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PURPOSE: Hypofractionation is noninferior to conventional fractionation in the treatment of localized prostate cancer. Using results from the European Society of Radiation Oncologys (ESTRO) Global Impact of Radiotherapy in Oncology (GIRO) initiative survey on hypofractionation, this study identifies rates of adoption, facilitating factors, and barriers to adoption of hypofractionation in prostate cancer across World Bank income groups. MATERIALS AND METHODS: The ESTRO-GIRO initiative administered an international, anonymous, electronic survey to radiation oncologists from 2018 to 2019. Physician demographics, clinical practice characteristics, and hypofractionation regimen use (if any) for several prostate cancer scenarios were collected. Responders were asked about specific justifications and barriers to adopting hypofractionation, and responses were stratified by World Bank income group. Multivariate logistic regression models were used to analyze variables associated with hypofractionation preference. RESULTS: A total of 1,157 physician responses were included. Most respondents (60%) were from high-income countries (HICs). In the curative setting, hypofractionation was most often preferred in low- and intermediate-risk prostate cancers, with 52% and 47% of respondents reporting hypofractionation use in ≥50% of patients, respectively. These rates drop to 35% and 20% in high-risk prostate cancer and where pelvic irradiation is indicated. Most respondents (89%) preferred hypofractionation in the palliative setting. Overall, respondents from upper-middle-income countries and lower-middle- and low-income countries were significantly less likely to prefer hypofractionation than those from HICs (P < .001). The most frequently cited justification and barrier were availability of published evidence and fear of worse late toxicity, respectively. CONCLUSION: Hypofractionation preference varies by indication and World Bank income group, with greater acceptance among providers in HICs for all indications. These results provide a basis for targeted interventions to increase provider acceptance of this treatment modality.

Background: Complications following head and neck microvascular free tissue transfer (MFTT) are common. Less is known about when they occur. Method: Retrospective study of patients with primary or recurrent head and neck cancer undergoing MFTT reconstruction at a tertiary care institution. MFTT reconstructions with inpatient postoperative complications were included. The Kruskal–Wallis test was used to compare median postoperative day (POD) onset of complication by flap type. Results: Of 1090 patients undergoing MFTT reconstruction, 126 (11.6%) patients experienced inpatient complications including fibula (n = 35), anterolateral thigh (n = 60), or radial forearm (n = 31) MFTTs. POD onset was shortest for surgical site hematoma (median = 1 [IQR 1–5]), and longest for donor site infection (median = 11.5 [IQR 8–15]). There was no significant difference between flap types and POD onset of complications (p > 0.05). Conclusion: Hematoma formation and flap failure occur earliest during hospitalization, while dehiscence, infection, and fistula occur later. There is no difference in complication timing between flap types. [ABSTRACT FROM AUTHOR]

Background: Orbital involvement of invasive fungal sinusitis (IFS) is an ominous prognostic marker that should prompt rapid intervention. Transcutaneous retrobulbar administration of amphotericin B (TRAMB) is an off-label adjunctive treatment that can increase drug penetrance into diseased orbital tissue. To date, there is a lack of consensus regarding the use of TRAMB for treatment of IFS with orbital involvement. Objective: This systematic review aims to synthesize the indications, efficacy, and potential complications of TRAMB. Methods: PubMed, EMBASE, and Web of Science databases were probed for systematic review. Article search was conducted through June 2023 using the keywords "invasive fungal sinusitis," "invasive fungal rhinosinusitis," "rhino-orbital mucormycosis," "rhinosinusitis," "orbital," "retrobulbar," and "amphotericin." Results: In suitable cases as determined by radiologic and clinical evaluation, TRAMB administration has the potential to improve orbital salvage rates and improve versus stabilize visual acuity. Treatment complications are more likely with deoxycholate than with liposomal amphotericin formulations. The existing literature describing use of TRAMB is limited due to its retrospective nature, but the increase in IFS cases since 2020 due to the COVID pandemic has broadened the literature. Conclusions: TRAMB is an effective adjunctive treatment in IFS with mild-to-moderate orbital involvement when used in combination with standard of care debridement, systemic antifungal therapy, and immunosuppression reversal. Prospective longitudinal studies and multi-institutional randomized trials are necessary to determine the definitive utility of TRAMB. [ABSTRACT FROM AUTHOR]

Objectives: Decisional conflict (DC) is high in obstructive sleep apnea (OSA) surgical candidates interested in positive airway pressure (PAP) alternatives. We evaluated the impact of pre‐consultation video decision aids on patient DC and decision readiness. Methods: Prior to consultation for PAP alternatives, adult OSA patients were enrolled and completed a questionnaire querying DC (scored 0 [no conflict]–100 [high conflict]) and decision readiness. Those considering ≥3 treatment options were categorized as "high‐conflict." Patients were randomized to either an intervention group with video review about PAP and surgical options prior to their visit or to a control group that received no video review. Audio recordings of clinic visits were analyzed for patient engagement. Results: Twenty‐five participants (control: n = 12, intervention: n = 13) were found to have comparably high DC (mean score: 40.0). Both groups experienced post‐visit improvements in DC scores (post‐consult: 25.2, p = 0.003) which did not differ between the two groups (intervention: 20.5 ± 15.1 vs. control: 11.7 ± 12.1 points, p = 0.13). The intervention group showed significant improvement in decision‐making stage after the visit, with 72.7% "close to selecting an option" (p = 0.04) versus 41.7% in the control group. Use of videos was not associated with any differences in patient satisfaction, engagement, or decision to pursue surgery (all p > 0.05). High‐conflict patients (n = 5) who reviewed pre‐visit videos (intervention sub‐group) spoke fewer words during the visit (687 ± 139 vs. 1120 ± 389 words, p = 0.047) and had shorter visit times (18.7 ± 2.9 vs. 24.3 ± 3.1 min, p = 0.02) than high‐conflict control patients. Conclusions: Patients have high levels of DC when considering PAP alternatives. Use of video decision aids prior to sleep surgery consultation may improve the treatment decision‐making process. Level of Evidence: 2 Laryngoscope, 134:2958–2963, 2024 [ABSTRACT FROM AUTHOR]

