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Introduction The COVID‐19 pandemic has raised controversies regarding safe and effective care of head and neck cancer patients. It is unknown how much the pandemic has changed surgeon practice. Methods A questionnaire was distributed to head and neck surgeons assessing opinions related to treatment and concerns for the safety of patients, self, family, and staff. Results A total of 67 head and neck surgeons responded during the study period. Surgeons continued to recommend primary surgical treatment for oral cavity cancers. Respondents were more likely to consider non‐surgical therapy for patients with early glottic cancers and HPV‐mediated oropharynx cancer. Surgeons were least likely to be concerned for their own health and safety and had the greatest concern for their resident trainees. Conclusions This study highlights differences in the willingness of head and neck surgeons to delay surgery or alter plans during times when hospital resources are scarce and risk is high. This article is protected by copyright. All rights reserved.

BACKGROUND We aim to define a set of terms for common free flap complications with evidence-based descriptions. METHODS Clinical consensus surveys were conducted among a panel of head and neck/reconstructive surgeons (N = 11). A content validity index for relevancy and clarity for each item was computed and adjusted for chance agreement (modified kappa, K). Items with K

This article provides best practice guidelines regarding nasopharyngolaryngoscopy and OHNS clinic reopening during the COVID‐19 pandemic. The aim is to provide evidence‐based recommendations defining the risks of COVID‐19 in clinic, the importance of pre‐visit screening in addition to testing, along with ways to adhere to CDC guidelines for environmental, source, and engineering controls.

Background Carotid body tumors are rare, neurogenic tumors arising from the periadventitial chemoreceptive tissue of the carotid body. The purpose of this study is to ascertain the presentation and preoperative risk factors associated with surgical resection. Methods A single-center retrospective review of 25 carotid body tumor resections from 2002 to 2019. Demographics, periprocedural details, and postoperative outcomes were analyzed using Stata (Stata Corporation, College Station, TX). Results Among 25 patients, 64% were women, 84% were asymptomatic, and the mean age was 49 years (range 21–79). Forty-four percent of tumors were Shamblin III. Nine patients underwent preoperative embolization but did not correlate with decreased blood loss (299 cm3 vs 205 cm3, P = .35). The 30-day death, stroke, and cranial nerve injury rates were 0%, 8%, and 32%, respectively. Cranial nerve injuries included 20% vagus, 4% hypoglossal, 4% facial, and 4% glossopharyngeal, with permanent deficits in 4% (n = 1). Mean length of stay was 3.0 days (range 1–9 days). At a mean follow-up of 12 months (range 1–63 months), there has been no recurrence. Conclusion Although carotid body tumors are uncommon in the Midwest, complete surgical resection is curative of these typically hormonally inactive tumors. Preoperative embolization did not affect blood loss, and the incidence of death, stroke, and permanent cranial nerve injury rates remained very low.

OBJECTIVE To evaluate factors associated with overall survival (OS) of patients with non-rhabdomyosarcoma soft tissue sarcomas of the head and neck. STUDY DESIGN Retrospective cohort study. METHODS The National Cancer Database was queried for cases of non-rhabdomyosarcoma soft tissue sarcomas of the head and neck between 2004 and 2014. Cases were categorized according to the World Health Organization classification of soft tissue tumors. A multivariable Cox proportional hazards model was used to evaluate associations with OS. RESULTS A total of 4,555 patients (63.6% male, 36.4% female, mean age 59.6 years) met inclusion criteria. The majority of tumors were classified as miscellaneous (35.9%), followed by vascular (20.1%), smooth muscle (13.5%), fibroblastic/myofibroblastic (12.1%), peripheral nerve (8.5%), adipocytic (7.4%), and undifferentiated (2.5%) sarcomas. The mean follow-up was 37.9 months, and overall mortality (MR) was 45.3%. The best prognosis was seen with fibroblastic/myofibroblastic sarcomas (MR = 20.6%, P

