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Background: The impact of timing of PORT initiation for major salivary gland cancers on survival is unknown. We aim to examine the impact of PORT timeliness on overall survival (OS) of patients with major salivary gland cancers., Methods: This was a cross-sectional analysis using data from the National Cancer Database (2004-2017) and included patients with major salivary gland cancer treated with surgery and PORT., Results: In total, 5701 patients were included (3133 [55%] male, 4644 [82%] white, mean age 59 ± 16 years). For the overall cohort, PORT >6 weeks was not associated with decreased OS (1.00 aHR, 95% CI 0.89-1.11). When specifically examining patients with mucoepidermoid carcinoma, PORT >6 weeks was associated with a decreased OS (1.27 aHR, 95% CI 1.01-1.58)., Conclusions: Overall, this analysis did not demonstrate a survival benefit for initiating PORT within 6 weeks for patients with salivary gland malignancies. Subset analysis did support initiating PORT within 6 weeks after resection for patients with mucoepidermoid carcinomas. This was not demonstrated in other major salivary gland cancer histologies., (© 2024 The Author(s). Head & Neck published by Wiley Periodicals LLC.)

Objective: Medical literature identifies stark racial disparities in head and neck cancer (HNC) in the United States, primarily between non-Hispanic white (NHW) and non-Hispanic black (NHB) populations. The etiology of this disparity is often attributed to inequitable access to health care and socioeconomic status (SES). However, other contributors have been reported. We performed a systematic review to better understand the multifactorial landscape driving racial disparities in HNC., Data Sources: A systematic review was conducted in Covidence following Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidelines. A search of PubMed, SCOPUS, and CINAHL for literature published through November 2022 evaluating racial disparities in HNC identified 2309 publications., Review Methods: Full texts were screened by 2 authors independently, and inconsistencies were resolved by consensus. Three hundred forty publications were ultimately selected and categorized into themes including disparities in access/SES, treatment, lifestyle, and biology. Racial groups examined included NHB and NHW patients but also included Hispanic, Native American, and Asian/Pacific Islander patients to a lesser extent., Results: Of the 340 articles, 192 focused on themes of access/SES, including access to high-quality hospitals, insurance coverage, and transportation contributing to disparate HNC outcomes. Additional themes discussed in 148 articles included incongruities in surgical recommendations, tobacco/alcohol use, human papillomavirus-associated malignancies, and race-informed silencing of tumor suppressor genes., Conclusion: Differential access to care plays a significant role in racial disparities in HNC, disproportionately affecting NHB populations. However, there are other significant themes driving racial disparities. Future studies should focus on providing equitable access to care while also addressing these additional sources of disparities in HNC., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

The control of ambient air quality in the United States has been a major public health success since the passing of the Clean Air Act, with particulate matter (PM) reductions resulting in an estimated 160 000 premature deaths prevented in 2010 alone. Currently, public policy is oriented around lowering the levels of individual pollutants and this focus has driven the nature of much epidemiological research. Recently, attention has been given to viewing air pollution as a complex mixture and to developing a multi-pollutant approach to controlling ambient concentrations. We present a statistical approach for estimating the health impacts of complex environmental mixtures using a mixture-altering contrast, which is any comparison, intervention, policy, or natural experiment that changes a mixture's composition. We combine the notion of mixture-altering contrasts with sliced inverse regression, propensity score matching, and principal stratification to assess the health effects of different air pollution chemical mixtures. We demonstrate the application of this approach in an analysis of the health effects of wildfire PM air pollution in the Western US., (© 2022 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.)

Importance: Multidisciplinary care (MDC) yields proven benefits for patients with cancer, although it may be underused in the complex management of head and neck squamous cell carcinoma (HNSCC)., Objective: To characterize the patterns of MDC in the treatment of HNSCC among elderly patients in the US., Design, Setting, and Participants: This nationwide, population-based, retrospective cohort study used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from January 1, 1991, to December 31, 2011, to identify patients 66 years or older diagnosed with head and neck cancer and determine the dates of diagnosis, oncology consultations, treatment initiation, and speech therapy evaluation in addition to MDC completion. Multidisciplinary care was defined in a stage-dependent manner: localized disease necessitated consultations with radiation and surgical oncologists, and advanced-stage disease also included a medical oncology consultation, all before definitive treatment. Data were analyzed between December 2016 and September 2020., Main Outcomes and Measures: Rates of MDC across all subsites of head and neck cancer as measured by the presence of an evaluation for each oncologist on the MDC team and its effect on treatment initiation., Results: This cohort study assessed 28 293 patients with HNSCC (mean [SD] age, 75.1 [6.6] years; 67% male; 87% White) from the SEER-Medicare linked database. The HNSCC subsites included larynx (40%), oral cavity (30%), oropharynx (21%), hypopharynx (7%), and nasopharynx (2%). Overall, the practice of MDC significantly increased over time, from 24% in 1991 to 52% in 2011 (P < .001). For patients with localized (stage 0-II) tumors, 60% received care in the multidisciplinary setting, whereas 28% of those with advanced-stage disease did. A total of 18 181 patients (64%) were treated with initial definitive nonsurgical therapy across all stages. Regardless of stage and subsite, few patients (2%) underwent evaluation by a speech-language pathologist before definitive therapy. Multidisciplinary care prolonged the time to initiation of definitive treatment by 11 days for localized disease and 10 days for advanced disease., Conclusions and Relevance: This cohort study found that most elderly patients with localized HNSCC received MDC, whereas few patients with advanced-stage disease received such care, although a significant proportion received adjuvant therapy. Multidisciplinary care may prolong time to initiation of definitive treatment with an uncertain impact. Consultation with a speech-language pathologist before definitive therapy was rare.

