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PURPOSE: While pain is prevalent among survivors of head and neck cancer (HNC), there is a lack of data on pain management in the community oncology setting. We described sociodemographic correlates and disparities associated with patient-reported pain among patients with HNC. METHODS: We used the 2017-2021 nationwide community oncology data set from Navigating Cancer, which included electronic patient-reported outcomes. We identified a retrospective cohort of patients diagnosed with HNC (N = 25,572), with ≥ 1 patient-reported pain event. We adjusted for demographic (sex, age, smoking history, marital status) and clinical (cancer site) factors associated with pain reporting and pain resolution by new pain prescription on the basis of race (White v non-White patients), using multivariate logistic regression models. RESULTS: Our analytic cohort included 2,331 patients, 90.58% White, 58.62% married, with an average age of 66.47 years. Of these, 857 patients (36.76%) reported ≥ 1 pain event during study period. Mean resolution time (in minutes) for pain incidents was significantly longer for White patients than non-White patients (99.6 ± 3.2 v 74.9 ± 7.2, P < .05). After adjusting for covariates, smoking was associated with a 25% increased odds of reporting pain incidents (adjusted odds ratio [aOR], 1.25; 95% CI, 1.03 to 1.52). There was no statistically significant difference in odds of pain reporting between White versus non-White patients (aOR, 0.97; 95% CI, 0.73 to 1.30). However, White patients were significantly more likely to receive new prescription for pain than non-White patients (aOR, 2.52; 95% CI, 1.09 to 5.86). CONCLUSION: We found racial differences in patient-reported pain management, with White patients significantly more likely to receive new pain prescriptions. As pain management is a mainstay in cancer care, equity in pain management is critical to optimize quality of life for patients with HNC.

Purpose Privately insured patients with head and neck cancer (HNC) typically have better outcomes; however, differential outcome among Medicaid versus the uninsured is unclear. We aimed to describe outcome disparities among HNC patients uninsured versus on Medicaid. Methods A cohort of 18-64-year-old adults (n = 57 920) with index HNC from the Surveillance, Epidemiology, and End Results 18 database (2007-2015) was analyzed using Fine and Gray multivariable competing risks proportional hazards models for HNC-specific mortality. Results Medicaid (sdHR = 1.65, 95% CI 1.58, 1.72) and uninsured patients (sdHR = 1.55, 95% CI 1.46, 1.65) had significantly greater mortality hazard than non-Medicaid patients. Medicaid patients had increased HNC mortality hazard than those uninsured. Conclusion Compared with those uninsured, HNC patients on Medicaid did not have superior survival, suggesting that there may be underlying mechanisms/factors inherent in this patient population that could undermine access to care benefits from being on Medicaid.

Objectives Human papillomavirus (HPV)-associated cancers account for about 9% of the cancer mortality burden in the United States; however, survival differs among sociodemographic factors. We determine sociodemographic and clinical variables associated with HPV-associated cancer survival. Methods Data derived from the Surveillance, Epidemiology, and End Results 18 cancer registry were analyzed for a cohort of adult patients diagnosed with a first primary HPV-associated cancer (anal, cervical, oropharyngeal, penile, vaginal, and vulvar cancers), between 2007 and 2015. Multivariable Fine and Gray proportional hazards regression models stratified by anatomic site estimated the association of sociodemographic and clinical variables and cancer-specific survival. Results A total of 77 774 adults were included (11 216 anal, 27 098 cervical, 30 451 oropharyngeal, 2221 penile, 1176 vaginal, 5612 vulvar; average age = 57.2 years). The most common HPV-associated cancer was cervical carcinoma (58%) for females and oropharyngeal (81%) for male. Among patients diagnosed with anal/rectal squamous cell carcinoma (SCC), males had a higher risk of death than females. NonHispanic (NH) blacks had a higher risk of death from anal/rectal SCC, oropharyngeal SCC, and cervical carcinoma; and Hispanics had a higher risk of death from oropharyngeal SCC than NH whites. Marital status was associated with risk of death for all anatomic sites except vulvar. Compared to nonMedicaid insurance, patients with Medicaid and uninsured had higher risk of death from anal/rectal SCC, oropharyngeal SCC, and cervical carcinoma. Conclusions There exists gender (anal) and racial and insurance (anal, cervical, and oropharyngeal) disparities in relative survival. Concerted efforts are needed to increase and sustain progress made in HPV vaccine uptake among these specific patient subgroups, to reduce cancer incidence.

