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PURPOSE Hearing loss is a significant late effect among childhood cancer survivors. Recent guidelines note insufficient evidence to quantify its natural history or risk associated with specific exposures. We examined the long-term incidence and predictors of hearing loss requiring hearing amplification devices (HADs) using population-based health care data. METHODS In Ontario, Canada, HAD costs are subsidized by the Assistive Devices Program (ADP). Ontario children < 18 years of age at cancer diagnosis between 1987 and 2016 were identified and linked to ADP claims. Cumulative HAD incidence was compared between cases and matched controls. Patient, disease, and treatment predictors of HAD were examined. RESULTS We identified 11,842 cases and 59,210 controls. Cases were at higher risk for HAD (hazard ratio [HR], 12.8; 95% CI, 9.8 to 16.7; P < .001). The cumulative incidence of HAD among survivors was 2.1% (95% CI, 1.7% to 2.5%) at 20 years and 6.4% (95% CI, 2.8% to 12.1%) at 30 years post-diagnosis. The 30-year incidence was highest in neuroblastoma (10.7%; 95% CI, 3.8% to 21.7%) and hepatoblastoma (16.2%; 95% CI, 8.6% to 26.0%) survivors. Predictors of HAD in multivariable analyses included age 0-4 years at diagnosis ( v 5-9 years; HR, 2.2; 95% CI, 1.4-3.3; P < .001). Relative to no cisplatin exposure, patients receiving < 200 mg/m2 were not at greater risk, unlike those receiving higher cumulative doses. Relative to no cranial or facial radiation, those who had received ≤ 32.00 Gy were at no higher risk, unlike those who had received > 32.00 Gy. Carboplatin exposure was not associated with HAD. CONCLUSION Childhood cancer survivors are at elevated risk for requiring HAD, which continues to increase between 20 and 30 years after diagnosis. Thresholds of cisplatin and radiation exposure exist, above which risk substantially increases. Prolonged monitoring and trials of otoprotective agents are warranted in high-risk populations.

Background Distant metastases (DM) are a leading cause of death for patients with oropharyngeal cancer (OPSCC). The objective of this study was to compare the rates of DM after chemoradiotherapy (CRT) and radiotherapy alone (RT) in patients with human papillomavirus (HPV)‐positive and HPV‐negative OPSCC. Method In a retrospective population‐based study of 525 patients across Ontario, Canada, in 1998/99/03/04, we compared treatment effectiveness using cumulative incidence function curves and cause‐specific Cox regression models. Results Sixty of 525 patients developed DM. There was no difference in rates (overall 10%‐15%) between HPV‐positive and HPV‐negative patients or between CRT‐ and RT‐treated patients. CRT reduced the risk of DM for the 15% of all HPV‐positive patients with higher risk (T4 and/or N3) and not for HPV‐negative patients (hazard ratio, 1.82 [0.65‐5.07]). Conclusion The addition of platin‐based chemotherapy to conventional RT did not decrease the rates of DM in the majority of patients with HPV‐positive or in HPV‐negative OPSSC.

Introduction Although fractures of the pelvic ring account for only 2–3% of all fractures, they are present in approximately 7–20% of patients with high-energy polytrauma. High-energy pelvic fractures are life-threatening injuries, with mortality estimates ranging from 6 to 35%. The purpose of this study was to examine trends in the incidence, diagnosis, treatment, and mortality rates of high-energy pelvic fractures in Ontario, Canada over a 10-year period. Methods A cohort of 3915 patients who sustained a high-energy pelvic fracture in Ontario between 01 April 2005 and 31 March 2015 was identified using the Ontario Trauma Registry and administrative healthcare data linked by the Institute for Clinical Evaluative Science (ICES). Severely injured patients (defined as having an Injury Severity Score (ISS) of ≥16) with pelvic fractures following high-velocity mechanisms of injury were identified using applicable ICD-10 codes. Trends were assessed statistically using the Poisson and the Cochrane-Armitage tests for trend. Modified Poisson regression was used to model the adjusted risk ratio of mortality by pelvic fracture treatment. Results The incidence of pelvic fracture remained constant at approximately 4.6 cases per 100,000 population annually between 2005 and 2011. From 2012, there was a decrease in patients with ISS ≥ 16 due to changes in the calculation of the ISS. The proportion of patients presenting with ISS > 50 increased from 8.2% to 14.1% (p = 0.008) over the study period. Automobile collisions or pedestrians struck by vehicles accounted for over half of injuries. Approximately 6% of patients underwent angioembolisation. Treatment with external fixation (15.5%–20.2%) or no surgical intervention (46.2%–61.3%) increased from 2005 to 2015. Mortality remained constant (11% at 30 days), and laparotomy was the only major intervention not associated with decreased risk of death. Conclusions Stable mortality despite increasing injury severity suggests that the quality of care provided to patients with high-energy pelvic fractures has improved over time. However, unchanged incidence suggests the need for ongoing efforts aimed towards injury prevention. ISS at presentation was the most significant predictor of mortality in this patient population.

Objectives To characterize risk factors that predict the need for multiple tympanostomy tube (TT) procedures. Study design Retrospective population-based cohort study of children aged 18 years and younger in Ontario, Canada, who underwent at least one TT placement between January 1, 1994, and October 31, 2013. Methods The relative risk (RR) of need for multiple TT procedures was determined using log-binomial regression. Results There were 193,880 children who underwent TT insertion included in this cohort. Of these, 28.58% underwent at least two separate TT procedures. Over time, the RR of undergoing multiple TT procedures is decreasing for all children. In general, the younger the child was at the first TT procedure, the more likely the child was to undergo multiple TT procedures. Significantly higher RR for multiple TT procedures also was associated with male sex, the second-highest neighborhood income quintile, asthma or reactive airways, gastrointestinal disease, prematurity, or cleft lip and/or palate. Significantly lower RR for multiple TT procedures was associated with adenoidectomy or tonsillectomy (with or without adenoidectomy) at first TT placement or within 3 years prior. Furthermore, the benefit of adjuvant adenoidectomy or tonsillectomy was present for children aged under 4 years, in addition to those aged 4 years and older. Conclusion Among Ontario children who have had TT placement, more than one in four will have multiple sets placed. These identified risk factors permit improved preoperative counseling and enable identification of children who need closer follow-up. Level of evidence 2b. Laryngoscope, 128:991-997, 2018.

