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Objective: Characterizing factors associated with palliative care (PC) use in patients with stage III and VI head and neck cancer using Anderson's behavioral model of health service use. Study Design: A retrospective study of the 2004 to 2020 National Cancer Database.gg Methods: We used multivariate logistic regression to assess the association of predisposing, enabling, and need factors with PC use. We also investigated the association of these factors with interventional PC type (chemotherapy, radiotherapy, surgery) and refusal of curative treatment in the last 6 months of life. Results: Five percent of patients received PC. "Predisposing factors" associated with less PC use include Hispanic ethnicity (adjusted odds ratio [aOR], 086; 95% confidence interval [CI], 0.76‐0.97) and white and black race (vs white: aOR, 1.14; 95% CI, 1.07‐1.22). "Enabling factors" associated with lower PC include private insurance (vs uninsured: aOR, 064; 95% CI, 0.53‐0.77) and high‐income (aOR, 078; 95% CI, 0.71‐0.85). "Need factors" associated with higher PC use include stage IV (vs stage III cancer: aOR, 2.25; 95% CI, 2.11‐2.40) and higher comorbidity index (vs Index 1: aOR, 1.58; 95% CI, 1.42‐1.75). High‐income (aOR, 0.78; 95% CI, 0.71‐0.85) and private insurance (aOR, 0.6; 95% CI, 0.53, 0.77) were associated with higher interventional PC use and lower curative treatment refusal (insurance: aOR, 0.82; 95% CI, 0.55, 0.67; income aOR, 0.48; 95% CI, 0.44, 0.52). Conclusion: Low PC uptake is attributed to patients' race/culture, financial capabilities, and disease severity. Culturally informed counseling, clear guidelines on PC indication, and increasing financial accessibility of PC may increase timely and appropriate use of this service. [ABSTRACT FROM AUTHOR]

Objective(s): Describe recent national trends in overall treatment modalities for T1 glottic squamous cell carcinomas (SCC), and identify factors associated with treatment regimens. Methods: National Cancer Database from 2004–2020 was queried for all patients with glottic cT1N0M0 SCC. Treatment patterns over time were analyzed using the Cochran‐Armitage test for trend. Multivariable logistic regressions were used to determine the factors associated with treatment regimens. Results: Of the 22,414 patients identified, most patients received RT only (57%), 21% received surgery only, and 22% received dual‐modality treatment ("over‐treatment"). Over the time period, there was a decreasing trend in rates of over‐treatment for T1 glottic SCC (p < 0.001) and an increasing trend in surgery only (p < 0.001). Treatment in 2016–2018 (OR: 1.168 [1.004 to 1.359]), 2013–2015 (OR: 1.419 [1.221 to 1.648]), 2010–2012 (OR: 1.611 [1.388 to 1.871]), 2007–2009 (OR: 1.682 [1.450 to 1.951]), or 2004–2006 (OR: 1.795 [1.548 to 2.081]) versus 2019–2020 was associated with greater likelihood of over‐treatment. T1b tumors were less likely to be over‐treated (OR: 0.795 [0.707 to 0.894]) versus T1a tumors, and less likely to receive surgery first (OR: 0.536 [0.485 to 0.592]) versus T1a tumors. Conclusion: Over‐treatment for T1 glottic SCC has been declining, with increasing rates of surgery only. Year of treatment was significantly associated with the receipt of dual‐modality treatment. Finally, patients with T1b disease were more likely to receive RT as the first and only treatment. Level of Evidence: 3 Laryngoscope, 134:3633–3644, 2024 [ABSTRACT FROM AUTHOR]

This article discusses the development and validation of a decision aid (DA) for patients newly diagnosed with vestibular schwannoma (VS). The lack of information is identified as a major barrier for patients facing treatment decisions for VS. The study involved the use of virtual focus groups, discussions with treating physicians, and a literature review to identify the 15 items included in the DA. Participants were randomized into groups, with one group receiving the DA and a fact sheet, and the other group receiving only the fact sheet. The primary outcome measure was the difference in Decisional Conflict Scale (DCS) between two time points. The results showed that the use of the DA reduced decisional conflict and increased patient satisfaction with their decision. This study is significant because it is the first randomized control trial (RCT) of a DA for VS patients. [Extracted from the article]