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Summary Objectives Transoral Robotic Surgery (TORS) has emerged as an alternative to radiotherapy or chemoradiotherapy for the treatment of oropharyngeal squamous cell carcinoma (OPSCC). Many centers restrict the use of TORS to early (T1–2) OPSCC. The purpose of this article was to assess oncologic and functional outcomes of TORS for primary treatment of early OPSCC. Study design Systematic review. Methods A systematic literature search was performed for all relevant English language studies using Embase, Medline, and Pubmed. Our primary outcome measure was local control; secondary outcomes included overall survival (OS) and tracheostomy tube (TT) and gastrostomy tube (GT) dependence rates. Three authors independently extracted study information and analyzed all included articles for quality and bias using the Newcastle–Ottawa Quality Assessment Scale. Results A total of 206 papers were identified, with 11 meeting the inclusion criteria (190 patients). For T1–2 OPSCC, the aggregate local control rate was 96.3% with an OS rate of 95.0%. Rates of prolonged (>12 month) TT and GT dependence were 0.0% and 5.0% respectively. Conclusions This systematic review suggests that TORS offers high rates of disease control with low rates of long-term TT or GT dependence in T1–2 OPSCC. However, further study is needed to compare TORS outcomes to those of traditional therapies.

Summary Objective To investigate the association between head and neck cancer (HNC) incidence and socioeconomic status (SES) in Canada, and investigate changes in the relationship between HNC incidence and SES from 1992 to 2007. Materials and methods Cases were drawn from the Canadian Cancer Registry (1992–2007), and were categorized into three subsites: oropharynx, oral cavity, and “other” (hypopharynx, larynx, and nasopharynx). Demographic and socioeconomic information were extracted from the Canadian Census of Population data for the study period (1992–2007), which included four census years. We linked cases to income quintiles (InQs) according to patients’ postal codes. Results Incidence rates in the lowest InQs were significantly higher than in the highest InQs for all HNC subsites. The incidence of oropharyngeal cancer increased over the time period 1992–2007 for all InQs. However, the greatest increase in incidence was in the highest InQs. As a result, over the time period the gap between the incidence of the highest and lowest InQs significantly narrowed for oropharyngeal cancer. For oral cavity cancer and the other head and neck cancers, the overall incidence did not increase and the gap in incidence did not change significantly. Conclusion HNC incidence was higher with lower income in all HNC subsites in Canada from 1992 to 2007. The gap in incidence between the highest and the lowest InQs narrowed for oropharyngeal cancer over the time period studied, but was unchanged for the other HNC subsites.

To determine if socio-economic status (SES) affects the stage at presentation of head and neck cancer (HNC) patients in Ottawa, Canada. To determine if the method of diagnosis affects the stage at presentation in these patients. We obtained data on SES, method of diagnosis, and stage at presentation for patients presenting to the head and neck cancer clinic at The Ottawa Hospital Regional Cancer Centre (TORCC). We performed a logistic regression analysis using stage at presentation as the dependent variable. We found no statistically significant association between average family income (by postal code) and stage at presentation. We found that oral cancers presented at a later stage compared with other HNCs but that who made the diagnosis was an important factor. Oral cancers diagnosed by a dentist had 3.44 times the odds of being at a later stage than other HNCs (CI 1.01-11.96), but oral cancers diagnosed by other means had 11.42 times the odds of being at a later stage than other HNCs. We found that male patients presented at a later stage than female patients (OR 2.62, CI 1.03-6.63). Finally, former smokers had about 1/3 the odds of presenting at a later stage than current smokers (OR 0.33, CI 0.13-0.84) although nonsmokers were not significantly less likely than current smokers to present later (OR 0.47, CI 0.17-1.32). We found no evidence that in Ottawa, Canada patients of a lower SES with HNC presented at an different stage than patients with higher SES. We found that patients presenting with oral cancers presented at an earlier stage if they were diagnosed by a dentist.

Summary In an earlier study we identified an increased incidence of head and neck cancer (HNC) in individuals with lower socio-economic status (SES) in the United States. The objective of this study was to determine if lower SES is associated with a similar increase in the incidence of HNC in Canadian patients. We obtained data on SES (income, education and immigration status), demographic characteristics, frequency of dental visits and smoking behavior for adult patients residing in the Eastern Ontario region who were referred to the Ottawa Regional Cancer Centre with HNC. We compared the SES and frequency of dental visits of these HNC patients with the SES and frequency of dental visits of a control sample in the same region from the 2004–2005 Statistics Canada Canadian Community Health Survey (CCHS 3.1). We then performed a logistic regression analysis on the combined sample of patients and controls using incidence of HNC as the dependent variable. This allowed us to eliminate confounding variables such as tobacco intake and to isolate the effect of SES, frequency of dental visits, and immigration status on HNC incidence. There was a statistically significant decrease in the incidence of HNC among adults with a higher median family income (OR = 0.5429, CI = [.3352, .8795]). Also, adults with less than grade 8 education had significantly higher rates of HNC than adults who had completed high school (OR 3.65, CI = [1.88, 7.08]). As well, immigrants had a significantly lower incidence of HNC than Canadian born adults (OR = 0.3825, CI = [.2063, .7090]). Lastly, we found that individuals who typically visited a dentist less than once per year had a significantly higher incidence of HNC than individuals who typically visited a dentist at least once per year (OR = 1.69, CI = [1.01, 2.83]). Even when controlling for tobacco intake, the incidence of HNC in Eastern Ontario was higher in patients with lower median family income and less than grade 8 education. It was higher in individuals who visited a dentist less than once per year, and lower in immigrants to Canada. This was similar to what has been observed in the United States. Further study into the reason for this increased incidence of HNC in patients with lower SES is warranted.