Summary Cbl is an adaptor protein that is phosphorylated and recruited to several receptor and non-receptor tyrosine kinases upon their activation. After binding to the activated receptor, Cbl plays a key role as a kinase inhibitor and as an E3 ubiquitin ligase, thereby contributing to receptor down-regulation and internalization. In addition, Cbl translocates to intracellular vesicular compartments following receptor activation. We report here that Cbl also associates with Golgi membranes. Confocal immunofluorescence staining of Cbl in a variety of unstimulated cells, including CHO cells, revealed a prominent perinuclear colocalization of Cbl and a Golgi marker. Both the prominent Cbl staining and the Golgi marker were dispersed by brefeldin A. Subcellular fractionation of CHO cells demonstrated that about 10% of Cbl is stably associated with membranes, and that Golgi-enriched membrane fractions produced by isopycnic density centrifugation and free-flow electrophoresis are also enriched in Cbl, relative to other membrane fractions. The membrane-bound Cbl was hyperphosphorylated and it co-immunoprecipitated with endogenous Src. By immunofluorescence, some Src colocalized with Cbl and Golgi markers, and Src, like Cbl, was present in the Golgi-enriched fraction prepared by sequential density centrifugation and free-flow electrophoresis. Transfection of an activated form of Src, but not wild-type Src, increased the amount of Src that co-immunoprecipitated with Cbl, and increased the intensity of Cbl staining on the Golgi. This result, together with the increased tyrosine phosphorylation of the membrane-associated Cbl, suggests that Golgi-associated Cbl could be part of a molecular complex that contains activated Src. The localization and interaction of Src and Cbl at the Golgi and the regulation of the interaction of Cbl with Golgi membrane suggest that this complex may contribute to the regulation of Golgi function.

e18205 Background: The Institute of Medicine (IOM) and Commission on Cancer (CoC) recommend systematic delivery of supportive oncology and survivorship care to all cancer patients. CSOC aims to improve the quality of supportive care across Chicago-area providers. Methods: 35 CSOC participating institutions (cancer centers, support centers, hospice) formed care delivery design teams Distress, Survivorship & Palliative. Teams collaboratively developed solutions to supportive oncology gaps: patient screening tools, care delivery processes, provider training, and quality metrics to assess supportive oncology quality and the CSOC impact. Six implementation centers (2 safety-net, 3 academic & 1 public) reviewed charts at baseline (2014 diagnoses) and after the initial implementation period (2015 diagnoses), compared by frequencies and Fisher’s exact test. Results: Eight metrics contained patient data at 2 time points; improvements were seen in 7/8 metrics. Conclusions: CSOC developed supportive oncology screening, and care processes aligned with IOM and CoC standards. Significant improvements were shown after implementation across diverse settings. Ongoing work will further evaluate the impact of CSOC efforts on patient care. [Table: see text]

Lateral temporal bone reconstruction after ablative surgery for malignancy, chronic infection, osteoradionecrosis, or trauma presents a challenge for the reconstructive surgeon. This complexity is due to the 3D nature of the region, potential dural exposure, and the possible need for external surface repair. Successful reconstruction therefore requires achieving separation of the dura, obliteration of volume defect, and external cutaneous repair. There is significant institutional bias on the best method of reconstruction of these defects. In this review, the advantages and disadvantages of reconstructive options will be discussed as well as the potential pitfalls and complications.

We describe a case of primary malignant paraganglioma of the thyroid gland that was found in a 55-year-old woman who had undergone surgery for bilateral carotid body tumors. The paraganglioma was treated with a total thyroidectomy followed by radiation therapy, and the patient was disease-free after more than 2 years of follow-up. Malignant paragangliomas of the thyroid gland are extremely rare. The diagnosis of malignancy is based on histopathologic findings, tumor behavior, and metastasis. These tumors can be misdiagnosed as other types of thyroid malignancies, thus resulting in less than optimal treatment. A genetic etiology was suspected in our patient.

2 Background: The Institute of Medicine (IOM) and Commission on Cancer (CoC) recommend supportive oncology and survivorship care. The Coleman Supportive Oncology Collaborative (CSOC) aims to improve quality of supportive care and survivorship in Chicago. Methods: CSOC includes 35 institutions (cancer centers, support and hospice), structured in two design teams (Distress & Survivorship and Palliative). Participants identified opportunities and gaps in supportive and survivorship care in an iterative development of: screening tools, follow-up processes, provider training, and quality metrics to assess CSOC impact. Six process improvement sites (2 safety-net, 3 academic & 1 public) reviewed patient charts at baseline and Q1 2015, compared by Fisher’s exact test. Results: Eight metrics contained patient data at the 2 time points; improvements were seen in 6/8 metrics. Conclusions: CSOC successfully developed supportive oncology, survivorship screening, and care processes aligned with IOM and CoC standards. Significant improvements were shown after implementation in diverse settings. Ongoing work will continue to evaluate the impact of the CSOC on patient care. [Table: see text]