This study assessed if race and gender predict known sexual risk factors associated with HPV. Data (n = 301) were from a cross-sectional study conducted at a drag racing event on September 12–13, 2015 in Madison, Illinois. Both multivariable logistic and linear regression models estimated the association between race, gender, and sexual risk factors. About 63% of participants were males, and 65% identified as Blacks. Compared to females, males were more likely to have a higher number of oral sexual partners (OR = 2.10; 95% CI: 1.23, 3.57). Males were also more likely to have earlier oral sexual (b = −2.10; 95% CI: −3.60, −0.60) and vaginal sexual (b = −1.10; 95% CI: −1.69, −0.31) debuts compared to females. Blacks were more likely to have higher number of vaginal sexual partners (OR = 3.38; 95% CI: 1.81, 6.31) and earlier vaginal sex (b = −1.09; 95% CI: −1.78, −0.41) but less likely to have earlier oral sexual debuts compared with Whites (b = 2.67; 95% CI: 1.21, −4.13). Because HPV is associated with several cancers, our findings provide impetus for the development of targeted educational interventions aimed at improving the knowledge of these sexual risk factors, especially among men and across race groups.

Pott's puffy tumor (PPT) is a rare clinical entity characterized by osteomyelitis of the frontal bone with subperiosteal abscess collection. The frequency of reported cases of PPT in the literature has increased in recent years. Previous reviews of PPT exist primarily in the form of small, retrospective case series and anecdotal case reports. Therefore, the aim of this study is to provide the literature's largest comprehensive, up-to-date review of the essential clinical findings, diagnostic modalities, microbiologic considerations, and treatment approaches utilized in the management of PPT, both in pediatric and adult populations.We searched MEDLINE, PubMed, and Embase databases for English-language studies published from January 1950 through January 30, 2022. The authors reviewed all cases of PPT, focusing specifically on those describing therapeutic management of PPT. A total of 321 patients were included, consisting of 318 patients (from 216 articles) and an additional 3 adult cases from our institution.PPT most often results from untreated rhinosinusitis, as well as direct head trauma, substance use, and odontogenic disease. Infections are classically polymicrobial with an anaerobe-predominant microbiome. Both CT and MRI imaging modalities are commonly obtained for presurgical assessment of sinusitis and intracranial extension. The core of treatment is an early and aggressive approach to prevent long-term complications. A significant association exists between surgical management and clinical outcomes for patients with PPT. Recent literature suggests endoscopic sinus surgery is essential for successful disease resolution.PPT is an important and relatively morbid disease process that is often underrecognized and misdiagnosed at presentation due to its variable clinical presentation. Management of PPT includes both antimicrobial therapy and surgical intervention. Determination of the optimal approach depends on patient clinical features including age, history of prior endoscopic sinus surgery, and presence of intracranial involvement on presentation. An individualized, targeted, and interdisciplinary approach to the treatment of PPT is critical for successful disease resolution.

We examined differences in HPV and HPV vaccine knowledge among individuals who use the Internet as their main source of health information versus those who do not. Data were obtained from the Healt...

Objectives To assess head and neck cancer (HNC) patients’ perspectives on the value and burdens of routine cancer follow-up care. Materials and methods Data was obtained from HNC patients (n = 100) at an urban, tertiary head and neck cancer clinic. A novel 15-question survey tool evaluated the logistic, financial, and psychosocial burdens associated with clinic visits. The clinical characteristics and survey responses of demographic groups were analyzed with comparative statistics. Linear regression modeling was utilized to identify predictors of overall stress. Results A majority of study participants were male (74%), white (83%), and had histories of tobacco (77%) and alcohol (77%) use. Most participants were satisfied with the frequency of their office visits (75%). Patients with laryngeal cancer, advanced stage disease, or who underwent multimodality therapy more often desired increased appointment frequency. These patients also rated the burdens of travel cost and overall stress higher, compared to patients desiring visits less often (41.5% vs 28.4%, p = 0.047 and 46.6% vs 38.3%, p = 0.003, respectively). Travel stress was associated with highest overall stress (beta 0.6, CI: 0.4, 0.7). Conclusion The HNC survivor population is uniquely disenfranchised in several social and economic ways. While most patients are satisfied with their follow-up care, a significant subset of patients – those with limited social support, high financial stress, functional deficits, and those with transportation burdens – desire more frequent care. Survivorship care plans should incorporate the perspectives of current survivors.

