ABSTRACT
OBJECTIVES: To determine the level of knowledge of HPV related oropharyngeal cancer and practice patterns of HPV vaccine use by pediatricians. STUDY DESIGN, SUBJECTS, METHODS: IRB approved 18-question survey was administered to members of the Louisiana Chapter of the American Academy of Pediatrics. RESULTS: We received 116 responses (response rate: 15.9 percent );. 104 respondents (89.66 percent ); routinely recommend/offer HPV vaccine, 6 (5.17 percent ); occasionally or only at caregiver request, and 6 (5.17 percent ); do not offer the vaccine. 17 (15.5 percent ); reported having no awareness of the link between oropharyngeal cancer and HPV, and only 50 (45.9 percent ); had knowledge that HPV-related oropharyngeal cancer incidence was increasing. Strength of recommendation for males and knowledge of HPV-related oropharyngeal cancer were not associated with years in practice, practice type or patient population served. CONCLUSIONS: Increased awareness regarding HPV-related oropharyngeal cancers among primary care providers may increase HPV immunization rates, especially in males.
Subject(s)
Oropharyngeal Neoplasms/prevention & control , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/therapeutic use , Practice Patterns, Physicians'/statistics & numerical data , Female , Health Knowledge, Attitudes, Practice , Humans , Louisiana , Male , Oropharyngeal Neoplasms/epidemiology , Oropharyngeal Neoplasms/virology , Pediatricians , Surveys and QuestionnairesABSTRACT
OBJECTIVE: Laryngopharyngeal reflux may cause significant morbidity in the head and neck cancer population. The goal was to determine if pharyngeal reflux is increased as a result of treatment for laryngeal cancer. STUDY DESIGN: A prospective clinical trial. SETTING: Tertiary care center. SUBJECTS: Head and neck cancer patients treated at LSU Health-Shreveport with a plan for total laryngectomy. METHODS: Pharyngeal pH probes with resultant reflux scores were utilized in patients with laryngeal/pharyngeal cancer with a plan for total laryngectomy. RESULTS: Twenty-four patients were enrolled, of whom 10 underwent postlaryngectomy pH probe monitoring. The mean upright Ryan score for patients with prior radiotherapy was 238.4 (n = 8), compared with 22.0 (n = 16) in those without prior radiotherapy (P = .02). The supine score was 12.7 in the radiotherapy group and 2.7 in those without radiotherapy (P = .12). For those who completed the postlaryngectomy pH study (n = 10), the mean preoperative upright Ryan score was 106.32 ± 279.1 versus a postoperative score of 209.0 ± 352.6 (P = .04). The mean supine preoperative Ryan score in this group was 3.9 ± 3.47, as opposed to 8.1 ± 9.6 postoperatively (P = .13) CONCLUSIONS: This study suggests that treatment of laryngeal cancer may increase the incidence of pharyngeal reflux. Consider screening for reflux in patients previously treated for laryngeal cancer.
Subject(s)
Laryngeal Neoplasms/therapy , Laryngopharyngeal Reflux/epidemiology , Adult , Aged , Aged, 80 and over , Combined Modality Therapy , Female , Humans , Hydrogen-Ion Concentration , Incidence , Laryngeal Neoplasms/complications , Laryngectomy , Laryngopharyngeal Reflux/diagnosis , Laryngopharyngeal Reflux/etiology , Laryngoscopy , Louisiana/epidemiology , Male , Middle Aged , Pilot Projects , Prognosis , Prospective StudiesABSTRACT
IMPORTANCE: Laryngeal cancer survival rates have declined over the past 2 decades. Primary surgical therapy may increase survival rates in advanced-stage tumors. OBJECTIVE: To compare survival outcomes for initial surgical treatment of advanced-stage primary tumors in the Louisiana health system with outcomes in the National Cancer Database (NCDB). DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis was conducted at an academic tertiary referral hospital. Patients diagnosed as having laryngeal carcinoma between 1998 and 2007 were identified via a tumor registry. Louisiana State University Health-Shreveport (LSU Health) data and national data from 2000 to 2010 were obtained from the NCDB of the American College of Surgeons. INTERVENTIONS: Treatment of laryngeal cancer. MAIN OUTCOMES AND MEASURES: Age, sex, race/ethnicity, socioeconomic status, laryngeal subsite, stage, primary treatment modality, and observed survival were analyzed and compared. RESULTS: A total of 165 patients treated at LSU Health met the inclusion criteria. One hundred seventeen (70.91%) presented with advanced-stage (III/IV) disease, compared with 46.67% nationwide (P < .01). For stage IV disease our 5-year survival rate was 55.54% (95% CI, 43.35%-66.11%)compared with 31.60% (95% CI, 30.40%-32.90%) nationally (P < .05). Our proportion of uninsured patients was 23.73% vs 5.05% of patients nationally (P < .001), and our patients traveled further distances for care with 60.47% traveling 50 miles or more, compared with 15.87% nationally (P < .001). Sixty-four of the patients with advanced-stage disease (54.70%) underwent primary surgical therapy to include total laryngectomy. Data from the NCDB indicate that the rate of laryngectomy declined from 40% to 60% in the 1980s to 32% in 2007. CONCLUSIONS AND RELEVANCE: Louisiana State University Health-Shreveport treated more uninsured patients with advanced-stage laryngeal cancer compared with national data but demonstrated higher survival rates for those with advanced-stage disease. The results also demonstrate that we have continued a high rate of primary surgical therapy for advanced-stage disease, despite the national trend toward organ preservation. We believe that upfront laryngectomy may explain our higher survival rates for advanced-stage laryngeal cancer.
