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Background: Health literacy (HL) comprises skills and knowledge required to understand, access, and make decisions about healthcare. Our aim was to examine associations between patient HL and time intervals (defined in the Aarhus statement) along the pathway to treatment of head and neck cancer (HNC). Methods: A prospective cohort study was conducted from October 2018 to March 2020. Participants completed the Health Literacy Questionnaire (HLQ®) and described key events and dates along the pathway to treatment using validated questionnaires. Correlations between six diagnostic time intervals and domains of HL were explored, and factors predicting exceeding maximum acceptable timeframes were assessed using logistic regression. Results: One hundred patients with a diagnosis of HNC within the preceding 6 months were recruited. HLQ® Domain 2 (sufficient information to manage health) was significantly negatively associated with four intervals: the patient interval (first symptom to first presentation), primary care interval (first presentation to referral to secondary care), diagnostic interval (first presentation to diagnosis), and total interval (first symptom to treatment onset); correlation coefficients −0.25 to −0.27 (P < 0.05). Domain 8 (ability to find good information) was significantly negatively associated with three intervals (primary care interval, diagnostic interval, and total interval; correlation coefficients −0.23 to −0.34; P < 0.05). Higher education, age, and comorbidity levels were associated with shorter patient and diagnostic intervals. Conclusions: HL may be a potential target to improve timeliness of HNC diagnosis and reduce disparities in outcomes. [ABSTRACT FROM AUTHOR]

Background Dental restoration is an integral part of head and neck cancer reconstruction. Methods We evaluated the success rate of osseointegrated implants in patients with head and neck cancer, comparing outcomes between implants placed in fibula free flaps to those placed in native mandibular and maxillary bone. Results A total of 1132 implants were placed in 246 patients. The overall implant loss rate was 3.7% and was higher in fibula flaps (8.2%) compared to the native mandible (2.6%) and maxilla (2.2%), although these differences did not reach statistical significance ( p = .059 and p = .053, respectively). The failure rate was 8.0% for implants placed after radiation and 3.6% in patients who did not undergo radiation ( p = .097). Osteoradionecrosis (ORN) occurred in 19 patients (7.7%) after implant placement, and tobacco use was found to be a risk factor ( p = .027). Conclusion Osseointegrated implants are reliable in patients with head and neck cancer, including those undergoing bony free flap reconstruction. © 2015 Wiley Periodicals, Inc. Head Neck 38: E321-E327, 2016 [ABSTRACT FROM AUTHOR]

Background Postoperative radiation therapy (PORT) is frequently recommended to improve survival outcome. The effect of PORT-associated morbidity on patients' quality of life (QOL) is, however, not well established. This study assessed the effect of PORT on medium-term (ie, at 6 months) QOL in patients with oral cavity squamous cell carcinoma (SCC). Methods Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Quality of Life Questionnaire Core Head and Neck 35 (QLQ-HN35) at initial presentation, and at 3-, 6-, and 12-month follow-up. Baseline QOL scores were adjusted for using analysis of covariance (ANCOVA). Results Global health status (mean difference = 13.3; p = .042) and xerostomia (mean difference = 35.4; p = .003) were significantly worse at 6 months in patients who received PORT compared to those treated with surgery alone. Conclusion The survival advantage needs to be balanced against increased treatment toxicity. PORT is associated with reduced global health status, increased xerostomia, and marginally increased levels of fatigue at 6 months posttreatment for oral cavity cancer. © 2013 Wiley Periodicals, Inc. Head Neck 36: 834-840, 2014 [ABSTRACT FROM AUTHOR]

Background Current literature on the effect of postoperative complications on survival outcomes in head and neck cancers remains contradictory. This study assesses whether postoperative complications adversely affect survival in cases of complex surgical ablation and reconstruction of oral squamous cell carcinoma. Methods In all, 255 consecutive patients with complete clinicopathologic data were included. Survival was determined using the log-rank test and Kaplan-Meier survival curves were generated. A Cox proportional hazards model was used to adjust for the effect of other significant covariates to determine the independent effect of complication variables for overall survival (OS). A competing risk model was used for disease-specific survival (DSS). Results On multivariable analysis, major complications independently prognosticated for reduced OS [hazard ratio (HR) 2.4, 95% confidence interval (CI) 1.1-3.2, p = .02]. There was no evidence for an association between any complication-variable and DSS or recurrence. Conclusions Major postoperative complications are independently associated with decreased OS. © 2013 Wiley Periodicals, Inc. Head Neck 36: 55-59, 2014 [ABSTRACT FROM AUTHOR]