Objectives There exists a significant gap in vaccine coverage of the human papillomavirus (HPV) among college-aged students. This study assessed sexual risk-taking behavior among university students and analyzed predictors of HPV vaccine initiation and completion in this population. Materials and methods Data (n = 746) were from an anonymous online, cross-sectional survey distributed to university students, between the ages of 19–26 years, at a private Midwestern university. Both chi-square and multivariable logistics regression models estimated the association between sociodemographic characteristics and sexual risk factors (including number of vaginal sexual partners, number of oral sexual partners, initiation of oral sex, and initiation of vaginal sex), with HPV vaccine initiation and completion. Results A significant number of participants (40%) had not received a single dose of the HPV vaccine series. Of those who initiated the series, more than half (51%) did not achieve completion. Additionally, a greater number of participants have had multiple (4 or more) oral sexual partners than vaginal sexual partners (25.7% vs. 20.3%). After adjusting for covariates, it was found that sexual risk factors were not significantly associated with HPV vaccine initiation or completion. Conclusion HPV vaccine initiation and completion rates are suboptimal among university students. High levels of sexual-risk taking behaviors associated with HPV infection persist, yet are not significant predictors of HPV vaccine behaviors in this age group. To increase uptake among 18–26-year-old students, future public health interventions should focus on HPV vaccine education and uptake across the entire population, irrespective of sexual risk profile.

150 Background: There are currently 500,000 head and neck cancer (HNC) survivors in the United States. Pain is common among survivors and associated with adverse quality of life and outcomes. There is however a lack of data on pain management in the community oncology setting, where a growing number of patients may be receiving long-term care. We described sociodemographic correlates of patient-reported pain among HNC patients receiving care in the community setting. Methods: We used data from Navigating Cancer, a nationwide, community-oncology, patient-reported outcomes database that include electronic patient-reported outcomes (ePROs) from 253 cancer clinics and over 1 million cancer survivors. We identified a retrospective cohort of patients diagnosed with HNC after January 1, 2017, with at least one record of patient-reported pain through nurse triage. We characterized demographic and clinical factors associated with any reported pain, and pain resolution by new pain prescription, based on race (white vs. non-white patients), and other sociodemographic characteristics. Results: Our cohort included 3,762 patients, 62.8% white, 45.3% married, with an average age of 66.0 years. Of these, 652 patients (17%) reported at least one pain event during study period. After adjusting for covariates, there was no statistically significant difference in the odds of any reported pain between white vs. non-white patients (aOR = 0.81; 95% CI 0.57, 1.15). However, we found that white HNC patients were significantly more likely to be provided a new prescription for pain management more than non-white patients, (aOR = 4.58; 95% CI 2.23, 9.38). Other factors associated with prescription of new pain prescription included being single/unpartnered (aOR = 1.34; 95% CI 1.03, 1.75) compared to being married/partnered, having Medicare (aOR = 3.07; 95% CI 1.59, 5.93) or commercial insurance (aOR = 2.88; 95% CI 1.54, 5.38) compared to Medicaid. Additionally, male patients were significantly less likely to receive new prescription compared to females (aOR = 0.48; 95% CI 0.37, 0.61). Conclusions: One-in-six HNC patients in the community oncology setting reported pain, and while there were no racial differences in any pain report, white patients were significantly more likely to receive new pain prescription, as were those with Medicare or commercial insurance. There may be disparity in the management of reported pain among HNC survivors based on race.

Key Points Question Does public sentiment of human papillomavirus (HPV) vaccine safety align with spontaneous HPV vaccine adverse event reporting data? Findings This cross-sectional analysis of the 2015 to 2018 National Immunization Survey indicates a 79.9% increase in the proportion of parents who refused the HPV vaccine for their adolescents due to safety concerns. In contrast, estimates from the national vaccine safety surveillance system found that the HPV vaccine adverse event reporting rate per 100 000 doses distributed decreased from 44.7 in 2015 to 29.4 in 2018. Meaning These findings suggest an urgent need to combat safety concerns about the HPV vaccine in the US., This cross-sectional study investigates trends in human papillomavirus (HPV) vaccine adverse event reporting and trends in HPV vaccine safety concerns among caregivers of vaccine-eligible US adolescents from 2015 to 2018., Importance In the US, safety concern has been identified as a primary barrier to initiating the human papillomavirus (HPV) vaccine. It is unclear if the public’s sentiment concerning HPV vaccine safety aligns with postmarketing vaccine safety surveillance data. Objective To perform a parallel assessment of trends in HPV vaccine safety concerns and HPV vaccine adverse event (AE) reporting. Design, Setting, and Participants This study was a cross-sectional analysis of the National Immunization Survey (NIS) and Vaccine Adverse Event Reporting System (VAERS). Participants in the NIS were adolescents aged 13 to 17 years. AEs were reported to VAERS by patients, health care clinicians, or other sources. Statistical analysis was performed from October 2020 to May 2021. Main Outcomes and Measures Secular trends in HPV vaccine safety concerns and spontaneous AE reporting for HPV vaccination from 2015 to 2018. Results Caregivers of 39 364 unvaccinated adolescents with a mean (SD) age of 15.57 (0.08) years (26 996 White adolescents [62.9%], 22 707 male adolescents [56.1%], 11 392 privately insured [62.6%], and 32 674 above the poverty level [79.3%]) reported their reasons for not initiating the HPV vaccine series in the 2015-2018 NIS. Citing safety concerns as the primary reason for not initiating the HPV vaccine series increased from 13.0% (95% CI, 12.1%-14.0%) in 2015 to 23.4% (95% CI, 21.8%-25.0%) in 2018 (P for trend