Background Early diagnosis is important in head and neck cancer (HNC) patients in order to maximize the effectiveness of the treatments and minimize the debilitation associated with both the cancer and the invasive treatments of advanced disease. Many patients present with advanced disease, and there is little understanding as to why. This study investigated patients’ symptom appraisal, help-seeking and lay-consultancy up to the time they first went to see a health care professional (HCP). Methods We interviewed 83 patients diagnosed with HNC. The study design was cross-sectional and consisted of structured telephone interviews and a medical chart review. We gathered information on the participant's personal reactions to their symptoms, characteristics of their social network and the feedback they received. Results We found that 18% of the participants thought that their symptoms were urgent enough to warrant further investigation. Participants rarely (6%) attributed their symptoms to cancer. Eighty-nine percent reported that they were unaware of the early warning signs and symptoms of HNC. Fifty-seven percent of the participants disclosed their symptoms to at least one lay-consultant before seeking help from an HCP. The lay-consultants were usually their spouse (77%) and the most common advice they offered was to see a doctor (76%). Lastly, 81% of the participants report that their spouse influenced their decision to see an HCP. Conclusions The results of this study suggest that patients frequently believe that their symptoms were non-urgent and that their lay-consultants influence their decision to seek help from an HCP.

BACKGROUND The highest rates of thyroid cancer are observed in Pacific Island nations as well as Australia and Asian countries bordering the Pacific. The objective of this study was to determine the risk for thyroid cancer among immigrants to Canada from Southeast and East Asia compared with immigrants from other regions and nonimmigrants. METHODS This was a population-based, longitudinal cohort study using health care administrative data to examine all residents of Ontario without pre-existing thyroid cancer. Individuals were followed from January 1997 or 5 years after they became eligible for health care coverage in Ontario, whichever came later. Patients were followed until March 2015 for incident-differentiated thyroid cancer, and then for recurrence. RESULTS The study followed 14,659,733 individuals for a median of 17 years. Thyroid cancer incidence was 43.8 cases per 100,000 person-years among Southeast Asian immigrants, 28.6 cases per 100,000 person-years among East Asian immigrants, 21.5 cases per 100,000 person-years among other immigrants, and 14.5 cases per 100,000 person-years among nonimmigrants. Incidence was highest among immigrants from the Philippines (52.7 cases per 100,000 person-years), South Korea (33.5 cases per 100,000 person-years), and China (30.0 cases per 100,000 person-years). Adjusted hazard ratios for thyroid cancer compared with nonimmigrants were 2.66 (95% confidence interval, 2.48-2.84) for Southeast Asian immigrants, 1.87 (95% confidence interval, 1.75-2.00) for East Asian immigrants, and 1.51 (95% confidence interval, 1.45-1.57) for other immigrants. Immigrants were more likely to have papillary histology and stage I cancer. East Asian immigrants, but not Southeast Asian immigrants, had a lower risk of recurrence (hazard ratio, 0.73 [95% confidence interval, 0.57-0.94] and 1.01 [95% confidence interval, 0.81-1.26], respectively). CONCLUSIONS Immigrants from Southeast and East Asia had markedly higher thyroid cancer incidence than nonimmigrants. At particularly elevated risk were immigrants from the Philippines, South Korea, and China. Cancer 2017;123:3320-5. © 2017 American Cancer Society.

OBJECTIVE: To provide an overview of the use and possible overuse of diagnostic neck ultrasound (DNUS) by describing and comparing both the ordering rates and the downstream results of DNUS by regions across Ontario. DESIGN: Retrospective population-based cohort study based on electronic health care data. SETTING: Ontario. PARTICIPANTS: Ontario residents (adults aged > 18 years) who had a diagnosis of thyroid cancer between October 1, 1999, and June 30, 2014, and residents who had a DNUS in 2012. MAIN OUTCOME MEASURES: Proportion of Ontario residents in each sub–Local Health Integration Network (LHIN) group who had their first DNUS in 2012 and went on to other relevant tests, diagnoses, and surgery. The sub-LHIN groups were based on increasing age- and sex-adjusted rates of first DNUS. RESULTS: There were 77 238 DNUS tests in 2012 and there was a 7.4-fold variation in the rate of test ordering across the sub-LHIN populations leading to variable rates of actual disease, suggesting screening or uncertain indications for tests. CONCLUSION: Across Ontario, the indications for ordering DNUS are variable, and screening or testing without indication might be a common practice. Establishing effective guidelines for the ordering of DNUS would potentially reduce costs and ultimately reduce the rates of thyroid cancer.

Routine follow-up is a cornerstone of oncology practice, but evidence to support most aspects of follow-up is lacking. Our objective was to investigate the relationship between frequency of routine follow-up and survival. This population-based study used electronic health care data relating to 5310 patients from Ontario diagnosed with squamous-cell head-and-neck cancer during 2007&ndash, 2012. Treatments included surgery (24.6%), radiotherapy with or without chemotherapy (52.4%), and combined surgery and radiotherapy (23%). We determined the oncologist who was following each patient after treatment, calculated the average follow-up visits to the oncologist during the subsequent 2.5 years for all patients who were doing well, and used Kaplan&ndash, Meier and multiple variable regression analysis to compare, by treatment, overall survival for patients in the high, typical, and low follow-up oncologist groups. Many oncologists saw patients 40%&ndash, 80% more often than other oncologists did. No relationship of appointment frequency with survival was observed for patients in any treatment group. The practice of routine follow-up varies and is costly both to a health care system and to patients. Without evidence about the effectiveness of current policies, further research is required to investigate new or optimal practices.

Importance In the management of differentiated thyroid cancer (DTC), the extent of surgical treatment required for most patients remains controversial and varies widely. This variation may be associated with theEnthusiasm Hypothesis, the notion that geographic differences in use of health care services are driven by the prevalence of physicians with a preference for particular services. Objective To evaluate the Enthusiasm Hypothesis and its applicability to the variation in the surgical treatment of thyroid cancer in Ontario, Canada. Design, Setting, and Participants This population-based study obtained electronic data on all health care–associated events for the complete population of insured residents of Ontario, Canada. Patients (n = 28 754) who were 18 years of age or older and underwent an initial therapeutic thyroid surgical procedure for a papillary or follicular carcinoma diagnosis between January 1, 2000, and December 31, 2015, were included. The final data analysis was performed January 31, 2019. Exposures Therapeutic thyroid cancer surgical procedure. Main Outcomes and Measures Numbers of surgeons, extent of surgical treatment, and case volumes in 14 geographic regions in Ontario. Results In total, 28 754 patients with DTC were included, of whom 22 600 (78.6%) were female, with a mean (SD) age of 49 (14) years. The use of total thyroidectomy for DTC varied widely across geographic regions of Ontario, from 45.8% to 77.1% of all cancer cases. More than 90% of the overall variation in practice (total thyroidectomy vs less-than-total thyroidectomy) could be explained by the practices of the high-volume surgeons (enthusiasts) in regions with the highest rates of thyroid cancer diagnosis. Conclusions and Relevance The Enthusiasm Hypothesis appears to be consistent with the findings of this study. The practices of the high-volume surgeons who were enthusiastic for total thyroidectomy in the geographic regions with the highest rates of thyroid cancer diagnosis may account for the variation in practice across Ontario between 2000 and 2015.

