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Malpractice claims data include valuable information about patient safety. We used mixed methods to analyze claims against medical oncologists (MO) from 2008 to 2019 using a national database. MO claims were compared to a group of other internal medicine subspecialties (OIMS). Logistic regression was used to examine correlates of closing with an indemnity payment. A subset of claims against MO were thematically analyzed using a validated safety incident taxonomy as a framework. 456 claims against MO were compared with 5771 claims against OIMS. MO claims closed with indemnity payments 29.8% of the time versus OIMS 30.3% (p = 0.87). Median MO and OIMS indemnity payments were similar ($190,591 vs. $233,432; p = 0.20). Correlates of MO claims closing with payment included patient assessment, communication among providers, and safety and security as contributing factors. Thematic analysis identified provider cognitive error, adverse drug events and relational problems as the most common safety incidents. MO malpractice claims have similar outcomes to OIMS. We demonstrate the proof‐of‐concept of applying a safety incident taxonomy to medical malpractice. Finding ways to reduce patient exposure to provider cognitive errors, adverse drug reactions, and communication breakdowns should be strategic priorities for safer cancer care. [ABSTRACT FROM AUTHOR]

Background: Associations between patient‐reported outcomes and dose to organs at risk (OARs) may promote management and guide future investigations. Methods: We retrospectively evaluated PROs and OAR dose in head and neck (H&N) cancer. Results: In 169 patients, we identified weak associations between: "Difficulty swallowing/chewing" and increased mean RT dose to the oral cavity, larynx, pharyngeal constrictor muscles (PCM) and contralateral parotid; "choking/coughing" and larynx mean dose; "problems with mucus in mouth and throat" and oral cavity, contralateral parotid mean dose and parotid V30, contralateral submandibular gland and PCM mean dose; "difficulty with voice/speech" and oral cavity, contralateral parotid, contralateral submandibular gland and larynx mean dose; and "dry mouth" and ipsilateral submandibular gland, oral cavity and PCM mean dose. Conclusion: We identified weak associations between PRO and dose to OARs—these data can guide on treatment management, patient counseling, and serve as a baseline for future investigations. [ABSTRACT FROM AUTHOR]

A randomized phase 3 trial results of the treatment of squamous-cell carcinoma of head and neck is presented. Patients receiving docetaxel plus cisplatin and fluorouracil induction chemotherapy plus chemoradiotherapy showed longer survival than those receiving cisplatin and fluorouracil induction chemotherapy plus chemoradiotherapy.

Background: There is limited information on the management and outcomes of oligometastases (OM) in adenoid cystic carcinoma (ACC). Methods: Retrospective study of 42 patients with metastatic ACC of the head and neck. Imaging studies were analyzed to identify patients with OM (1–5 lesions) at any point during follow‐up. Results: There was radiographic evidence of OM in 33/42 (79%) patients. Eighteen patients had OM when treated for metastases, with median overall survival (OS) of 36.0 versus 9.2 years for patients with polymetastases (6+ lesions, HR 0.38, 95%CI 0.14–0.89). Earlier locally ablative treatment, but not systemic treatment, of patients with OM predicted improved survival 3 years after metastasis (HR 0.15, 95%CI 0.02–0.63) and postponed systemic treatment by 80 more months (HR 0.22, 95%CI 0.07–0.71). Conclusions: There is a considerable population of ACC patients with detectable oligometastases, and early locally ablative treatment of oligometastases may be associated with improved outcomes. [ABSTRACT FROM AUTHOR]

Background: Patients with head and neck cancer (HNC) treated with radiation therapy (RT) are at risk for jaw osteoradionecrosis (ORN), which is largely characterized by the presence of exposed necrotic bone. This report describes the incidence and clinical course of and risk factors for exposed intraoral bone in the multicenter Observational Study of Dental Outcomes in Head and Neck Cancer Patients (OraRad) cohort. Methods: Participants were evaluated before RT and at 6, 12, 18, and 24 months after RT. Exposed bone was characterized by location, sequestrum formation, and other associated features. The radiation dose to the affected area was determined, and the history of treatment for exposed bone was recorded. Results: The study enrolled 572 participants; 35 (6.1%) were diagnosed with incident exposed bone at 6 (47% of reports), 12 (24%), 18 (20%), and 24 months (8%), with 60% being sequestrum and with 7 cases (20%) persisting for >6 months. The average maximum RT dose to the affected area of exposed bone was 5456 cGy (SD, 1768 cGy); the most frequent associated primary RT sites were the oropharynx (42.9%) and oral cavity (31.4%), and 76% of episodes occurred in the mandible. The diagnosis of ORN was confirmed in 18 participants for an incidence rate of 3.1% (18 of 572). Risk factors included pre‐RT extractions (P =.008), a higher RT dose (P =.039), and tobacco use (P =.048). Conclusions: The 2‐year incidence of exposed bone in the OraRad cohort was 6.1%; the incidence of confirmed ORN was 3.1%. Exposed bone after RT for HNC is relatively uncommon and, in most cases, is a short‐term complication, not a recurring or persistent one. The 2‐year incidence of exposed bone in the Observational Study of Dental Outcomes in Head and Neck Cancer Patients cohort is 6.1%, and the incidence of confirmed cases of jaw osteoradionecrosis is 3.1%. Exposed bone after radiation therapy for head and neck cancer is relatively uncommon and, in most cases, is a short‐term complication, not a recurring or persistent one. [ABSTRACT FROM AUTHOR]