Objectives: To compare pediatric external auditory canal (EAC) foreign body extraction outcomes by clinical setting and identify factors predictive of successful removal. Methods: Retrospective review of pediatric patients with EAC foreign bodies to a single institution emergency department (ED) and otolaryngology clinic (OTO) between January 2010 and April 2015. Patient characteristics, foreign body type, removal attempts, instrumentation utilized, and complications were evaluated with respect to clinical setting and patient outcome. Results: In all, 1197 patients with EAC foreign bodies were identified, 759 (63%) of whom presented primarily to the ED. Successful removal was achieved in OTO in 92.9% of cases and the ED in 67.9% of cases. Beads and spherical objects had the overall lowest rates of successful removal. Likelihood of removal decreased significantly after one unsuccessful attempt. Complications were reported in 35.7% of patients undergoing removal in the ED and 5.0% of patients undergoing removal in the otolaryngology clinic. Conclusions: Patients commonly present to the ED for removal of EAC foreign bodies. Referral to an otolaryngologist is recommended if the object is spherical or after one unsuccessful attempt at removal.

Background: For women who suffer from abruption in the first pregnancy, the extent to which birth spacing has an impact on maternal and fetal outcomes in a second pregnancy remains unclear.Objectiv...

Objectives: In 2009, there were 48,010 new cases of head and neck cancer in the United States. A decade later, it is projected that there will be 65,410 new cases in 2019, a 36% increase in new cases of the disease. While this number represents the general head and neck cancer population in the United States, only a few studies have described incidence and trends in head and neck cancer in the pediatric, adolescent, and young adult population—individuals who may have to live with the effects of cancer treatment due to a younger than average age of diagnosis. This study aimed to estimate head and neck cancer incidence and trends in the United States’ pediatric, adolescent, and young adult population. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) 9 database from 1975-2016, we analyzed age-adjusted head and neck cancer incidence rates for pediatric cases (aged 0 to 14 years) and young adult cases (aged 15-39 years). We used Joinpoint regression analyses to examine incidence trends stratified by sex (male, female), race (white, blacks, and Others), and age groups (0-14, and 15-39 years). Results: There were 424 pediatric HNC cases and 6,936 adolescent and young adult cases in the study. Whites accounted for 70.6% of cancers, and 57.6% of cancers occurred in males. Overall, there was a 14.7% decrease in the incidence of HNC (1.32 per 100,000 in 1975 vs. 1.12 per 100,000 in 2016). For pediatric cases, there was a 51.2% decrease in incidence of HNC (0.18 per 100,000 in 1975 vs. 0.09 per 100,000 in 2016); in young adults, there was a 12.8% decrease in incidence of HNC (2.01 per 100,000 in 1975 vs. 1.75 per 100,000 in 2016). While there was overall decrease in incidence, we found differences based on sex. Among young adult males, the annual percent change (APC) from 1975 to 2016 was -0.46 (p < 0.05) while among young adult females, it significantly increased by 0.50 (p < 0.05). This difference in young adult male vs. female head and neck cancer incidence may have been driven by race: as stratified by race, the APC for white young adult males was -0.29 (ns) while white females had an APC of 0.55 (p < 0.05); and among black young adults, APC for males was -2.24 (p < 0.05) and APC for females was -0.82 (p < 0.05). Conclusions: Among pediatric, adolescent, and young adults in the United States, head and neck cancer has decreased markedly in all groups in the last four decades, except among white female adolescents and young adults where there has been a significant increase in the time period of the study. As this trend differs from the adult head and neck cancer population, it is critical that further investigations provide more insight into the epidemiology of head and neck cancer among white adolescent and young adult females. Note: This abstract was not presented at the conference. Citation Format: Nosayaba Osazuwa-Peters, Kara M. Christopher, Matthew C. Simpson, Premal B. Desai, Rebecca L. Rohde, Sai D. Challapalli, Adnan S. Hussaini, Neelima Panth, Eric Adjei Boakye. Incidence and trends in head and neck cancer among United States’ pediatric, adolescent, and young adult population [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr A05.