OBJECTIVE To investigate future surgery for chronic ear disease in children who underwent tympanostomy tube (TT) placement, compared with non-surgically treated patients and healthy controls. STUDY DESIGN Retrospective population-based cohort study. SETTING All hospitals in the Canadian province of Ontario. PATIENTS/INTERVENTION Of children aged 18 years and younger, three cohorts were constructed: 1) TT: patients who had undergone at least one TT procedure (n = 193,880), 2) No-TT: patients with recurrent physician visits for middle ear concerns who did not undergo TT (n = 203,283), and 3) Control: an age-sex matched control group who had not had TT or physician visits for recurrent middle ear concerns (n = 961,168). MAIN OUTCOME MEASURES Risk, and odds ratios (ORs) of surgery for chronic ear disease. RESULTS The TT cohort had a higher risk of tympanoplasty (OR 9.50 versus No-TT, p

Purpose A retrospective population-based cohort study was conducted to determine the risk of ischemic stroke with respect to time, associated with curative radiation therapy in head and neck squamous cell carcinomas (HNSCC). Methods and Materials On the basis of data from the Ontario Cancer Registry and regional cancer treatment centers, 14,069 patients were identified with diagnoses of squamous cell carcinoma of the oral cavity, larynx, and pharynx who were treated for cure between 1990 and 2010. Hazards of stroke and time to stroke were examined, accounting for the competing risk of death. Stroke risk factors identified through diagnostic and procedural administrative codes were adjusted for in the comparison between treatment regimens, which included surgery alone versus radiation therapy alone and surgery alone versus any exposure to radiation therapy. Results Overall, 6% of patients experienced an ischemic stroke after treatment, with 5% experiencing a stroke after surgery, 8% after radiation therapy alone, and 6% after any exposure to radiation therapy. The cause-specific hazard ratios of ischemic stroke after radiation therapy alone and after any exposure to radiation therapy compared with surgery were 1.70 (95% confidence interval [CI]: 1.41-2.05) and 1.46 (95% CI: 1.23-1.73), respectively, after adjustment for stroke risk factors, patient factors, and disease-related factors. Conclusions Radiation therapy was associated with an increased risk of ischemic stroke compared with surgery alone: for both radiation therapy alone and after all treatment modalities that included any radiation treatment were combined. Because of a shift toward a younger HNSCC patient population, our results speak to the need for adequate follow-up and survivorship care among patients who have been treated with radiation therapy. Advances in treatment that minimize chronic morbidity also require further evaluation.

Background We sought to expand upon preliminary data suggesting that metformin confers a survival benefit to patients with head and neck squamous cell carcinoma (HNSCC). Methods A large-scale retrospective cohort study of all patients in Ontario diagnosed with squamous cancer of the larynx, hypopharynx, and nasopharynx between Dec 1st 2007 to Dec 1st 2012 was undertaken. The Institute for Clinical and Evaluative Sciences was accessed to obtain patient demographic, treatment and outcome information. We included patients on metformin at the time of diagnosis. Kaplan Meier methods and Cox Regression models were used. Results Patients taking metformin at the time of diagnosis had a higher comorbid status but were otherwise similar to patients without metformin usage. Using multivariate analysis, neither overall survival nor disease specific survival was improved in patients on metformin (OS: HR 1.123, p = .338; DSS: HR 1.048, p = .792). Conclusions No survival advantage was observed in patients with HNSCC taking metformin at the time of diagnosis. Electronic supplementary material The online version of this article (10.1186/s40463-018-0322-7) contains supplementary material, which is available to authorized users.

BACKGROUND: Major injury continues to be a common source of morbidity and mortality; improving the functional recovery of survivors of major trauma requires a better understanding of the mental health outcomes that may occur in this population. We assessed the association between major trauma and the development of a new mental health diagnosis or death by suicide. METHODS: We completed a population-based, self-controlled, longitudinal cohort analysis using linked administrative data on patients treated for major trauma in Ontario between 2005 and 2010. All survivors were included and composite rates of mental health diagnoses during inpatient admissions were compared between the 5 years after injury and the 5 years before injury, using Poisson regression with generalized estimating equations. The incidence of suicide was calculated for the 5 years after injury. Risk factors for suicide were calculated using Cox proportional hazard regression analyses. RESULTS: The analysis included 19 338 patients, predominantly men (70.7%) from urban areas (82.6%), with unintentional (89%), blunt injuries (93.4%). Overall, trauma was associated with a 40% increase in the postinjury rate of mental health diagnoses (incidence rate ratio [IRR] 1.4, 95% [confidence interval] CI 1.1 to 1.8). The suicide rate was 70 per 100 000 patients per year, substantially higher than the population average. Risk factors for completing suicide were prior inpatient diagnosis of mood disorder (hazard ratio [HR] 4.3, 95% CI 2.1 to 8.8) and self-inflicted injury (HR 7.8, 95% CI 3.9 to 15.4). INTERPRETATION: Survivors of major trauma are at a heightened risk of developing mental health conditions or death by suicide in the years after their injury. Patients with pre-existing mental health disorders or who are recovering from a self-inflicted injury are at particularly high risk.

This study aimed to determine the incidence of noninvasive follicular thyroid neoplasm with papillary-like features (NIFTP) in Ontario, Canada and the predictors of disease-free survival (DFS) by comparing patients with follicular variant papillary thyroid cancer (FVPTC) and patients with NIFTP. This population-based retrospective cohort study included all patients who had definitive surgery for well-differentiated thyroid cancer (WDTC) in Ontario, Canada between 1990 and 2001 and were followed until 2014. A conservative decision rule was applied to subtype-select FVPTCs into NIFTPs after pathology report review. The primary outcome was DFS, for which Cox proportional hazard regression analysis was performed to assess the impact of FVPTC versus NIFTP. At pathology re-review of the 725 FVPTC cases, 318 were reclassified as potential NIFTP. The median follow-up time was 15.3 years for the entire cohort and 15.9 years for those alive at the last follow-up visit. Disease failure occurred for 109 patients, 79 (19.4%) in the FVPTC group and 30 (9.4%) in the NIFTP group (p

BACKGROUND Preclinical and early-phase clinical studies have suggested an oncoprotective role of statins in head and neck squamous cell carcinoma (HNSCC). The purpose of this study was to determine whether incidental statin use in patients with human papillomavirus (HPV)-negative HNSCC is predictive of improved oncologic outcomes. METHODS A retrospective cohort study of 1194 patients from the Ontario Cancer Registry diagnosed with HNSCC from 2007 to 2012 was performed using linked databases from the Institute for Clinical Evaluative Sciences. Overall survival (OS) and disease-specific survival (DSS) were compared between patients taking statins and controls. RESULTS Patients with statin exposure demonstrated improved OS (hazard ratio [HR] 0.758; P = .0011; 95% confidence interval [CI] 0.642-0.896), and DSS (HR 0.693; P = .0040; 95% CI 0.539-0.889) compared with those not on statins at the time of diagnosis. CONCLUSION Incidental statin use at the time of diagnosis of HPV-negative squamous cell carcinoma (SCC) of the larynx, hypopharynx, and nasopharynx demonstrated improved OS and DSS.