Importance: For decades, the American Head and Neck Society (AHNS) has been providing funding for meritorious research to investigators for studies on head and neck cancer. Recently, the AHNS Foundation sought to evaluate the impact of its funds for investigators and research., Objective: To examine the mechanisms and outcomes of research funding by the AHNS., Design, Setting, and Participants: An online survey was sent to all AHNS grant-funded principal investigators who had received funds from 1998 to 2018. Over this time, approximately $1.5 million in grant funding was awarded for research. Grants were separated into 2 groups: pilot and resident grants (PRs), approximately $10 000 each type of grant for 1 year, and career development grants (CDAs), approximately $20 000 to $80 000 over 1 to 2 years., Results: Of 82 awardees, 49 individuals (60%) responded to the survey (36 men [73%]), including 28 recipients (57%) of PR grants and 21 recipients (43%) of CDA grants. Twenty-six studies (53%) were reported as translational, 20 studies (41%) were basic science, 2 studies (4%) were clinical, and 1 study (2%) was outcomes research. At the time of the award, 19 recipients (39%) were faculty/attending physicians, 11 recipients (22%) were fellows, and 19 recipients (39%) were residents/students. Twenty of 21 CDA grants (95%) were given to fellows or faculty. Thirty-seven grants (75%) resulted in publications, with a total of 84 publications reported. Nineteen CDA grants (90%) and 18 PR grants (64%) resulted in publication. Thirty-one (63%) investigators were awarded another grant after their AHNS grant: 19 CDA (90%), 8 pilot (44%), and 4 (40%) resident awardees reported having a future grant. Fourteen respondents (29%) reported a future K, R, or other major foundation grant. Of all awardees, 46 recipients (93%) were still conducting research and 40 recipients (82%) reported serving as academic faculty. Respondents also noted associations between grants and mentorship, investigator development, institutional support, and academic promotion., Conclusions and Relevance: The findings of this study suggest that, over the past 20 years, the AHNS funding mechanism has resulted in 80% of awards generating publications and 63% resulting in future funding. The additional benefits of AHNS grant awards on the culture of research is also substantial. Continued analysis of these data may help guide future AHNS funding and award decisions.

Objectives/hypothesis: Although the multidisciplinary tumor board (MTB) is accepted as best practice for the management of head and neck squamous cell carcinoma (HNSCC), there is limited evidence showing its impact on survival. Our goal was to investigate the impact of an MTB following the hiring of a fellowship-trained head and neck surgeon and implementation of an MTB at our institution. We hypothesized that these changes would demonstrate an improvement in survival., Study Design: Retrospective chart review., Methods: A review of HNSCC treated at our institution between October 2006 and May 2015 was performed. The cohort was divided into pre-MTB (October 2006-February 2011) and post-MTB (February 2011-May 2015) cohorts. Patient demographics, cancer stage, and treatment outcomes were reviewed. Univariate, multivariate, and survival analysis were performed., Results: The study included 224 patients, 98 in the pre-MTB cohort and 126 in the post-MTB cohort. Of total patients, 139 (62%) were black and 91 (40%) were on Medicaid or uninsured. Average follow-up time was 2.8 years, and most cases were advanced stage (68%). On Kaplan-Meier evaluation, overall survival and disease-specific survival were significantly improved in the post-MTB cohort compared with the pre-MTB cohort, with a 5-year disease-specific survival of 52% vs. 75% (P = .003). A matched cohort analysis showed that the post-MTB cohort had significantly lower risk of death (hazard ratio: 0.48)., Conclusions: Our study demonstrates that treatment of HNSCC by a dedicated multidisciplinary team results in improved survival. Multidisciplinary care should be considered best practice in the care of HNSCC., Level of Evidence: 3b Laryngoscope, 130:946-950, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

