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  • Dihexa br Objective To explore differences

    2022-05-07


    Objective: To explore differences in psychosocial factors between HPV+ OPSCC patients versus OCSCC smokers. Methods: A prospective cohort study at a single multidisciplinary, tertiary care HNC center was completed with recruitment from 2010 to 2013 using self-administered questionnaires before treatment and at 12 months. Patients were included with a diagnosis of HPV+ OPSCC or OCSCC with a smoking history. 38 (21 HPV+ OPSCC/17 OCSCC) met criteria. The main outcomes included self-efficacy, symptom severity, cancer worry, and depression.
    Conclusions and relevance: This pilot study highlighted a pattern of reduced quality of life parameters in OCSCC patients at baseline with similar improvements over time compared to the OPSCC cohort. Although different in cancer etiology and treatment plans, HPV+ OPSCC and tobacco-related OCSCC patients both require multi-disciplinary cancer care plans that address psychosocial concerns.
    Level of evidence: 2B
    Abbreviations: HPV, human papilloma virus; HNC, head and neck cancer; QoL, quality of life; OPSCC, oropharyngeal squamous cell carcinoma; OCSCC, oral cavity squamous cell carcinoma ☆ This is the first submission on this topic.
    ☆☆ The authors have no funding, financial relationships, or conflicts of interest to disclose.
    Corresponding Author at: 135 Rutledge Ave., Charleston, SC 29425, United States of America. E-mail address: [email protected] (T.A. Janz).
    1. Introduction
    Head and neck cancers (HNC) affect over 600,000 patients yearly worldwide [1]. Additionally, squamous cell carcinoma accounts for over 90% of oral or oropharynx cancers within the United States [2]. However, a dramatic shift in the HNC patient Dihexa has occurred. Over the past three decades, the number of cases of HNC related to alcohol and tobacco has decreased while the number of cases related to the human papilloma virus (HPV) has increased [3]. While advance-ments in treatments for patients with HNC have impacted outcomes, survival beyond 5 years has not improved [4–6]. In response to the high mortality of HNC, treatment modalities have become both targeted and aggressive. While aggressive therapies may improve patient survival, symptoms and toxicities commonly arise and affect a patient's quality of life (QoL) [7–9]. Patients with HNC experience changes in physical and emotional well-being during their care. For example, during HNC radiotherapy treatments, patients may experience high levels of psychosocial distress [10]. Additionally, physical symptoms such as xerostomia and dys-phagia are commonly encountered throughout a patient's cancer course [11]. Furthermore, patients at different points in their cancer care or who have different types of HNC may differ in their reported QoL [12]. Therefore, identifying unique factors associated with HNC patients' QoL may direct the implementation of customized patient care plans to meet each patient's needs.
    HNC affects multiple different regions of the head and neck and risk factors vary by cancer site. The role of the human papilloma virus (HPV) in the pathogenesis of oropharyngeal squamous cell carcinoma (OPSCC) is well documented, as is the comparatively improved survival of patients with HPV-associated disease [13]. Patients with HPV related disease are younger, have fewer comorbid conditions, and have lower rates of tobacco and alcohol abuse [3]. In contrast, oral cavity squa-mous cell carcinoma (OCSCC) is associated with tobacco and alcohol use [14,15]. As clinical management (i.e., staging and treatment) of the two groups evolves, it becomes important to also understand patient experiences. Specifically, the 2018 AJCC staging specifies a new staging algorithm for HPV+ OPSCC which will allow for the proper intensity of therapy to be determined for these patients [16]. While etiology, pre-sentation, staging, treatment, and survival differ between OPSCC and OCSCC patients, recent research has shown mixed results regarding whether psychosocial factors differ by HNC type [17–21]. Thus, it re-mains unknown whether patient experiences and outcomes differ be-tween these two groups.
    Therefore, this pilot study was performed to explore demographic, behavioral, and psychosocial factors in HPV+ OPSCC patients and to-bacco-related OCSCC patients. This study used prospective, self-re-ported measures of depression, cancer worry, health behaviors, self-efficacy, and tobacco and alcohol use at diagnosis and at a 12-month follow-up and evaluated potential differences in psychosocial factors between the HPV+ OPSCC patients and OCSCC tobacco users. These findings will help providers understand whether differences exist be-tween these two patient populations and how to best address each patient's comprehensive care needs.