Background: Patient Reported Outcome (PRO) data comparing bolus (B‐CP) with weekly (W‐CP) cisplatin concurrent with radiation are lacking. Methods: We performed a retrospective study comparing PRO among 99 patients with head and neck radiation, 26% who received concurrent B‐CP and 73% treated with W‐CP. Results: W‐CP patients had a higher Charlson comorbidity index (CCI) (P =.004). There were no differences in median cisplatin dose, PROs, percutaneous endoscopic gastrostomy (PEG) dependence or hospitalization between arms. Patients with a greater decline in their self‐reported dysphagia score were more often PEG dependent at the end of radiation therapy (P =.03). There was also a trend toward PEG dependence with a higher maximum dysphagia score and greater change in aspiration score (P =.06). The maximum decline in white cell count and absolute neutrophil count were greater in the W‐CP group (P =.04, P =.01). Conclusion: Both B‐CP and W‐CP are well tolerated. PROs do not suggest a benefit to W‐CP. [ABSTRACT FROM AUTHOR]

Background: Although high‐grade salivary gland cancers (SGCs) often express androgen receptor (AR) and/or HER‐2/neu, therapeutically targeting these receptors in SGC remains investigational. We investigated the prevalence of receptor expression and the benefit of adjuvant HER‐2 directed therapy in the high‐risk postoperative setting and explored the clinical utility of sequentially targeting these receptors in the setting of advanced disease. Materials and Methods: We clinically annotated 95 patients with SGC (excluding adenoid cystic carcinoma) treated at our institution from 2002 to 2019 and recorded AR, HER‐2/neu status, and tumor genomic profiling results when available. Clinicopathologic information was then integrated with outcomes. Results: Of 95 patients, most had high‐risk histologies, with salivary duct carcinoma (SDC) as the most frequent diagnosis (43, 45%). Thirty‐five (37%) experienced recurrence (51% SDC). HER‐2/neu was positive (1–3+) by immunostaining in 34 of 52 (65%) evaluable cases. There was no difference in survival based on HER‐2/neu or AR expression. Nine of 17 (53%) patients with HER‐2+ SDC received adjuvant chemoradiation with trastuzumab. Median disease‐free survival (DFS) and overall survival (OS) were longer among patients with HER‐2/neu 3+ staining tumors who received adjuvant trastuzumab versus those who did not (DFS, 117 vs. 9 months; p =.02; OS, 74 vs. 43 months; p =.02), with no difference among other HER‐2/neu subgroups (0–2+). Two of nine (22%) patients treated with adjuvant trastuzumab demonstrated recurrence, both with low HER‐2/neu staining intensity (1+). Longer time to recurrence (hazard ratio, 0.94; p =.01) predicted improved outcomes. Both androgen deprivation and HER‐2‐directed therapies had clinical benefit beyond the first‐line metastatic setting, with partial response observed beyond second‐line use. Conclusion: Although prospective data are lacking, the use of adjuvant trastuzumab in high‐risk patients with SGC appears beneficial, particularly among patients with tumors exhibiting HER‐2/neu 3+ immunostaining. Implications for Practice: Results of this study showed an improved disease‐free and overall survival in patients treated with adjuvant trastuzumab for high‐risk salivary gland cancers with strong HER‐2/neu staining intensity. Following recurrence or metastatic spread, sequential HER‐2, and androgen‐directed therapies may benefit certain patients with salivary gland cancer. This article evaluates long‐term outcomes in patients with HER2‐positive salivary gland cancer (SGC) who received adjuvant HER2‐directed therapy and in patients with recurrent or metastatic non‐adenoid cystic carcinoma SGC treated with sequential androgen deprivation therapy and/or HER2‐directed therapies over time. [ABSTRACT FROM AUTHOR]

Background: There is substantial variation in head and neck cancer (HNC) mortality and competing mortality among patients with HNC. In this study, the authors characterize the causes and risks of short-term mortality among patients with oropharynx cancer (OPC) and how these risks differ by human papillomavirus (HPV) status.Methods: A custom Surveillance, Epidemiology, and End Results (SEER) data set with HPV status was used to identify 4930 patients with OPC who were diagnosed with nonmetastatic (M0) disease from 2013 to 2014, including 3560 (72.2%) HPV-positive patients and 1370 HPV-negative patients. Causes of death and cumulative incidence estimates for HNC-specific mortality, competing mortality, second-cancer mortality, and noncancer mortality were analyzed by HPV status. Risk factors for mortality events were determined using multivariable competing risk regression models.Results: Compared with HPV-negative patients, HPV-positive patients had a lower risk of 2-year cumulative incidence of all-cause mortality (10.4% vs 33.3%; P < .0001) and a lower risk of both HNC-specific mortality (4.8% vs 16.2%; P < .0001) and competing-cause mortality (5.6% vs 16.8%; P < .0001). Second-cancer mortality was the most common cause of non-HNC mortality among HPV-negative patients. Both second-cancer mortality and noncancer mortality were significantly higher among patients who had HPV-negative OPC (10.8% and 6.1%, respectively) compared with those who had HPV-positive OPC (2.4% and 3.2%, respectively; both P < .0001). The median follow-up was 11 months (range 1-23 months) in this cohort with known HPV-status.Conclusions: Patients with HPV-positive and HPV-negative OPC have significantly different rates of both HNC mortality and competing mortality. HPV-negative patients are at substantial risk of competing mortality, even within 2 years of cancer diagnosis. These differences can inform power calculations for clinical trials and patient management in the acute and survivorship settings. [ABSTRACT FROM AUTHOR]