The actual practices of routine follow-up after curative treatment for head-and-neck cancer are unknown, and existing guidelines are not evidence-based. This retrospective population-based study used administrative data to describe 5 years of routine follow-up care in 3975 head-and-neck cancer patients diagnosed between 2007 and 2012 in Ontario. The mean number of visits per year declined during the follow-up period (from 7.8 to 1.9, p < 0.001). The proportion of patients receiving visits in concordance with guidelines ranged from 80% to 45% depending on the follow-up year. In at least 50% of patients, 1 head, neck, or chest imaging test was performed in the first follow-up year, that proportion subsequently declined (p < 0.001). Factors associated with follow-up practices included comorbidity, tumour site, treatment, geographic region, and physician specialty (p < 0.05). Given current practice variation and the absence of an evidence-based standard, the challenge in identifying a single optimal follow-up strategy might be better addressed with a harmonized approach to providing individualized follow-up care.

The management of differentiated thyroid cancer has traditionally consisted of total thyroidectomy with or without adjuvant radioactive iodine. However, in the last two decades, this approach has been challenged, with the consideration of more conservative approaches such as less radical surgery and deferring adjuvant treatment, especially in lower-risk patients. The objective of this study was to consider the effectiveness of current treatment options by comparing the survival outcomes from different geographic regions with different treatment philosophies. This study design was based on the concept of natural experiments in patient care that occur when physicians in different regions treat the spectrum of typical patients with varying treatments.This population-based retrospective cohort study investigated 2444 patients with differentiated thyroid cancer ≤4 cm between 1990 and 2001 from Ontario, Canada. Extent of disease and extent of surgery were abstracted from pathology reports and were linked to downstream administrative medical information on treatments and outcomes. Patient demographics, tumor characteristics, treatments, and outcomes were compared between those geographic regions with more aggressive treatments and those regions with less aggressive treatments.Treatment varied across the province. When comparing outcomes in regions where patients had more extensive treatment to those in regions where patients had less extensive therapy, similar rates were found for 15-year survival, recurrence, and survival after recurrence.There were significant variations in treatment but no differences in outcomes for regions with more versus less aggressive approaches. These findings support the trend toward more conservative management approaches in the treatment of thyroid cancer.

To characterize risk factors that predict the need for multiple tympanostomy tube (TT) procedures.Retrospective population-based cohort study of children aged 18 years and younger in Ontario, Canada, who underwent at least one TT placement between January 1, 1994, and October 31, 2013.The relative risk (RR) of need for multiple TT procedures was determined using log-binomial regression.There were 193,880 children who underwent TT insertion included in this cohort. Of these, 28.58% underwent at least two separate TT procedures. Over time, the RR of undergoing multiple TT procedures is decreasing for all children. In general, the younger the child was at the first TT procedure, the more likely the child was to undergo multiple TT procedures. Significantly higher RR for multiple TT procedures also was associated with male sex, the second-highest neighborhood income quintile, asthma or reactive airways, gastrointestinal disease, prematurity, or cleft lip and/or palate. Significantly lower RR for multiple TT procedures was associated with adenoidectomy or tonsillectomy (with or without adenoidectomy) at first TT placement or within 3 years prior. Furthermore, the benefit of adjuvant adenoidectomy or tonsillectomy was present for children aged under 4 years, in addition to those aged 4 years and older.Among Ontario children who have had TT placement, more than one in four will have multiple sets placed. These identified risk factors permit improved preoperative counseling and enable identification of children who need closer follow-up.2b. Laryngoscope, 128:991-997, 2018.

Background Positron emission tomography (PET)-CT is a useful diagnostic adjunct for cancer unknown primary (CUP) of the head and neck; however, the increased cost has not been justified with an economic evaluation in this patient population. Methods A decision tree analysis was performed from the perspective of the third party payer. Primary outcome was cost per life year gained ($/LYG). The 2 comparative groups were: (1) PET-CT followed by panendoscopy versus (2) panendoscopy alone. Results The incremental cost-effectiveness ratios for N1, N2, and N3 CUP were $369.83/LYG, $329.43/LYG, and $4900.28/LYG, respectively. The sensitivity analysis demonstrated a 96.8%, 97.1%, and 60.1% certainty that PET-CT is cost-effective for CUP with N1, N2, and N3 disease, respectively. Conclusion The use of PET-CT in patients with N1 and N2 CUP is the cost-effective choice. The cost-effectiveness in N3 CUP is questionable and should be used on an individual case basis. © 2014 Wiley Periodicals, Inc. Head Neck, 2014

Background Concurrent chemoradiotherapy (CRT) became the standard of care for locoregionally advanced head and neck cancers based on clinical trials but its effectiveness at the community level is not reported. Methods We conducted a population-based comparative effectiveness study of all 571 patients with oropharyngeal cancer in Ontario Canada (2003–2004) that describes the patients and the treatments and compares concurrent CRT to radiotherapy (RT) alone. Results When comparing the outcomes (CRT vs RT) for all patients or patients eligible for either treatment, for patients of centers with the “higher use” of CRT to patients of the ‘lower use’ centers and comparing all centers, we found no overall or disease-specific advantage to CRT over RT alone. There was also no difference in recurrence-free survival, pattern of recurrences, or distant control. Conclusion In Ontario (2003–2004), in daily clinical practice, the addition of concurrent CRT to RT had little impact on survival in patients with oropharyngeal carcinoma. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1461–1469, 2015

Objectives/Hypothesis We aimed to assess whether surgeon and/or institution resection volume predicts long-term overall survival in head and neck cancer in a publicly funded healthcare system. Study Design Population-based retrospective cohort study. Methods Head and neck cancer patients in Ontario, Canada, who underwent a resection confirmed by both hospital-level and physician-level administrative data between 1993 and 2010, comprised our cohort (N = 5,720). Physician and hospital volumes were calculated based on number of cases performed in the year prior by the physician and at an institution performing each case, respectively. A multilevel hierarchical Cox regression model was used to estimate the effect on overall survival of each 25 increase in procedure volume. Results A crude model without patient or treatment characteristics demonstrated that both surgeon volume (hazard ratio [HR]: 0.927, 95% confidence interval [CI]: 0.879-0.978, P = .006) and hospital volume (HR: 0.980, 95% CI: 0.970-0.991, P = .0003) were associated with improved overall survival. After controlling for clustering and patient/treatment covariates, hospital volume (HR: 0.976, 95% CI: 0.955-0.997, P = .02), but not physician volume (HR: 1.042, 95% CI: 0.941-1.155, P = .43), remained a statistically significant predictor of overall survival. This translates into a 2.4% decrease in the HR for every 25 additional cases performed at an institution. Conclusions Both high-volume surgeons and hospitals are predictors of better overall survival in head and neck cancer patients. However, the effect is largely explained by hospital volume. This benefit, at the institution level, could potentially be explained by important processes of care that contribute to overall survival. Level of Evidence 4 Laryngoscope, 124:2081–2088, 2014