72 Background: The IOM 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) standard 3.2 requires distress screening and indicated action. Screening tools are not standardized across institutions and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric consolidated screening tool based on validated instruments (NCCN Distress Problem List, PHQ-4, PROMIS) and IOM and CoC. The screening tool was piloted at 6 practice improvement cancer centers in the Chicago area (3 academic, 2 safety-net, 1 public). Patients, providers assessing each patient’s screening results (assessors), and providers receiving referrals (referral providers) were surveyed after each use of the screening tool. Descriptive statistics were used to assess effectiveness of the tool. Results: Responders included 29 patients, 81 assessors and 26 referral providers (SW, chaplain, subspecialist). The majority of patients (22/29, 75%) completed the screening in < 10 minutes without assistance and will complete at every visit. Most assessors (59/77, 76%) spent < 5 minutes reviewing screening results. The majority of patients, assessors, and referral providers reported that the screening tool asked the “right questions”. Assessors reporting partial relevance of some screening questions for 34% (26/77) of patients, uncovered ≥ 1 relevant needs for 96% (25/26) of those patients (p = 0.002). Conclusions: Use of a consolidated supportive oncology screening tool across multiple institutions is feasible, discovered unmet patient needs, and was beneficial for assessors and providers. As the tool is adopted by collaborating institutions, variations in supportive oncology screening may decline, thus improving access to supportive oncology care with implications for national dissemination. [Table: see text]

Publisher Summary The primary goal of outcomes research is to assess treatment effectiveness, or the positive impact that a given therapy has on aspects of care that are of interest to both patient and clinician. It is designed to identify the most effective form of treatment for cancer among the variety of treatment options. By combining cost analysis with a thorough calculation of treatment outcome according to the expanded definition, the physician and the patient obtain the most complete information regarding the treatment for head and neck cancer. Central to the task of outcome assessment is the definition of a clinically relevant outcome. In contrast to nonneoplastic processes, the usual outcome of an unsuccessful treatment in head and neck cancer is death from uncontrolled disease. Subsequently, the primary outcome measure used to assess treatment effectiveness has been survival. In modern outcomes research, the emphasis is broadened to encompass measures of outcome other than survival alone. This broader approach evaluates not only traditional end points, such as mortality and local control, but also other parameters, such as patient satisfaction, quality of life, functional status, and cost of care.

PURPOSE. The pupose of this study was to compare maternal and paternal risk factors and the outcomes of Asian Pacific Islander (API) pregnancies with other racial/ethnic groups (Black, Hispanic, and White) in Illinois. METHODS. We examined computerized birth certificate files in Illinois to descriptively analyze birth outcomes and parental characteristics for births occurring between 1989 and 1993. Infant mortality tables were examined for birth cohorts born from 1989 to 1992. Rates among Illinois API groups were presented for the following: maternal and paternal socio-demographic factors; maternal medical risk factors, amount of prenatal care and type of method of delivery; newborn complications and various morbidity outcomes; and, early neonatal mortality. For comparison, simliar Illinois data are presented for Blacks and Whites and Hispanics. We statistically evaluated the significance in variability of rates. PRINCIPAL FINDINGS. APIs in Illinois experienced a lower infant mortality rate. API mothers were more likely to be married, beyond the teenage years, have more education and smoke less often during their pregnancy than any of the other racial/ethnic groups. In addition, API mothers were more likely to experience primiparity rather than high parity. We detected statistically signifacnt differences for maternal and paternal socio-demographic characteristics among the four populations (p0.0001). Similarly we found statistically significant differences in risk factors during pregnancy and labor and delivery complications among four race/ethnic population (p0.0001). CONCLUSIONS. Fetal, neonatal, post-natal and infant mortality rates were the lowest among APIs when compared to Hispanic, Black and White neonates. These differences were statistically signifacant. However, rates of inadequate prenatal care, labor and elivery complications, prematurity and low birth weight were not similarly lower among APIs. RELEVANCE TO ASIAN AND PACIFIC ISLANDER AMERICAN POPULATIONS. This paper provides a state-level examination of parental risk factors and birth outcomes among APIs. KEY WORDS. infant mortality rates; pregnancy outcomes; prenatal care; maternal risk factors; paternal risk factors; women; Illinois.