HIV-positive people are at increased risk for malignancies associated with human papillomavirus (HPV) infection, including oropharyngeal squamous cell carcinoma (OPSCC). The purpose of this study was to determine whether cancer treatment disparities exist between HIV-positive and HIV-negative people with OPSCC. We conducted a retrospective cohort study comparing OPSCC treatment adequacy and treatment outcomes in HIV-positive and HIV-negative people in the post-antiretroviral therapy era. Treatment adequacy was determined by measuring two primary endpoints associated with OPSCC survival: time to therapy and total radiation dose. Treatment outcomes were assessed by measuring disease-free and overall survival. We identified a total of 37 HIV-positive and 149 HIV-negative people with OPSCC. HIV-positive people experienced a median delay of 10 days from time of OPSCC diagnosis to start of therapy compared with HIV-negative people [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.38-0.98]. Total post-radiation dose in HIV-positive people was lower than that in HIV-negative people [58.5 Gray (Gy) versus 64.4 Gy, p  = .04]. HIV-positive people also experienced greater hazards for disease recurrence (HR 3.43, 95% CI 1.39-8.46) and death (HR 4.21, 95% CI 1.29-13.80) compared with HIV-negative people. In conclusion, we detected a clinically important delay in time to therapy as well as worse disease-free and overall survival in HIV-positive people with OPSCC compared with their HIV-negative counterparts. These findings are relevant to understanding how HIV-positive people are diagnosed and undergo therapy for HPV-associated malignancies and highlight the need to address cancer treatment disparities in this group.

Epidemiological studies of wildfire PM 2.5 constituents are hindered by the limited information on the population exposure to ambient PM 2.5 constituents during high-pollution episodes from wildfires ("smoke waves"). The chemical composition of wildfire-related PM 2.5 can be affected by different ecosystems. Current literature assessing the differences in PM 2.5 pollution from wildfire smoke by ecosystems often analyzes air samples collected from the smoke near the center of an individual fire, but the results might not represent the exposure of the general public living away from the fire center but affected by the smoke of the fire. We assessed the population-based exposure to wildfire-related PM 2.5 species by integrating monitor measurements on 29 PM 2.5 species and previous findings on smoke waves during 2004-2009 in 51 Western US counties across six ecoregions. We found that across all ecoregions, smoke waves were associated with an increase in the fraction of organic carbon of total PM 2.5 by 20 percentage points (95% confidence interval (CI): 17, 23), an increase in the fraction of elemental carbon by 0.99 percentage points (95% CI: 0.43, 1.6), and decreases in fractions of sulfate and crustal species. While the PM 2.5 mixtures were dominated by the same source (wildfires), compositions in North American Deserts and the Great Plains during smoke waves were distinct. Besides expanding the knowledge of wildfire PM 2.5 , our study has implications beyond wildfires and could aid future population-based epidemiological research on PM 2.5 mixtures by source and region.

Background: Most studies on human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (SCC) have been performed on white Americans. Our study examined the incidence of HPV in an African American oropharyngeal SCC cohort and its survival., Methods: African American patients with oropharyngeal SCC in a combined tumor registry were identified. HPV16 testing was performed by polymerase chain reaction (PCR) from DNA extracted from tumor blocks. The p16 staining was performed using standard immunohistochemistry., Results: Forty-four patients were identified for analysis. Seventy-three percent of the tumors were HPV-positive. Only 39% of the patients who were HPV-positive were also p16-positive. Survival between all 3 tumor types, patients who tested HPV-positive/p16, HPV-positive/p16-positive, and HPV-negative/p16-negative was significantly different (p = .03). HPV/p16 status was significant on univariate and multivariate analysis., Conclusion: HPV oropharyngeal SCC is strongly present in this African American cohort. Two thirds of the patients who were HPV-positive were p16-negative. Greater study is needed to explain the high p16 negativity among this HPV-positive oropharyngeal SCC African American cohort. © 2015 Wiley Periodicals, Inc. Head Neck 38: E867-E872, 2016., (© 2015 Wiley Periodicals, Inc.)

Laryngeal cancer disproportionately affects more African-Americans than European-Americans. Here, we analyze the genome-wide somatic point mutations from the tumors of 13 African-Americans and 57 European-Americans from TCGA to differentiate between environmental and ancestrally-inherited factors. The mean number of mutations was different between African-Americans (151.31) and European-Americans (277.63). Other differences in the overall mutational landscape between African-American and European-American were also found. The frequency of C>A, and C>G were significantly different between the two populations (p-value<0.05). Context nucleotide signatures for some mutation types significantly differ between these two populations. Thus, the context nucleotide signatures along with other factors could be related to the observed mutational landscape differences between two races. Finally, we show that mutated genes associated with these mutational differences differ between the two populations. Thus, at the molecular level, race appears to be a factor in the progression of laryngeal cancer with ancestral genomic signatures best explaining these differences., (Copyright © 2015 Elsevier Inc. All rights reserved.)