Background: In the absence of clear evidence on the efficacy of concurrent chemoradiotherapy (CRT) over conventional radiotherapy (RT) for HPV+ve and for HPV−ve oropharyngeal cancer (OPC), this study compares the treatments and outcomes from pre-CRT years to post-CRT years. Methods: A population-based retrospective treatment-effectiveness study based on all patients with OPC treated in Ontario Canada in 1998, 1999, 2003 and 2004. Charts were reviewed, tissue samples were requested and tissue was tested for p16 or in situ hybridisation. Overall survival (OS) and disease-specific survival (DSS) were compared by treatment era and by treatment type for all 1028 patients, for 865 treated for cure and for 610 with HPV status. Results: There was no improvement in OS comparing pre-CRT to post-CRT eras for the HPV+ve patients (P=0.147) or for the HPV−ve patients (P=0.362). There was no difference in OS comparing CRT to RT for the HPV+ve cohort (HR=0.948 (0.642–1.400)) or for the HPV–ve patients (HR=1.083 (0.68–1.727)). Conclusions: In these ‘real-world’ patients what appeared to be improvements in OS with CRT in clinical trials were confounded by HPV status in Ontario. CRT did not improve outcomes for HPV+ve or for HPV−ve patients.

BACKGROUND Supraglottic laryngeal carcinoma has an entirely different etiology, clinical presentation, and prognosis compared to glottis cancer but the only evidence for the use of concurrent chemotherapy with radiotherapy (CRT) is the 5.4% 5-year improvement in overall survival (OS) for the combined laryngeal site. METHOD We conducted a retrospective population-based study using administrative data to compare OS, disease-specific survival (DSS), laryngectomy-free survival, and laryngoesophageal dysfunction-free survival over time and by treatment for all patients with supraglottic laryngeal carcinoma diagnosed between January 1, 1990, and December 31, 2014, in Ontario, Canada. RESULTS There was no improvement over time in OS (hazard ratio [HR] 1.006; P = .90), DSS (HR 1.031; P = .65), or laryngoesophageal dysfunction-free survival (P = .39). The patients selected for CRT had similar OS (HR 1.04; P = .66), laryngectomy-free survival (HR 0.95; P = .23), and laryngoesophageal dysfunction-free survival (P = .79) compared with patients undergoing radiotherapy. CONCLUSION The addition of CRT by head and neck oncologists in Ontario, Canada, did not improve outcomes for the "real world" patients with supraglottic laryngeal carcinoma.

The highest rates of thyroid cancer are observed in Pacific Island nations as well as Australia and Asian countries bordering the Pacific. The objective of this study was to determine the risk for thyroid cancer among immigrants to Canada from Southeast and East Asia compared with immigrants from other regions and nonimmigrants.This was a population-based, longitudinal cohort study using health care administrative data to examine all residents of Ontario without pre-existing thyroid cancer. Individuals were followed from January 1997 or 5 years after they became eligible for health care coverage in Ontario, whichever came later. Patients were followed until March 2015 for incident-differentiated thyroid cancer, and then for recurrence.The study followed 14,659,733 individuals for a median of 17 years. Thyroid cancer incidence was 43.8 cases per 100,000 person-years among Southeast Asian immigrants, 28.6 cases per 100,000 person-years among East Asian immigrants, 21.5 cases per 100,000 person-years among other immigrants, and 14.5 cases per 100,000 person-years among nonimmigrants. Incidence was highest among immigrants from the Philippines (52.7 cases per 100,000 person-years), South Korea (33.5 cases per 100,000 person-years), and China (30.0 cases per 100,000 person-years). Adjusted hazard ratios for thyroid cancer compared with nonimmigrants were 2.66 (95% confidence interval, 2.48-2.84) for Southeast Asian immigrants, 1.87 (95% confidence interval, 1.75-2.00) for East Asian immigrants, and 1.51 (95% confidence interval, 1.45-1.57) for other immigrants. Immigrants were more likely to have papillary histology and stage I cancer. East Asian immigrants, but not Southeast Asian immigrants, had a lower risk of recurrence (hazard ratio, 0.73 [95% confidence interval, 0.57-0.94] and 1.01 [95% confidence interval, 0.81-1.26], respectively).Immigrants from Southeast and East Asia had markedly higher thyroid cancer incidence than nonimmigrants. At particularly elevated risk were immigrants from the Philippines, South Korea, and China. Cancer 2017;123:3320-5. © 2017 American Cancer Society.

Oral cavity cancers can be detected early yet many are diagnosed with advanced disease. We assessed risk factors for advanced stage disease in a population-based study. Study population was all Ontario patients with anterior tongue or floor of mouth cancers diagnosed between 1991 and 2000 (n=2033). Data are from a retrospective chart review. Risk factors included: demographic characteristics, co-morbidity, precancerous lesions, dental status, smoking, alcohol use, and social marginalization. Multivariate regression analyses assessed independent associations while controlling for disease grade and site. Forty percent had advanced disease. Eighty-nine percent presented with symptoms and 66% were referred by a family physician. Risk factors in the tongue group were being: age ≥80 (RR 1.47), widowed (RR 1.34), social marginalized (RR 1.69), a current smoker (RR 1.26), or a smoker-heavy drinker (RR 1.73). Risk factors in the floor of mouth group were being: age ≥70 (70-79: RR 1.24 and ≥80: RR 1.43), and socially marginalized (RR 1.22). Having a pre-cancerous lesion (RR 0.44) or a regular dentist (RR 0.84) was protective in the floor of mouth group. Risk factors for those with co-morbid illnesses were being: age ≥70 (70-79: RR 1.28 and ≥80: RR 1.55), separated/divorced (RR 1.26), socially marginalized (RR 1.37), or a smoker-heavy drinker (RR 1.44); while having a regular dentist was protective (RR 0.83). Targeted education to alert those at risk about oral cancer warning signs and better training coupled with opportunistic oral cavity exams by family physicians could reduce the burden of this disease.