7035 Background: Medicaid expansion has been associated with increased access to care and earlier stage at diagnosis among patients with head and neck cancer (HNC). However, it is unclear whether Medicaid expansion has impacted HNC mortality rates. We examined the associations between early Medicaid expansions (2010-2011) with mortality rates for HNC in the United States. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. SEER*Stat was utilized to obtain mortality rates for early expansion (CA, CT, DC, MN, NJ, and WA) and non-early expansion states (all others) in the year ranges as available in SEER: 2005-2007 (pre-expansion) and 2012-2016 (post-expansion). Deaths in 2008-2011 were excluded as a phase-in/washout period. Difference-in-differences analyses were utilized to compare mortality rates pre- and post-early expansion in early expansion vs. non-early expansion states. The parallel trends assumption was tested comparing changes in HNC mortality rates between early expansion and non-early expansion states from 2002-2004 to 2005-2007 and from 2005-2007 to 2008-2011. Results: There were 6882 and 35459 deaths due to HNC in early expansion and non-early expansion states, respectively. HNC mortality rates (deaths per 100,000) decreased from 2005-2007 to 2012-2016 in both early expansion (2.17 to 1.85, difference = -0.32, 95% CI = -0.42 to -0.22) and non-expansion states (2.59 to 2.43, difference = -0.16, 95% CI = -0.22 to -0.11). Relative to non-expansion states, there was a reduction of 0.16 deaths per 100,000 (95% CI = 0.05 to 0.27, p = 0.007) after early Medicaid expansion in expansion states. However, in parallel trends testing, there was no difference in the change in mortality rates between early expansion and non-expansion states from 2002-2011 (p > 0.37). Conclusions: In this quasi-experimental analysis, there was an association between early Medicaid expansion with decreased HNC mortality. Thus, Medicaid expansion might help decrease disparities associated with access to care among HNC survivors. As longer-term data emerges, additional follow-up will be necessary to understand the mechanisms that underlie the HNC mortality benefits seen in early Medicaid expansion.

Objective Depression is a significant problem for patients with head and neck cancer (HNC). This study explored the prevalence of and sociodemographic and clinical factors associated with depression, among patients with HNC. Methods We performed a retrospective analysis of 71 541 cases of HNC using a national dataset, the Nationwide Inpatient Sample, from 2008 to 2013. Weighted, multivariate logistic regression analysis estimated association between sociodemographic/clinical factors and tumor anatomical site with diagnosis of a major depressive disorder. Results Overall prevalence of major depressive disorder in HNC was 9.3%; highest prevalence was found in patients with laryngeal cancer (28.5%). Compared with laryngeal cancer, there were lower odds of depression among patients with oral cavity cancer (adjusted odds ratio [aOR] = 0.90; 95% CI, 0.84-0.97) and other anatomic sites (aOR = 0.87; 95% CI, 0.81-0.94), except oropharyngeal cancer (aOR = 1.00; 95% CI, 0.93-1.08). For every unit increase in comorbidities, odds of depression increased by 20% (aOR = 1.20; 95% CI, 1.19-1.23). Sociodemographic factors associated with increased odds of depression included being female (aOR = 1.77; 95% CI, 1.68-1.87), white (aOR = 1.75; 95% CI, 1.59-1.92), and having Medicaid (aOR = 1.09; 95% CI, 1.01-1.19) or Medicare insurance (aOR = 1.19; 95% CI, 1.10-1.27). Conclusions Depression odds vary depending on HNC anatomic site, and one in four patients with laryngeal cancer may be depressed. Since depression is prevalent in this survivor cohort, it is important that psychosocial assessment and intervention are integrated into mainstream clinical care for patients with HNC.

