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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: We examined process‐related quality metrics for oral squamous cell carcinoma (OSCC) depending on treating facility type across a health system and region. Study Design: Retrospective in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Setting: Single health system and region. Methods: Patients with OSCC diagnosed between 2012 and 2018 were identified from tumor registries of 6 hospitals (1 academic and 5 community) within a single health system. Patients were categorized into 3 care groups: (1) solely at the academic center, (2) solely at community facilities, and (3) combined care at academic and community facilities. Primary outcome measures were process‐related quality metrics: positive surgical margin rate, lymph node yield (LNY), adjuvant treatment initiation ≤6 weeks, National Comprehensive Cancer Network (NCCN)‐guideline adherence. Results: A total of 499 patients were included: 307 (61.5%) patients in the academic‐only group, 101 (20.2%) in the community‐only group, and 91 (18.2%) in the combined group. Surgery at community hospitals was associated with increased odds of positive surgical margins (11.9% vs 2.5%, odds ratio [OR]: 47.73, 95% confidence interval [CI]: 11.2‐275.86, P <.001) and lower odds of LNY ≥ 18 (52.8% vs 85.9%, OR: 0.15, 95% CI: 0.07‐0.33, P <.001) relative to the academic center. Compared with the academic‐only group, odds of adjuvant treatment initiation ≤6 weeks were lower for the combined group (OR: 0.30, 95% CI: 0.13‐0.64, P =.002) and odds of NCCN guideline‐adherent treatment were lower in the community only group (OR: 0.35, 95% CI: 0.18‐0.70, P =.003). Conclusion: Quality of oral cancer care across the health system and region is comparable to or better‐than national standards, indicating good baseline quality of care. Differences by facility type and fragmentation of care present an opportunity for bringing best in‐class cancer care across an entire region. [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]

Objective: While tobacco use is understood to negatively impact HPV+ oropharyngeal squamous cell carcinoma (OPSCC) outcomes, debate remains as to how this impact differs between cohorts. Multiple smoking metrics have been identified as having the greatest prognostic significance, and some recent works have found smoking to have no significant impact. Herein, we show through an analysis of four common smoking metrics that while smoking impacts overall survival (OS), it has a limited impact on recurrence‐free survival (RFS) in our cohort. Methods: We conducted a retrospective review of patients treated for HPV+ OPSCC in our health system from 2012 to 2019. Patients with metastatic disease or concurrent second primaries were excluded. Four metrics of tobacco use were assessed: current/former/never smokers, ever/never smokers, and smokers with >10 or >20 pack‐year (PY) smoking histories. Our main outcomes were 3‐year RFS and OS. Results: Three hundred and sixty‐seven patients met inclusion criteria. 37.3% of patients (137/367) were never‐smokers; 13.8% of patients (51/367) were currently smoking at diagnosis and 48.8% of patients (179/367) were former smokers. No tobacco‐use metric significantly impacted 3‐year RFS. On univariate analysis, all smoking metrics yielded inferior OS. On multivariate analysis, current and ever smoking status significantly impacted 3‐year OS. Conclusion: The impact of tobacco use on HPV+ OPSCC outcomes is not universal, but may instead be modulated by other cohort‐specific factors. The impact of smoking may decrease as rates of tobacco use decline. Level of Evidence: 3 (Cohort and case–control studies) Laryngoscope, 134:3158–3164, 2024 [ABSTRACT FROM AUTHOR]

With the American Joint Committee on Cancer (AJCC) 8th edition staging guidelines update, human papillomavirus‐positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is now staged separately from its HPV‐negative counterpart, preventing meaningful comparison of cases staged with the 7th versus 8th edition criteria. Manual restaging is time‐consuming and error‐prone, hindering multiyear analyses for HPV+ OPSCC. We developed an automated computational tool for re‐classifying HPV+ OPSCC pathological and clinical tumor staging from AJCC 7th to 8th edition. The tool is designed to handle large data sets, ensuring comprehensive and accurate analysis of historic HPV+ OPSCC data. Validated against institutional and National Cancer Database data sets, the algorithm achieved accuracies of 100% (95% confidence interval [CI] 98.8%‐100%) and 93.4% (95% CI 93.1%‐93.7%), successfully restaging 326/326 and 26,505/28,374 cases, respectively. With its open‐source design, this computational tool can enhance future HPV+ OPSCC research and inspire similar tools for other cancer types and subsequent AJCC editions. [ABSTRACT FROM AUTHOR]

