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Background: There has been conflicting evidence on the independent prognostic role of human papillomavirus (HPV) status in sinonasal cancer. The objective of this study was to assess whether the survival of patients with sinonasal cancer differs based on various HPV statuses, including HPV‐negative, positive for the high‐risk HPV‐16 and HPV‐18 (HPV16/18) subtypes, and positive for other high‐risk and low‐risk HPV subtypes. Methods: In this retrospective cohort study, data from the National Cancer Database were extracted from the years 2010–2017 for patients who had primary sinonasal cancer (N = 12,009). The outcome of interest was overall survival based on HPV tumor status. Results: Study included an analytic cohort of 1070 patients with sinonasal cancer who had confirmed HPV tumor status (732 [68.4%] HPV‐negative; 280 [26.2%] HPV16/18‐positive; 40 [3.7%] positive for other high‐risk HPV; and 18 [1.7%] positive for low‐risk HPV). HPV‐negative patients had the lowest all‐cause survival probability at 5 years postdiagnosis (0.50). After controlling for covariates, HPV16/18‐positive patients had a 37% lower mortality hazard than HPV‐negative patients (adjusted hazard ratio, 0.63; 95% confidence interval [CI], 0.48–0.82). Patients aged 64–72 years (crude prevalence ratio, 0.66; 95% CI, 0.51–0.86) and 73 years and older (crude prevalence ratio, 0.43; 95% CI, 0.31–0.59) presented with lower rates of HPV16/18‐positive sinonasal cancer than those aged 40–54 years. In addition, Hispanic patients had a 2.36 times higher prevalence of non‐HPV16/18 sinonasal cancer than non‐Hispanic White patients. Conclusions: These data suggest that, for patients with sinonasal cancer, HPV16/18‐positive disease may confer a significant survival advantage compared with HPV‐negative disease. Other high‐risk and low‐risk HPV subtypes have survival rates similar to the rates for HPV‐negative disease. HPV status might be an important independent prognostic factor in sinonasal cancer that could be used in patient selection and clinical decisions. In this retrospective cohort study, patients who were positive for the human papillomavirus (HPV) 16/18 subtypes had a statistically significant lower hazard of mortality than HPV‐negative patients. HPV tumor status may be prognostic for sinonasal cancer and should be collected routinely in this patient population. [ABSTRACT FROM AUTHOR]

Background: Cost-related medication underuse (CRMU), a measure of access to care and financial burden, is prevalent among cancer survivors. The authors quantified the impact of the Patient Protection and Affordable Care Act (ACA) on CRMU in nonelderly cancer survivors.Methods: Using National Health Interview Survey data (2011-2017) for cancer survivors aged 18 to 74 years, the authors estimated changes in CRMU (defined as taking medication less than prescribed due to costs) before (2011-2013) to after (2015-2017) implementation of the ACA. Difference-in-differences (DID) analyses estimated changes in CRMU after implementation of the ACA in low-income versus high-income cancer survivors, and nonelderly versus elderly cancer survivors.Results: A total of 6176 cancer survivors aged 18 to 64 years and 4100 cancer survivors aged 65 to 74 years were identified. In DID analyses, there was an 8.33-percentage point (PP) (95% confidence interval, 3.06-13.6 PP; P = .002) decrease in CRMU for cancer survivors aged 18 to 64 years with income <250% of the federal poverty level (FPL) compared with those with income >400% of the FPL. There was a reduction for cancer survivors aged 55 to 64 years compared with those aged 65 to 74 years with income <400% of the FPL (-9.35 PP; 95% confidence interval, -15.6 to -3.14 PP [P = .003]).Conclusions: There was an ACA-associated reduction in CRMU noted among low-income, nonelderly cancer survivors. The ACA may improve health care access and affordability in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: The current study was conducted to determine whether the incidence of late-stage head and neck cancer (HNC) is decreasing and to estimate the risk of late-stage HNC diagnosis based on race and sex.Methods: Age-adjusted incidence rates for patients aged ≥18 years with stage IV HNC were abstracted from the Surveillance, Epidemiology, and End Results database (2004-2015). Rates were stratified by race, sex, and age. Joinpoint regression estimated annual percent changes (APCs) in rates over time, and logistic regression estimated adjusted odds ratios (aORs).Results: There were 57,118 patients with stage IV HNC in the current study cohort, with an average age of 61.9 years. From 2004 to 2015, the age-adjusted incidence rates for stage IV HNC significantly increased by 26.1% (6.11 per 100,000 person-years in 2004 to 7.70 per 100,000 person-years in 2015). White and Asian/Pacific Islander/American Indian/Alaska Native patients had significant increases in incidence (APC for white patients, 3.03 [P < .01] and APC for other races, 1.95 [P < .01]), whereas rates among black patients remained stable but were highest across racial groups. Incidence was higher among males compared with females. When restricted only to patients with stage IVC (metastatic) HNC, there remained a significant increase in incidence, especially for oropharyngeal cancer, which showed a 22.9% increase (0.21 per 100,000 person-years in 2004 vs 0.25 per 100,000 person-years in 2015). Despite a decreasing overall incidence of stage IV HNC in black patients (aOR, 1.28; 95% CI, 1.22-1.34) they, along with males (aOR, 3.95; 95% CI, 3.80-4.11), had significantly increased risks of being diagnosed with late-stage HNC.Conclusions: There is an increasing incidence of late-stage HNC in the United States, with male patients and black individuals faring the worst. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors face psychosocial issues that increase their risk of suicide. This study examined the risk of suicide across cancer sites, with a focus on survivors of head and neck cancer (HNC).Methods: The Surveillance, Epidemiology, and End Results 18-registry database (from 2000 to 2014) was queried for the top 20 cancer sites in the database, including HNC. The outcome of interest was suicide as a cause of death. The mortality rate from suicide was estimated for HNC sites and was compared with rates for 19 other cancer sites that were included in the study. Poisson regression was used to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) for 1) HNC versus non-HNC sites (the other 19 cancer sites combined), and 2) HNC versus each individual cancer site. Models were stratified by sex, controlling for race, marital status, age, year, and stage at diagnosis.Results: There were 404 suicides among 151,167 HNC survivors from 2000 to 2014, yielding a suicide rate of 63.4 suicides per 100,000 person-years. In this timeframe, there were 4493 suicides observed among 4219,097 cancer survivors in the study sample, yielding an incidence rate of 23.6 suicides per 100,000 person-years. Compared with survivors of other cancers, survivors of HNC were almost 2 times more likely to die from suicide (aRR, 1.97; 95% CI, 1.77-2.19). There was a 27% increase in the risk of suicide among HNC survivors during the period from 2010 to 2014 (aRR, 1.27; 95% CI, 1.16-1.38) compared with the period from 2000 to 2004.Conclusions: Although survival rates in cancer have improved because of improved treatments, the risk of death by suicide remains a problem for cancer survivors, particularly those with HNC. [ABSTRACT FROM AUTHOR]

The authors reflect on the study "Five-year relative survival for human papillomavirus-associated cancer sites" by H. Razzaghi and colleagues. They discuss the results of the study which offered up-to-date data quantifying the problem of HPV-associated cancer survival. The authors note that the study exposed the reality that at least one-third of all patients die within five years of developing an HPV-associated cancer.