Purpose: An estimated 8,200 cases of anal cancer will be diagnosed in 2017, accounting for nearly 1,100 deaths. Though anal cancer is a relatively rare malignancy, its increasing incidence has coincided with the increase in prevalence of risky sexual practices associated with anal human papillomavirus (HPV) infection, especially among men. At least 9 in 10 anal cancers are associated with HPV. Due to the rarity of anal cancer, little is known about factors affecting survivorship of anal cancer patients. The aim of this study was to evaluate clinical and nonclinical factors associated with anal squamous cell carcinoma (ASCC) survival in the United States. Methods: A retrospective cohort study of patients aged ≥18 years with ASCC in the National Cancer Institute Surveillance, Epidemiology, and End Results registry (2004-2014) was analyzed. ASCC (site codes C21.0-C21.9 and C20.9), were coded for invasive squamous cell carcinomas per the International Classification of Diseases for Oncology, third edition. The outcome was survival (alive or dead) and the exposures were clinical (stage of presentation and treatment modality), and nonclinical (marital status, age, sex, race/ethnicity). Fine and Gray proportional hazards regression model were used to assess differences in survival among sociodemographic and clinical factors. Results: There were 13,142 patients diagnosed with ASCC between 2004 and 2014. Mortality rate during the study period was 34.9% and median survival time was 113 months. In the adjusted model, a one-year increase in age was associated with 2% increased risk of death (adjusted hazard ratio (aHR) =1.02; 95% confidence interval (CI): 1.02-1.03). Compared with female patients, male patients (aHR=1.54; 95% CI: 1.40-1.70) had higher hazard of death, as did patients who were non-Hispanic black (aHR=1.40; 95% CI: 1.23-1.60) or non-Hispanic other (aHR=1.34; 95% CI: 1.09-1.65) versus non-Hispanic white. Patients who were never married (aHR=1.29; 95% CI: 1.15-1.44) or widowed (aHR=1.37; 95% CI: 1.18-1.59) had higher hazard of death compared to married patients. Patients had higher hazard of death if they were had stage II (aHR=2.01; 95% CI: 1.62-2.49), stage III (aHR=4.58; 95% CI: 3.70-5.67) or stage IV cancer (aHR=13.43; 95% CI: 10.74-16.78); and had not received surgery (aHR=1.41; 95% CI: 1.26-1.57). Conclusion: Besides the clinical factors known to impact survival, including stage and treatment modality, several nonclinical factors are associated with the survival of anal cancer in the United States: age, sex, race/ethnicity, and marital status. It is important that interventions considering these factors are developed to improve survivorship, especially among the unmarried, males, and minority patients. Citation Format: Eric Adjei Boakye, Matthew Simpson, Rebecca Rohde, Lauren Anderson, Betelihem B. Tobo, Thomas E. Burroughs, Nosayaba Osazuwa-Peters. Anal cancer survivorship: Clinical and nonclinical factors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4253.

Introduction: Although there are currently more than 430,000 head and neck cancer (HNC) survivors in the United States, it is accepted that many more patients would have survived longer if they presented at an earlier stage. Less than half of all head and neck cancer patients present with early-stage disease. One of the factors implicated in late stage of presentation for head and neck cancer patients is access to care, driven by health insurance status. While individuals with health insurance are known to present earlier, less is known about outcome differences for patients who are uninsured or who have Medicaid insurance. We have observed many head and neck cancer patients initially present without insurance despite qualifying for Medicaid, and so are assisted with obtaining insurance before discharge. This process blurs the line between uninsured and Medicaid patients. The aim of this study was to determine whether there are disparities in survival outcomes for HNC patients based on whether they are insured, uninsured, or have Medicaid insurance. Methods: A cohort of 49,524 patients aged 18-64 years with first primary HNC from the Surveillance, Epidemiology, and End Results (SEER) 18 database diagnosed from 2007-2014 was included. Actuarial survival curves stratified by insurance status (insured, Medicaid, and uninsured) were created to determine HNC-specific survival differences between the groups with a log-rank test. Patient characteristics including insurance, race/ethnicity, sex, county-level poverty, surgery, marital status, tumor site, stage, year of diagnosis, and age at diagnosis were utilized in a Fine and Gray competing risk proportional hazard model to compute adjusted hazard ratios (aHR) for cause-specific death from HNC. Multinomial logistic regression was also performed to determine characteristics of patients with each type of insurance by adjusted odds ratios (aOR). Results: The cohort was mostly male (75.6%) and insured (73.6%), with 18.6% on Medicaid and 7.8% uninsured. At the end of the 7-year follow-up period, HNC-specific survival rate was significantly lower for patients on Medicaid (49.5%) than uninsured (54.8%) and insured patients (74.2%) (log-rank p < 0.001). After controlling for other prognostic demographic and clinical factors, patients on Medicaid (aHR=1.63, 95% CI: 1.54, 1.71) and uninsured patients (aHR=1.33, 95% CI: 1.43, 1.64) had higher hazard of death from HNC compared to insured patients. Compared with non-Hispanic whites, other race/ethnicity groups were more likely to be on Medicaid, with non-Hispanic American Indians/Alaska Natives being the most likely (aOR=3.46, 95% CI: 2.66, 4.51). Medicaid were more likely not have received surgery than insured patients (aOR=1.34, 95% CI: 1.26, 1.42). They were also more likely to present at advanced disease. Conclusion: While patients with health insurance had better survival outcome in general, our study showed that patients with Medicaid did not have a better survival outcome than those without any insurance after adjusting for all other prognostic factors, including stage of presentation and treatment modality. Medicaid patients, in fact, had worse outcome than uninsured HNC patients. It could be that despite having insurance, Medicaid patients did not have adequate access to care and thus had delayed presentations. Our findings highlight the need to bridge the health insurance gap for HNC patients to increase survivorship. Citation Format: Nosayaba Osazuwa-Peters, Matthew C. Simpson, Sean T. Massa, Eric Adjei Boakye, Lauren M. Cass, Sai Deepika Challapalli, Rebecca L. Rohde, Mark A. Varvares. Survival outcomes for head and neck patients with Medicaid: A health insurance paradox [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C54.