With the increasing consolidation of physician practices, private equity (PE) firms have been playing a growing role in healthcare delivery and recently began entering the otolaryngology‐head and neck surgery space. To date, no studies have examined the extent of PE investment in otolaryngology. We assessed trends and geographic distribution of US otolaryngology practices acquired by PE using Pitchbook (Seattle, WA), a comprehensive market database. From 2015 to 2021, 23 otolaryngology practices were acquired by PE. The number of PE acquisitions increased over time: 1 practice was acquired in 2015 versus 4 practices in 2019 versus 8 practices in 2021. Nearly half (43.5%, n = 10) of acquired practices were in the South Atlantic region. The median number of otolaryngologists at these practices was 5 (interquartile range: 3‐7). As PE investment in otolaryngology continues to grow, further research is needed to assess its impact on clinical decision‐making, healthcare costs, physician job satisfaction, clinical efficiency, and patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To investigate rates of Surgical Care Improvement Project (SCIP) guideline adherence with regard to intraoperative antibiotic prophylaxis in head and neck surgery with free tissue transfer. Study Design: Retrospective case series. Setting: A single academic center. Methods: All patients who underwent mucosa‐violating head and neck oncologic surgery with free tissue transfer between March 2017 and June 2019 were reviewed. Intraoperative antibiotic data included type, dosage, frequency of administration, and duration. Any deviation from SCIP recommendations was defined as nonadherence. Antibiotic type was categorized as ampicillin‐sulbactam, cefazolin/metronidazole, clindamycin, and others. As a secondary exploratory analysis, postoperative infections were analyzed and stratified by adherent vs nonadherent and by antibiotic type. Results: A total of 129 surgical procedures were included. The mean ± SD number of antibiotic doses during surgery was 3.16 ± 1.2. The mean number of missed doses was 1.86 ± 1.65. Adherence rate with first dosing recommendation was 100%, as compared with 41.7% for dose 2, 23.1% for dose 3, 13.7% for dose 4, 5.26% for dose 5, 2.56% for dose 6, and 0% for dose 7 (P <.001). Ampicillin‐sulbactam (6.4%) had a significantly lower rate of average redosing adherence when compared with cefazolin/metronidazole (73.2%) and clindamycin (63.3%; P <.001). Conclusion: Significant opportunities exist in SCIP guideline adherence rates for intraoperative antibiotic prophylaxis. Cefazolin/metronidazole had a significantly higher rate of appropriate redosing when compared with ampicillin‐sulbactam, which should be considered when choosing a prophylactic antibiotic regimen and performing antibiotic‐based outcomes studies. More attention should be given to intraoperative antibiotic prophylaxis in head and neck surgery with free tissue transfer, as this presents an opportunity for quality improvement and future study heretofore not explored. [ABSTRACT FROM AUTHOR]

Objective(s): We aimed to develop a machine learning (ML) model to accurately predict the timing of oral squamous cell carcinoma (OSCC) recurrence across four 1‐year intervals. Methods: Patients with surgically treated OSCC between 2012–2018 were retrospectively identified from the Yale‐New Haven Health system tumor registry. Patients with known recurrence or minimum follow‐up of 24 months from surgery were included. Patients were classified into one of five levels: four 1‐year intervals and one level for no recurrence (within 4 years of surgery). Three sets of data inputs (comprehensive, feature selection, nomogram) were combined with 4 ML architectures (logistic regression, decision tree (DT), support vector machine (SVM), artificial neural network classifiers) yielding 12 models in total. Models were primarily evaluated using mean absolute error (MAE), lower values indicating better prediction of 1‐year interval recurrence. Secondary outcomes included accuracy, weighted precision, and weighted recall. Results: 389 patients met inclusion criteria: 102 (26.2%) recurred within 48 months of surgery. Median follow‐up time was 25 months (IQR: 15–37.5) for patients with recurrence and 44 months (IQR: 32–57) for patients without recurrence. MAE of 0.654% and 80.8% accuracy were achieved on a 15‐variable feature selection input by 2 ML models: DT and SVM classifiers. Conclusions: To our knowledge, this is the first study to leverage multiclass ML models to predict time to OSCC recurrence. We developed a model using feature selection data input that reliably predicted recurrence within 1‐year intervals. Precise modeling of recurrence timing has the potential to personalize surveillance protocols in the future to enhance early detection and reduce extraneous healthcare costs. Level of Evidence: 3 Laryngoscope, 133:1652–1659, 2023 [ABSTRACT FROM AUTHOR]

Background Head and neck squamous cell cancer (HNSCC) occurs at higher rates among persons with HIV (PWH). This study compares the impact of sociodemographic and clinicopathologic characteristics on outcomes among PWH-HNSCC compared with HNSCC patients without HIV. Methods Patient data from HNSCC individuals were collected at a single academic hospital center between 2002 and 2018. Forty-eight patients with HIV (HIV-HNSCC) and 2894 HNSCC patients without HIV were included. Multivariate analysis determined predictors of survival using Cox proportional hazards regression model. HIV-positive and -negative tumors were analyzed by quantitative immunofluorescence for expression of CD4, CD8, CD20 and PD-L1. Results HIV-HNSCC patients had a lower median overall survival than HNSCC patients without HIV (34 [18–84] vs 94 [86–103] months; P <.001). In multivariate analysis that included age, sex, race/ethnicity, stage, site, tobacco use, time to treatment initiation, and insurance status, HIV was an independent predictor of poorer survival, with a hazard ratio of 1.98 (95% CI: 1.32–2.97; P <.001). PWH with human papillomavirus (HPV)–positive oropharyngeal tumors also had worse prognosis than HPV-positive oropharyngeal tumors in the population without HIV (P <.001). The tumor microenvironment among HIV-HNSCC patients revealed lower intratumoral CD8 infiltration among HIV+ HPV+ tumors compared with HIV– HPV+ tumors (P =.04). Conclusions HIV-HNSCC patients had worse prognosis than the non-HIV population, with HIV being an independent predictor of poor clinical outcomes when accounting for important sociodemographic and clinicopathologic factors. Our findings highlight differences in tumor biology that require further detailed characterization in large cohorts and increased inclusion of PWH in immunotherapy trials. [ABSTRACT FROM AUTHOR]