Objectives To determine hospital incidence, mortality, and management for thoracic aortic dissections and aneurysms. Methods A population-based retrospective cohort study of anonymously linked data for residents of Ontario, Canada, was carried out. Incident cases of thoracic aortic dissections and aneurysms were identified between 2002 and 2014. Treatment and mortality trends were assessed. Results There were 5966 aortic dissections (Type A n = 2289 [38%] and Type B n = 3632 [61%]). Overall incidence proportion for aortic dissections was 4.6 per 100,000. There were 9392 thoracic aortic aneurysms with an overall incidence proportion of 7.6 per 100,000. The incidence for both dissections and aneurysms significantly increased over the 12-year study. Only 53% (1204 out of 2289) of Type A dissections underwent surgery. Type B dissection treatment was 83% (3000 out of 3632) medical, 10% (370 out of 3632) surgery, and 7% (262 out of 3632) endovascular. Thoracic aortic aneurysm treatment was 53% (4940 out of 9392) surgery, 44% (4129 out of 9392) medical, and 3% (323 out of 9392) endovascular. Thirty-five percent of known descending thoracic aortic aneurysms (323 out of 924) received a stent graft. Cardiac surgeons performed 87% of the open surgical repairs. Vascular surgeons performed 91% of the endovascular procedures. All-cause 3-year mortality significantly decreased for both aortic dissections (44% to 40%) and aneurysms (30% to 22%). All-cause hospital mortality also decreased. Women had worse outcomes than men. Conclusions The incidence of thoracic aortic dissections and aneurysms increased over time but all-cause hospital and late outcomes improved. Gender differences exist. Men incur more disease but women have higher hospital mortality. Surgery was primarily referred to cardiac surgeons. Endovascular therapy was primarily referred to vascular surgeons.

Objectives/Hypothesis: The objective of this study was to examine the evidence for an association between patient and/or provider-related diagnostic delay and late stage at diagnosis. Study Design: We identified all English language published studies worldwide and present a summary of the direction and magnitudes of the associations observed. We consider the role of study population characteristics and symptom variation across the head and neck cancer sites on the delay-stage association. Results: The 27 eligible studies reviewed varied considerably in the cancer types grouped by analysis, types of delay, and measurement of delay. The relationship between diagnostic delay and stage at diagnosis varied in direction and magnitude, with no consistent positive association in any of the head and neck cancer sites. Conclusions: Possible explanations for the lack of an observed relationship between patient delay and stage include: inaccurate measurement of delay, lack of sensitivity of disease stage to delay-related disease progression, and variation in tumor aggressiveness, which could lead to variation in symptom progression rates. We call for better evidence about the relationship between diagnostic delay and disease progression and/or disease outcomes. If demonstrated and validated, such associations would provide a much stronger argument than description of delay alone for education programs around symptom recognition and for more active screening of high-risk individuals.

Objectives: Knowledge of prognostic factors is essential for patient care and research. The objectives of this study were to demonstrate that prognostic factors and their impact can vary depending on study design and to examine the relationships between select prognostic factors. Methods: Retrospective population-based study of patients with cancer of the hypopharynx in Ontario, Canada, from January 1990 to December 1999 identifying and comparing prognostic factors for different survival outcomes and different subpopulations using Kaplan Meier analysis and Cox Proportional Hazards models. Results: The impact of prognostic factors varies within subgroups of a study population, varies with treatment decisions, and varies with the outcome of interest. Conclusions: N and T category were the dominant prognostic factors in hypopharyngeal cancer. Performance status was an independent predictor of survival. Laryngoscope, 2009

Clinical practice guidelines (cpgs) are systematically developed statements designed to assist practitioners and patients in making decisions about appropriate heath care interventions. Clinical practice guidelines are expensive and time-consuming to create. A cpg on concurrent chemotherapy with radiation therapy (ccrt) was developed in Ontario at a time when treatment approaches for head-and-neck cancer were changing significantly. An assessment of treatments and outcomes based on electronic and chart data obtained from a population-based study of 571 patients with oropharynx cancer treated in Ontario (2003&ndash, 2004) was combined with a review of relevant knowledge transfer (publications and presentations at major meetings) to understand variation in adherence to a cpg. In 9 Ontario cancer treatment centres, ccrt was used for 55% of all patients with oropharyngeal cancer, however, at the centres individually, that proportion ranged from 82% to 39%. Furthermore, there was no agreement on the chemotherapy regimen: 2&ndash, 4 years later (a period during which newer regimens were emerging), only 4 of 9 centres were following the guideline for most patients. When outcomes of treated patients were compared for centres with &ldquo, higher&rdquo, and &ldquo, lower&rdquo, use of ccrt, no difference in survival was observed (p = 0.64). At a time of treatment evolution, the new guideline was controversial, and there are many reasons for the mixed adherence. An estimation of adherence should be included during both development and review of guidelines.

You are creating a data abstraction form to assess the case mix, treatments, and treatment outcome for patients with cancer of the larynx at your center. You plan to perform univariate analysis including Kaplan-Meier curves with log-rank tests and multiple variable analysis to account for effect of disease and age on outcome. At your center some patients have radiotherapy, some have chemotherapy in association with radiotherapy, and some have primary surgery. A specific patient's treatment is based on the extent of disease and overall health. Patients with cancer of the larynx frequently have a variety of comorbid illnesses, often related to smoking and alcohol. For example, Mr. J.B. presented to the coronary care unit with his third myocardial infarction and was found to have a new cancer of the larynx. Due to his chronic obstructive pulmonary disease (COPD), diabetes, and past pulmonary embolus, he is not a candidate for either coronary revascularization or laryngectomy. How do you measure the impact of the comorbid illnesses on the decisions and the outcomes?

Background and Objectives The Ontario Cancer Registry (OCR) is a population-based tumor registry created to provide data for epidemiologic research and for cancer surveillance. Recently it has been used for health services research. The objective of this project was to assess the quality of the OCR data that is used in survival analysis. Methods and Design Clinical information for 898 patients with squamous carcinoma of the head and neck including index tumor site, date of diagnosis, vital status, date of death, and cause of death from a prospective database at the Kingston Regional Cancer Center is compared to the same data elements in the OCR for the same patients. Results There is no statistically significant difference in disease-specific survival between the information from the two databases (log rank P = .89). The OCR captured and correctly assigned index tumor site for 81.4% (detection rate). The site assignment was accurate 90.9% of the time (confirmation rate), there was agreement on vital status (dead vs. alive) for all but one patient, and there was excellent agreement on date of death. However, cause of death (cancer vs. noncancer) based on death certificates had a 31% error rate. Conclusion Researchers can be confident in the survival analysis generated from data in this registry, but need to be aware of potential sources of error.

Objectives/Hypothesis: Reports comparing case mix, treatments, and outcomes between different countries are uncommon in head and neck oncology. Prospective databases of unselected patients from regional cancer centers in southeastern Ontario, Canada, and southeastern Norway were compared. Study Design: Retrospective comparative study of two prospective databases. Methods: The case mix, treatments, and disease-specific mortality were compared using frequency tables, Kaplan-Meier survival curves, and the log rank test. Results: The case mix, except for differences in oral cavity, oropharynx, and the recorded tumor (T) category, was similar, and the treatments were different. There was no statistical difference in overall survival for all patients, as well as for some sites. Conclusions: The results of treatments, based on different overall treatment polices, for all patients were similar. The differences in recorded T category with no statistical difference in overall survival suggest a difference in staging assignment and raises a question about the reliability of the TNM staging process.

