal. Treatment, particularly in later stages, can be disfiguring and can change the way a person talks or eats.

Dr. Diergaarde and her team analyzed the records of 3,587 people enrolled in the Pittsburgh Lung Screening Study (PLuSS), which consists of current and ex-smokers aged 50 and older, to see if they had a higher chance of developing head and neck cancer.

In the general U.S. population, fewer than 43 per 100,000 people would be expected to develop head and neck cancer annually among those 50 and older. Among the PLuSS participants, the rate was 71.4 cases annually per 100,000 people.

Recently, the U.S. Preventive Services Task Force*, as well as the American Cancer Society and several other organizations, recommended annual screening for lung cancer with low-dose computed tomography in people 55 to 74 years old with a smoking history averaging at least a pack a day for a total of 30 years. The recommendation came after a national clinical trial showed that such screening reduces lung cancer mortality.

“Head and neck cancer is relatively rare, and screening the general population would be impractical,” said co-author David O. Wilson, M.D., M.P.H., associate director of UPMC’s Lung Cancer Center. “However, the patients at risk for lung cancer whom we would refer for the newly recommended annual screening are the same patients that our study shows also likely would benefit from regular head and neck cancer screenings. If such screening reduces mortality in these at-risk patients, that would be a convenient way to increase early detection and save lives.”

Dr. Diergaarde’s team is collaborating with otolaryngologists to design a national trial that would determine if regular head and neck cancer screenings for people referred for lung cancer screenings would indeed reduce mortality.

January, 2015|Oral Cancer News|

Experience counts with radiation for head and neck cancer

Source: www.oncologynurseadvisor.com
Author: Kathy Boltz, PhD

When it comes to specialized cancer surgery, the more experienced the surgeon, the better the outcome is generally true. The same might hold true for radiation therapy used to treat head and neck cancer, according to a new study.

Published in the Journal of Clinical Oncology(1) with an accompanying editorial(2), the study compared survival and other outcomes in 470 patients treated with radiation therapy at 101 treatment centers through a clinical trial held from 2002 to 2005. The trial was sponsored by the National Cancer Institute and organized by the Radiation Therapy Oncology Group (RTOG). It was conducted by researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital in Columbus.

The findings indicated that patients treated at the less-experienced centers were more likely to have cancer recurrence compared with highly experienced centers (62% vs 42%, respectively, at 5 years) and had poorer overall survival compared with those at the highly experienced centers (51% vs 69% 5-year survival, respectively).

“Our findings suggest that institutional experience strongly influences outcomes in patients treated with radiation therapy for head and neck cancer,” said first author Evan Wuthrick, MD. “They indicate that patients do better when treated at centers where more of these procedures are performed versus centers that do fewer.”

Radiation therapy for head and neck cancer requires complex treatment planning that can vary considerably between institutions and physicians. In addition, significant short-term and long-term side effects can occur that require management by a carefully coordinated multidisciplinary care team.

National Comprehensive Cancer Network (NCCN) guidelines recommend that head and neck cancer patients receive treatment at experienced centers, but whether provider experience affects outcomes was previously unknown.

The research team used participation in previous RTOG head and neck cancer clinical trials as a surrogate for experience. They identified 88 low-accruing centers that enrolled an average of four patients yearly to the trials, and 13 high-accruing centers that enrolled an average of 65 patients annually. Next, the researchers compared outcomes based on whether patients were treated at the high-accruing (more experienced) or low-accruing (less experienced) centers.

They found that 5-year local recurrence rates were higher among patients treated at less experienced centers versus more experienced centers (36% vs 21%). The radiation therapy plan was more likely to deviate from protocol at less experienced centers (18% vs 6%).

Treatment at low-accruing centers was associated with a 91% increased risk of death and an 89% increase in progression or death when compared with high-accruing centers.

Institutional elements not assessed by the study that can also influence outcomes included use of a tumor board, the number of colleagues and their years of practice, and ancillary services such as speech and swallowing therapy, diet and nutrition support, and specialized nursing.

References:
1. (2014; doi:10.1200/JCO.2014.56.5218)
2. (doi:10.1200/JCO.2014.58.2239)

January, 2015|Oral Cancer News|

Study suggests that experience counts when it comes to head and neck cancer treatments

Source: medicalxpress.com
Author: staff
 

When it comes to specialized cancer surgery, it’s generally true that the more experienced the surgeon, the better the outcome. The same might hold true for radiation therapy used to treat head and neck cancer, according to a new study led by researchers Evan Wuthrick, MD, assistant professor of radiation oncology at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James), and Maura Gillison, MD, PhD, professor of internal medicine and epidemiology at the OSUCCC – James.

Published in the Journal of Clinical Oncology with an accompanying editorial, the study compared survival and other outcomes in 470 patients treated with radiation therapy at 101 treatment centers through a clinical trial held from 2002 to 2005. The trial was sponsored by the National Cancer Institute and organized by the Radiation Therapy Oncology Group (RTOG).

The findings indicated that patients treated at the less-experienced centers were more likely to have cancer recurrence (62 percent versus 42 percent at five years) and had poorer overall survival compared with those at the highly-experienced centers (51 percent versus 69 percent five-year survival, respectively).

“Our findings suggest that institutional experience strongly influences outcomes in patients treated with radiation therapy for head and neck cancer,” says Wuthrick, the paper’s first author. “They indicate that patients do better when treated at centers where more of these procedures are performed versus centers that do fewer.”

Radiation therapy for head and neck cancer requires complex treatment planning that can vary considerably between institutions and physicians. In addition, significant short-term and long-term side effects can occur that require management by a carefully coordinated multidisciplinary care team. National Comprehensive Cancer Network guidelines recommend that head and neck cancer patients receive treatment at experienced centers, but whether provider experience affects outcomes was previously unknown.

Wuthrick, Gillison and their colleagues used participation in previous RTOG head and neck cancer clinical trials as a surrogate for experience. They identified 88 low-accruing centers that enrolled an average of four patients yearly to the trials, and 13 high-accruing centers that enrolled an average of 65 patients annually. Next, the researchers compared outcomes based on whether patients were treated at the high-accruing (more experienced) or low-accruing (less experienced) centers.

The study’s key findings include:

  • Five-year local recurrence rates were higher among patients treated at less experienced centers versus more experienced centers (36 percent and 21 percent, respectively);
  • The radiation therapy plan was more likely to deviate from protocol at less experienced centers (18 percent versus 6 percent);
  • Treatment at low-accruing centers was associated with a 91-percent increased risk of death and an 89-percent increase in progression or death when compared with high-accruing centers.

Institutional elements not assessed by the study that can also influence outcomes included use of a tumor board, the number of colleagues and their years of practice, and ancillary services such as speech and swallowing therapy, dietetic and nutritional support, and specialized nursing.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
December, 2014|OCF In The News|