e18058Background: Both clinical and nonclinical factors are known to impact survival of head and neck cancer (HNC). We aimed to compare survival benefits of chemotherapy vs. marital status among pa...

Background The HPV vaccine prevents HPV-associated cancers and genital warts, which cause significant morbidity and mortality in the US. While the vaccine is targeted toward 11-12-year-old boys and girls, there is a catch-up vaccination range up to 26 years. However, vaccination rates are very low among eligible young adults, aged 18-26 years, and besides college-related studies, not a lot is known about factors associated with the HPV vaccine uptake in this population. The aim of this study was to assess sociodemographic factors associated with HPV vaccination uptake in a nationally representative sample of 18-26-year-old adults. Methods The National Health Interview Survey 2014-2015 was examined for young adults, aged 18-26 years (n = 7588). HPV vaccine initiation was defined as receipt of at least one dose of the vaccine and completion as receipt of the three doses. Sociodemographic factors included age, gender, race, marital status, education, health insurance, regular provider, number of doctor visits, and geographic region. Survey-weighted multivariable logistic regression models were used to examine the socio-demographic factors that were associated with HPV vaccine uptake. Results Approximately 27% of respondents had initiated the HPV vaccine and 16% had completed the HPV vaccine. After adjusting for covariates, compared to females, males were 81% less likely to initiate HPV vaccine [(adjusted odds ratio) 0.19; (95 % confidence interval) 0.16-0.23]. Other factors associated with HPV vaccine initiation included having health insurance (1.70; 1.32-2.18), visiting the doctor’s office 6+ times (1.86; 1.48-2.34) and 1-5 times (2.09; 1.56-2.81) vs. no doctor’s office within the last 12 months, and having no high school diploma (0.46; 0.32-0.64) and having high school diploma (0.40; 0.31-0.52) vs. college degree or higher. The same factors were associated with HPV vaccine completion; but, being black (0.60; 0.44-0.83) vs. white and having no usual place of care (0.74; 0.57-0.96) were also associated with lower odds of completing the vaccine series. Conclusions Our study shows that there are sociodemographic factors associated with HPV vaccine uptake among young adults in the United States, and males, individuals with a lower education, and those without adequate healthcare access are less likely to initiate and complete the HPV vaccination. Our findings suggest it is necessary to develop targeted interventions to promote HPV vaccination among those in the catch-up age range. Citation Format: Eric Adjei Boakye, Betelihem B. Tobo, Daphne Lew, Meera Muthukrishnan, Vy T. Pham, Rebecca Rohde, Thomas Burroughs, Mark A. Varvares, Nosayaba Osazuwa-Peters. Factors associated with HPV vaccination initiation and completion among 18-26 year olds in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4221. doi:10.1158/1538-7445.AM2017-4221