Positron emission tomography (PET)-CT is a useful diagnostic adjunct for cancer unknown primary (CUP) of the head and neck; however, the increased cost has not been justified with an economic evaluation in this patient population.A decision tree analysis was performed from the perspective of the third party payer. Primary outcome was cost per life year gained ($/LYG). The 2 comparative groups were: (1) PET-CT followed by panendoscopy versus (2) panendoscopy alone.The incremental cost-effectiveness ratios for N1, N2, and N3 CUP were $369.83/LYG, $329.43/LYG, and $4900.28/LYG, respectively. The sensitivity analysis demonstrated a 96.8%, 97.1%, and 60.1% certainty that PET-CT is cost-effective for CUP with N1, N2, and N3 disease, respectively.The use of PET-CT in patients with N1 and N2 CUP is the cost-effective choice. The cost-effectiveness in N3 CUP is questionable and should be used on an individual case basis.

BACKGROUND The combination of T, N, and M classifications into stage groupings was designed to facilitate a number of activities including: the estimation of prognosis and the comparison of therapeutic interventions among similar groups of cases. The authors tested the UICC/AJCC 5th edition stage grouping and seven other TNM-based groupings proposed for head and neck cancer to determine their ability to meet these expectations in a specific site: carcinoma of the tonsillar region. METHODS The authors defined four criteria to assess each stage grouping scheme: 1) The subgroups defined by T and N comprising a given group within a grouping scheme have similar survival rates (hazard consistency); 2) The survival rates differ across the groups (hazard discrimination); 3) The prediction of cure is high (outcome prediction); and 4) The distribution of patients among the groups is balanced. The authors identified or derived a measure for each criterion and the findings were summarized using a scoring system. The range of scores was from 0 (best) to 7 (worst). Data were from a retrospective chart review on 642 cases of carcinoma of the tonsillar region treated with radiotherapy for cure at the Princess Margaret Hospital from 1970–1991. None of the patients had distant metastases. RESULTS The scheme proposed by Synderman and Wagner, which was published in Otolaryngology Head and Neck Surgery in 1995 (vol.112, pages 691–4), scored best at 1.2. The UICC/AJCC scheme scored worst at 6.1. The hazard consistency ranged from a 3.1% average survival difference to 6.7% across the 8 schemes. The hazard discrimination measure varied by 28% from the best to worst scheme. Prediction varied by up to almost twofold across the schemes assessed. The distribution of patients varied from expected by between 0.13% and 0.57%. CONCLUSION UICC/AJCC stage groupings were defined without empirical investigation. When tested, this scheme did not perform as well as any of seven empirically-derived schemes the authors evaluated. The results of the current study suggest that the usefulness of the TNM system can be enhanced by optimizing the design of stage groupings through empirical investigation. Cancer 2001;92:1484–94. © 2001 American Cancer Society.

Background The combination of T, N, and M classifications into stage groupings is meant to facilitate a number of activities, including the estimation of prognosis and the comparison of therapeutic interventions among similar groups of cases. We tested the UICC/AJCC 5th edition stage grouping and seven other TNM-based groupings proposed for head and neck cancer for their ability to meet these expectations in a specific site: carcinomas of the oral cavity. Methods We defined four criteria to assess each grouping scheme: (1) the subgroups defined by T, N, and M that make up a given group within a grouping scheme have similar survival rates (hazard consistency); (2) the survival rates differ among the groups (hazard discrimination); (3) the prediction of cure is high (outcome prediction); and (4) the distribution of patients among the groups is balanced. We identified or derived a measure for each criterion, and the findings were summarized by use of a scoring system. The range of scores was from 0 (best) to 7 (worst). The data are population based from a prospectively gathered series in Southern Norway, with 556 patients diagnosed from 1983 through 1995. Clinical stage assignment was used, and the outcome of interest was cause-specific survival. Results Summary scores across the eight schemes ranged from 1.66 for TANIS-3 to 6.50 for UICC/AJCC-5. The TANIS-7 staging scheme performed best on the hazard consistency criterion. The Kiricuta scheme performed best on the hazard discrimination criterion. Synderman predicted outcome best overall and Berg produced the most balanced distribution of cases among its groups. Conclusions UICC/AJCC stage groupings were defined without empirical investigation. When tested, this scheme did not perform as well as any of seven empirically derived schemes we evaluated. Our results suggest that the usefulness of the TNM system could be enhanced by optimizing the design of stage groupings through empirical investigation. © 2001 John Wiley & Sons, Inc. Head Neck 23: 613–624, 2001.

Background In North America, cigarette smoking and/or alcohol consumption not only cause head and neck cancer, they also cause many of the other diseases, illnesses, and conditions, also known as comorbidities, frequently found in our patients. Comorbidities can influence treatment decision making and treatment outcome. The aim of this study is to quantify the increased risk of comorbidity in our patients. Method The survival of 655 consecutive patients with squamous cell carcinoma from a regional cancer center is analyzed. We compare the survival curves for all-cause death, death from cancer, and death from noncancer causes to the expected survival of age/sex-matched populations of Ontario residents, Canadian smokers, and Canadian nonsmokers. Results Of those patients who had not survived 5 years, 59% died of their index tumor, 23% would have been expected to die if they did not have head and neck cancer, and 18% died of the increased comorbidity associated with being a patient with head and neck cancer. Discussion Comorbidity, and specifically the increased comorbidity found in patients with head and neck cancer, is an important factor in overall survival. © 2000 John Wiley & Sons, Inc. Head Neck 22: 317–322, 2000.

Background There is a need for a classification system for prognosis based on the TNM system for patients with squamous cell carcinoma of the head and neck such that patient groupings are homogeneous within and heterogeneous between. Methods Six hundred fifty-five consecutive patients with invasive squamous cell carcinoma of the head and neck followed prospectively are split into a training set and a test set. Using the training set, the Cox Proportional Hazards Model and the outcome of dead with disease, we created homogeneous prognostic levels (PLs) based on RR. Using the test set, we compare our model to others in the literature. Results Using the training set, we identified five PLs, and using the test set, we demonstrated that our model is superior to others for both within-group homogeneity and between-group heterogeneity. Conclusions A simple classification system can be used to group patients for survival and is valid for future study in prognostication. © 1999 John Wiley & Sons, Inc. Head Neck 21: 30–38, 1999.

