Search

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]

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]

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]

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]