Purpose To assess racial and gender differences, among a drag racing population, as predictors of sexual risk factors associated with HPV infection, including number of oral sexual partners, age of first vaginal sex, and age of first oral sex. Methods A cross-sectional study was conducted at a drag racing event on September 12-13, 2015 in Madison, Illinois. Independent variables were gender and race. Outcome variables were number of oral sexual partners (high vs. low), age of first vaginal sex, and age at first oral sex. Multivariable logistic regression was used to examine the association between race and gender, and number of sexual partners. Multivariable linear regression analysis assessed the association between race and gender, and age of first vaginal sex, and age at first oral sex. Results Three hundred and one individuals took our survey. Of these respondents, 63% were male, and 65% identified as African Americans. Mean age for this population was 48 ± 13 years. Approximately 45% of participants reported they have had four or more oral sexual partners. Mean age for first vaginal sex was 17 ± 3 years, 20 ± 6 years for first oral sex. Multivariate logistic regression revealed that gender was a significant predictor of number of oral sexual partners, but race was not significant. Men compared to women were more likely to have a high number of oral sexual partners (OR = 2.08; 95% CI: 1.23, 3.57). In multivariable linear regression, gender and race were significant predictors of age of first vaginal sex, and age at first oral sex. Men were more likely to have earlier vaginal sexual debut as compared to women (β = -1.13; 95% CI: -1.82, -0.43) as were African Americans compared to Caucasians (β = -1.14; 95% CI: -1.82, -0.46). Men were also more likely to have earlier oral sexual debut as compared to women (β = -2.51; 95% CI: -3.98, -1.04). Caucasians were more likely to have earlier oral sexual debut as compared to African Americans (β = 2.44; 95% CI: 1.02, 3.87). Conclusions Race and gender were independent predictors of HPV risk factors. Males were more likely to initiate earlier and engage in both oral and vaginal sexual behaviors that are high risk for developing HPV. Caucasians were more likely to initiate earlier, and engage in oral sexual behaviors that are high risk for developing HPV. These findings provide impetus for the development of targeted educational interventions aimed at improving knowledge of these sexual risk factors among Caucasians and males, in the community. Citation Format: Rebecca L. Rohde, Nosayaba Osazuwa-Peters, Eric Adjei Boakye, Rajan Ganesh, Ammar Moiyadi, Adnan S. Hussaini, Mark A. Varvares. Do race and gender independently predict risk factors associated with the Human papillomavirus. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1430.

Background/Objectives: There has been a 225% increase in the incidence of oropharyngeal cancer, a sub-site of head and neck cancer, in the United States in the last three decades. This massive increase is largely associated with HPV, a sexually transmitted infection that peaks in prevalence among adolescents and young adults of college age. This study aimed at assessing sexual risk-taking behavior among university students, analyzing predictors of HPV vaccine initiation, as well as assessing levels of knowledge of the association between HPV and head and neck cancer. Methods: An anonymous online cross-sectional survey was distributed to 921 university students between the ages of 19-26 years. The survey elicited sociodemographic characteristics, HPV and HPV vaccine knowledge, and barriers and facilitators for vaccine initiation and completion. Results: Seven-hundred and forty-six students completed the survey; primarily female (68%), White (78%), and non-smokers (96%). Among participants, 61.7% have had vaginal sex and 70.7% oral sex. A greater number of participants have had multiple (4 or more) oral sexual partners than vaginal sexual partners (25.5% vs. 20.3%). Average age at first vaginal and oral sex onset were similar (18.41 vs. 17.80 years). Almost half of participants (49%) had completed all 3-doses of the HPV vaccine, and 60% had received at least one dose. Only 38% had a high knowledge of association between HPV and head and neck cancer. After adjusting for covariables, it was found that HPV knowledge was the main predictor of HPV vaccine initiation. Those with a higher level of knowledge of HPV were more likely to have initiated the vaccine (aOR = 1.04, 95% CI 1.00-1.08). Additionally, there were decreased odds of initiating HPV vaccine as age increased (aOR = 0.83, 95% CI 0.75-0.90); and participant single or dating (aOR 1.72, 95% CI 1.12-2.65) and not currently dating (aOR 1.91, 95% CI 1.22-2.99) had higher odds of initiating the vaccine than those in committed relationships, including marriage. Race was a significant predictor of knowledge of association between HPV and head and neck cancer. Non-White students were 2.25 times (95% CI: 1.14 – 4.45) more likely to have low knowledge compared to White students. Conclusions: Sexual risk-taking behavior associated with HPV infection is high among university students, while knowledge of the association between HPV and head and neck cancer is low. These findings provide impetus for developing specifically targeted interventions that serve to increase head and neck cancer knowledge, improve HPV vaccine education and uptake, and mitigate sexual risk-taking behaviors among college-aged students. Citation Format: Nosayaba Osazuwa-Peters, Kara M. Christopher, Christian Geneus, Rebecca Rohde, Ronald J. Walker, Mark A. Varvares. Assessing university students' sexual risk behavior, knowledge of the human papillomavirus, (HPV), HPV vaccine, and association between HPV and head and neck cancer. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B58.