We aimed to assess whether surgeon and/or institution resection volume predicts long-term overall survival in head and neck cancer in a publicly funded healthcare system.Population-based retrospective cohort study.Head and neck cancer patients in Ontario, Canada, who underwent a resection confirmed by both hospital-level and physician-level administrative data between 1993 and 2010, comprised our cohort (N = 5,720). Physician and hospital volumes were calculated based on number of cases performed in the year prior by the physician and at an institution performing each case, respectively. A multilevel hierarchical Cox regression model was used to estimate the effect on overall survival of each 25 increase in procedure volume.A crude model without patient or treatment characteristics demonstrated that both surgeon volume (hazard ratio [HR]: 0.927, 95% confidence interval [CI]: 0.879-0.978, P = .006) and hospital volume (HR: 0.980, 95% CI: 0.970-0.991, P = .0003) were associated with improved overall survival. After controlling for clustering and patient/treatment covariates, hospital volume (HR: 0.976, 95% CI: 0.955-0.997, P = .02), but not physician volume (HR: 1.042, 95% CI: 0.941-1.155, P = .43), remained a statistically significant predictor of overall survival. This translates into a 2.4% decrease in the HR for every 25 additional cases performed at an institution.Both high-volume surgeons and hospitals are predictors of better overall survival in head and neck cancer patients. However, the effect is largely explained by hospital volume. This benefit, at the institution level, could potentially be explained by important processes of care that contribute to overall survival.

Because of the relative rarity of head and neck malignancies and their complex treatment, some groups have advocated for regionalized care. Studies comparing high- and low-volume centers have demonstrated mixed results.We conducted a systematic review using MEDLINE and EMBASE including all studies examining a volume-outcome relationship in the treatment of patients with head and neck cancer with meta-analysis for long-term survival results.Seventeen studies were identified. Meta-analysis was performed for studies that assessed long-term survival. High-volume hospitals (5 studies; hazard ratio [HR], 0.886; 95% confidence interval [CI], 0.820-0.956) and high-volume surgeons (2 studies; HR, 0.767; 95% CI, 0.641-0.919) have better overall survival than low-volume hospitals and surgeons, respectively.Volume-outcome associations exist for head and neck oncologic procedures, although this has not been fully investigated for salivary gland malignancies. Future quality of care studies in head and neck oncology should focus on processes of care, which may explain this relationship.

Background: Despite the increasing incidence of human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) in the Western World, there are little data describing the change in HPV incidence within Ontario, Canada. We therefore assessed HPV-positivity in a retrospective study of 612 OPC patient samples. Methods: Diagnostic formalin-fixed and paraffin embedded OPC patient samples belonging to two cohorts were retrieved from institutions across Ontario, Canada over two time periods: 1998-1999 (n = 245) and 2003-2004 (n = 367). In all samples, HPV status was assessed initially using p16 immunohistochemistry (IHC). For p16 negative and equivocal staining samples, HPV in situ hybridization (ISH; using an HPV subtype 16/18 probe) was performed as the final indicator for HPV positivity. HPV-positivity rate was then compared over time and geographic region. Results: Overall, p16-positivity was observed in 52.3% (320 of 612) of the OPC patients. For the p16-negative (n = 246) and p16-equivocal (n = 46) samples, 25.3% (n = 74) were positive by HPV16/18 ISH. The HPV infection incidence for the 1998-1999 cohort was 54.3% (133 of 245 samples; 95% CI: 53.9(47.4-60.2)). The HPV infection incidence increased significantly in the 2003-2004 cohort to 71.1% (261 of 367 samples; 95% CI: 71.4(66.5-76.0)) (p Conclusions: HPV-associated OPC increased in incidence in Ontario, Canada, over a 6-year period from 1998 to 2004, which appeared to be applicable across the entire province, regardless of urban or rural regions. A composite HPV detection method using p16 in combination with HPV ISH identified an additional 25% of HPV-positive OPC cases. Citation Format: Wei Shi, Stephen F. Hall, Katrina Rey-McIntyre, Rebecca Griffiths, Wei Xu, Jie Su, Jeff Bruce, Shaohui Huang, Brian O’Sullivan, Kenneth W Yip, Fei-Fei Liu. Time and regional incidence trends of human papillomavirus-associated oropharyngeal cancer in Ontario, Canada. [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 3440.

Malignant submandibular gland tumours are rare tumours treated primarily with surgery.This retrospective study was done to determine the effectiveness of adjuvant radiation therapy (RT), to document the patterns of failure, and to define the prognostic variables for treatment outcome.Between 1960 and 2002, 74 patients diagnosed as having malignant submandibular gland tumours were treated with radical surgery. The surgery included neck dissection in 37 patients and adjuvant RT in 50 patients with high-risk features.Forty-one (54%) patients experienced disease relapse. The local recurrence rates were 35% in those treated only with surgery and 21% in patients who underwent postoperative RT (p = .20). The risk of subclinical nodal metastases in the clinical N0 neck was 21%.The American Joint Committee on Cancer stage approached statistical significance for cause-specific survival. Although not statistically significant, RT probably reduced local recurrence. All patients with malignant submandibular tumours except T1 need elective neck treatment.

to demonstrate the extent of the variation in follow-up policies in Canadian head and neck cancer treatment centres.telephone survey of head and neck surgeons.there is a wide variation in both follow-up policies and beliefs about follow-up. The majority of centres saw patients every 2 to 3 months for the first 2 years, every 3 to 4 months in year 3, and every 6 months in years 4 and 5.research is required to determine effective follow-up policies to maximize both patient outcomes and resource management as the numbers of patients in follow-up increase.

It has been proposed that the increasing incidence of thyroid cancer is due to increasing detection. Using administrative data, we compare by year from 1993 to 2006, the rates of diagnostic imaging tests of the neck (computed axial tomography—CT, magnetic resonance imaging—MRI, and non-obstetrical ultrasound—US) to the incidence of thyroid cancer for the population of the Province of Ontario Canada. Women and men have different rates of tests, and those rates reflect the rates of new diagnoses of thyroid cancer. The rising incidence of thyroid disease in women is associated with increasing numbers of diagnostic imaging tests.

BACKGROUND: The authors compared the survival outcomes of radiotherapy +/− salvage surgery to surgery +/− postoperative radiotherapy for patients with squamous cell cancer of the hypopharynx. There was no evidence beyond observational studies and no consensus on the which treatment is most effective for this patient group. METHODS: The authors conducted a retrospective population-based study of 595 patients from Ontario Canada diagnosed between January 1, 1990 and December 31, 1999. Three different methodological approaches were used for the survival analysis including a restricted cohort study, a matched case-control study, and a natural experiment study across defined geographic regions. RESULTS: The authors found no survival advantage for either radiotherapy +/− salvage surgery or surgery +/− postoperative radiotherapy. CONCLUSIONS: This study set the baseline for clinical decisions that was not previously established there is no difference in survival for patients with hypopharynx comparing primary surgery to primary radiotherapy. This information is essential for the interpretation of current treatment results, the planning of future clinical studies and the treatment of patients who are not having chemoradiotherapy. Cancer 2009. © 2009 American Cancer Society.