This study aimed to systematically review the literature on the travel patterns of patients seeking radiation therapy globally. It examined the distance patients travel for radiation therapy as well as secondary outcomes, including travel time. A comprehensive search of 4 databases was conducted from June 2022 to August 2022. Studies were included in the review if they were observational, retrospective, randomized/nonrandomized, published between June 2000 and June 2022, and if they reported on the global distance traveled for radiation therapy in the treatment of malignant or benign disease. Studies were excluded if they did not report travel distance or were not written in English. Of the 168 studies, most were conducted in North America (76.3%), with 90.7% based in the United States. Radiation therapy studies for treating patients with breast cancer were the most common (26.6%), while external beam radiation therapy was the most prevalent treatment modality (16.6%). Forty-six studies reported the mean distance traveled for radiation therapy, with the shortest being 4.8 miles in the United States and the longest being 276.5 miles in Iran. It was observed that patients outside of the United States traveled greater distances than those living within the United States. Geographic location, urban versus rural residence, and patient population characteristics affected the distance patients traveled for radiation therapy. This systematic review provides the most extensive summary to date of the travel patterns of patients seeking radiation therapy globally. The results suggest that various factors may contribute to the variability in travel distance patterns, including treatment center location, patient residence, and treatment modality. Overall, the study highlights the need for more research to explore these factors and to develop effective strategies for improving radiation therapy access and reducing travel burden. [ABSTRACT FROM AUTHOR]

Objective: Human Papillomavirus (HPV) is a well-documented cause of cervical, oropharyngeal, vaginal, vulvar, anal, and penile cancers, largely preventable with the HPV vaccine. We aim to characterize the most popular TikTok videos pertaining to HPV-associated cancers and vaccination with a focus on oropharyngeal cancer., Methods: Observational study of public social media content. The top 200 TikTok videos that appeared when searching for #HPVvaccine and #Gardasil individually were included and analyzed on the basis of creator characteristics, viewer reach, content, and accessibility. Characteristics of each video were counted if mentioned or listed in the caption., Results: Forty-four percent of videos originated from creators self-identifying as health care professionals and had an average of 129,525 (SD: 59,997) views. 72.0% were pro-vaccination, and 17.5% were specifically anti-vaccination. Only 14.0% mentioned all six types of HPV-related cancer (including oropharyngeal). Other mentions included HPV prevention (62.0%), transmission (31.0%), infection risk factors (12.0%), and vaccine side effects (23.0%), while only 7.5% specifically regarded vaccines as safe. 35.5% of creators identified the Gardasil vaccine as appropriate for both men and women., Conclusions: Medical professionals have a strong presence on TikTok and overwhelmingly support HPV vaccination for cancer prevention but miss the mark in associating high-risk HPV with non-cervical cancers, addressing vaccine safety, and clearly defining who is eligible for the HPV vaccine/Gardasil. Despite oropharyngeal cancer eclipsing cervical cancer as the most common HPV-related malignancy, there is still a dearth of online patient education about this disease and the potential treatment/prevention measures available., (© 2025 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Accurately measuring the cost of a clinical process is critical to identifying ways to increase the value of a healthcare process. The objective of this study was to review time-driven activity-based costing (TDABC) in otolaryngology and to illustrate areas where value may be increased., Data Sources: PubMed, Web of Science, Embase, CINAHL Complete, and Business Source Complete from database inception to August 2024., Review Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guidelines, peer-reviewed full-length articles analyzing an otolaryngology care process with TDABC were included. Data collected included study characteristics, objectives, method of process mapping and costing, key study findings, subspecialty focus, and limitations., Results: Nine were included in the final review. Subspecialties consisted of pediatric otolaryngology (N = 4), head and neck surgery (N = 3), and rhinology (N = 2). The primary study aims were to reduce waste (N = 4), quantify cost (N = 4), evaluate the impact of a new intervention (N = 3), and identify quality improvement opportunities (N = 3). Most articles used input from involved personnel and/or direct observation to create process maps and reviewed institutional and/or public records to obtain cost information. TDABC was primarily used to study outpatient clinics or surgeries. Common limitations included limited generalizability, susceptibility to biases, and incomplete information., Conclusion: This scoping review demonstrated that TDABC can be a powerful and versatile tool for costing and identifying opportunities to increase the value of a care process in otolaryngology. Future costing studies can use TDABC to analyze care pathways in understudied otolaryngology subspecialties., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)