Background There is a small subgroup of patients with head and neck cutaneous squamous cell carcinoma (cSCC) in which nodal metastases present concurrently with the primary lesion. There is evidence that these tumors may represent a more aggressive subset of cSCC. The aim of this study was to determine whether alternative clinicopathologic prognostic factors should be applied to this patient cohort. Methods A retrospective analysis of data from prospective databases of 2 large head and neck cancer units in Sydney, Australia, was performed. Ninety-five patients with concurrent primary and nodal metastatic head and neck cSCC were suitable for inclusion in the study. Results Univariable analysis was performed for overall survival (OS) and disease-specific survival (DSS). OS was adversely affected by immunosuppression ( p = .011) and nodal extracapsular spread (ECS) ( p = .006). Similarly, immunosuppression ( p = .005) and ECS ( p = .005) indicated a worse outcome for DSS. ECS and immunosuppression remained significant in the multivariable analysis. Conclusions This study found that adverse prognostic factors were similar to the current evidence for nonconcurrent metastatic cSCC. In particular, the primary lesion had no significant influence on survival. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 [ABSTRACT FROM AUTHOR]

Background It remains unclear how primary tumor factors impact on prognosis in patients with nodal metastasis in head and neck cutaneous squamous cell carcinoma (SCC). The purpose of this study was to assess whether primary tumor characteristics are independent prognostic factors. Methods Patients treated for metastatic cutaneous SCC from 1978 to 2010 were identified ( n = 239). A proportional hazards model was used to assess the effect of primary tumor variables. Results On multivariable analysis, tumor differentiation (hazard ratio [HR], 0.2; 95% confidence interval [CI], 0.1-0.8; p = .03) was found to be significantly associated with disease-specific survival (DSS), unlike margin status ( p = .23), tumor size ( p = .21), and thickness ( p = .11). Patient, treatment, and nodal factors were confirmed to be important predictors of survival. Conclusion This article suggests that pathological features of the primary lesion bear little importance in the presence of established nodal metastasis, other than tumor differentiation. It validates the grouping of T1-3N1 as stage III under the current American Joint Committee on Cancer (AJCC) TNM staging system. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 [ABSTRACT FROM AUTHOR]

Background The parotid is the commonest site of cutaneous metastases in the head and neck. The role and extent of neck dissection in patients with parotid metastatic cutaneous malignancy remains controversial. Methods We reviewed the lymphoscintigraphy and single photon emission CT (SPECT) of patients with melanoma who had a sentinel node in the parotid to determine the second tier cervical lymph nodes. Results Levels II and III cervical nodes make up 82% of second tier lymph nodes for the parotid, and levels IV and V, 12% and 4%, respectively. Second tier lymph nodes isolated to levels I, IV, or V, bypassing levels II and III, occurred in only 2% of cases. Conclusion The risk of harboring occult metastasis in levels I, IV, and V when levels II and III are negative is low. Levels II and III neck dissection is likely to be an effective staging procedure in patients with isolated parotid metastases. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 [ABSTRACT FROM AUTHOR]

Background The seventh edition of the American Joint Committee on Cancer (AJCC) Staging Manual introduced a more detailed system to stage regional lymph node metastases for disease with cutaneous squamous cell carcinoma (SCC). The purpose of this study was to determine if the inclusion of disease staged N2 and N3 together with disease staged M1 is an appropriate grouping within stage IV. Methods A retrospective multicenter analysis was conducted of 603 patients with metastatic cutaneous SCC to compare survival data for regional (N2 and N3) versus distant metastases. Results Disease specific survival (DSS) and overall survival (OS) were much poorer for patients with distant disease compared to those with different stages of regional disease. After 5 years, only 25% of patients with N2 disease and 35% of patients with N3 disease died from their cancer compared with 89% of patients with distant metastases. Conclusion Our results indicate that in cutaneous SCC, stage IV represents a very heterogeneous group. Therefore, N2 and N3 disease should not be grouped with M1 together within AJCC stage IV. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 [ABSTRACT FROM AUTHOR]