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Original Investigation |

Competing Causes of Death and Medical Comorbidities Among Patients With Human Papillomavirus–Positive vs Human Papillomavirus–Negative Oropharyngeal Carcinoma and Impact on Adherence to Radiotherapy ONLINE FIRST

Clayton B. Hess, MD1; Dominique L. Rash, MD1; Megan E. Daly, MD1; D. Gregory Farwell, MD2; John Bishop, MD3; Andrew T. Vaughan, PhD1; Machelle D. Wilson, PhD4; Allen M. Chen, MD1
[+] Author Affiliations
1Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento
2Department of Otolaryngology–Head and Neck Surgery, University of California Davis Comprehensive Cancer Center, Sacramento
3Department of Pathology, University of California Davis Comprehensive Cancer Center, Sacramento
4Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento
JAMA Otolaryngol Head Neck Surg. Published online February 13, 2014. doi:10.1001/jamaoto.2013.6732
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Importance  Survival of patients with head and neck cancer can be affected by competing causes of mortality, as well as comorbidities that result in radiation treatment interruptions.

Objective  To discern how differences in preexisting medical and psychosocial comorbidities potentially influence adherence to radiation therapy according to human papillomavirus (HPV) status.

Design, Setting, and Participants  Retrospective analysis at a comprehensive cancer center of 162 consecutive patients with locally advanced squamous cell carcinoma of the oropharynx treated with primary chemoradiation (n = 95) or primary surgery followed by adjuvant radiation (n = 67). Immunostaining for p16 was used to determine HPV status.

Main Outcomes and Measures  Difference in alcohol, tobacco, and marijuana use was compared between patients with HPV-positive and HPV-negative tumors, as well as the prevalence of the following comorbidities: diabetes mellitus, chronic obstructive pulmonary disease (COPD), anxiety disorder, and major depression. The number of total missed treatment days was analyzed as both a continuous and categorical variable.

Results  Rates of self-reported heavy alcohol use (47% vs 16%; P = .02) and any marijuana use (47% vs 23%; P = .003) were significantly higher among HPV-negative patients. Fifty-four percent of HPV-positive patients self-identified as never smokers, compared with only 12% of HPV-negative patients (P < .001). HPV-negative patients had more missed treatment days (mean, 2.8 vs 1.7 days; P = .02), as well as an increased rate of at least 5 missed days (24% vs 10%; P = .04), and higher prevalences of COPD (12% vs 7%; P = .37) and anxiety disorder (12% vs 6%; P = .35).

Conclusions and Relevance  Pronounced differences exist in lifestyle habits between patients with HPV-negative and HPV-positive oropharyngeal cancer at diagnosis. These differences, as well as those of medical and psychosocial burden, may contribute to observed discrepancies in treatment adherence and need to be considered in outcomes reporting and clinical trial design.

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Figure.
Patients Missing Radiation Therapy Treatments for Oropharyngeal Cancer According to Human Papillomavirus (HPV) Status

Proportion of patients who missed at least 1, 2, 3, 4, and 5 days of the prescribed course of radiation therapy according to HPV status of their oropharynx cancer.

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