Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: B359
Session Name: Poster Session
Trends in Head and Neck Cancer Incidence, Characteristics and Mortality among Veterans Nationwide
Kristen L Zayan, MD1; Monique Boudreaux-Kelly, PhD2; Jennifer L McCoy, MA2; John Hotchkiss, MD2; Joshua Smith, MD1; Matthew E Spector, MD1; Jose Zevallos, MD1; Marci Nilsen, PhD, RN1; Angela Mazul, PhD1; Jessica H Maxwell, MD, MPH1; 1Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA; 2Veterans Affairs Medical Center, Pittsburgh, PAINTRODUCTION: The incidence of head and neck squamous cell carcinoma (HNSCC) among the Veteran population is approximately double that of the civilian population, with survival rates that remain poor. Unfortunately, Veterans have overall lower rates of HPV vaccination, in addition to higher rates of alcohol and tobacco use, placing them at risk for both HPV-related and HPV-unrelated HNSCC as well as poor outcomes. Nationwide data on the incidence and mortality trends among Veterans with HNSCC is largely unknown.
OBJECTIVES: This study aims to identify incidence trends of HNSCC subtype and overall survival (OS) among Veterans with HSNCC nationwide. A secondary aim is to examine the demographic and clinical characteristics between Veterans with oropharynx cancer (OPC) to Veterans with non-oropharynx cancers.
METHODS: This is a retrospective study of Veterans with HNSCC from 2012 to 2022, with medical record data extracted from the Veteran’s Health Administration’s Corporate Data Warehouse. Veterans were identified via ICD-9 and ICD-10 codes and categorized by primary subsite. Data on clinical-demographic factors, body mass index (BMI), Elixhauser Comorbidity Index, rurality (utilizing the Rural-Urban Commuting Area codes), and area deprivation index (ADI) were collected and analyzed across primary subsites. 3-year and 5-year OS were compared across primary tumor subsites as well.
RESULTS: 75,524 Veterans were identified with HNSCC. The majority had cancers of the larynx (n=26,828; 35.6%), followed by OPC (n=25,957; 34.4%), oral cavity (OC; n=17,052; 22.6%), hypopharynx (HP; n=2,809; 3.7%), and nasopharynx (NP; n=2,807; 3.7%). OPC accounted for 26.3% of HNSCC in 2012, rising to 46% in 2022. Conversely, larynx cancer and OC accounted for 41.2% and 26.2% in 2012, respectively, and declined to 29.3% and 16.8% by 2022, respectively. The proportion of HP and NP have remained stable at below 5% for both subtypes.
3-year OS was highest for OPC at 69.5% and lowest for HP at 48.5% (p<0.001). 5-year OS for OPC was 61.7%, followed by NP, OC, larynx, and HP at 58.3%, 56.6%, 54.3%, and 38.5%, respectively (Figure 1; p<0.001). Veterans with OPC had significantly lower Elixhauser scores (p<0.001), higher BMI (p<0.001), younger age (p<0.001), were more likely to be White (p<0.001), and were less likely to have smoked (p<0.001) or consumed alcohol (p<0.001) in the prior 2 years compared to non-OPC Veterans. Compared to Veterans with non-OPC HNSCC, Veterans with OPC were more likely to be married and have lower ADI (less deprivation). However, there were no differences in rurality, drive time, and distance to the treating facility across all primary subsites.
CONCLUSION: Overall, the proportion of OPC is rising among Veterans with HNSCC, while the proportion of larynx and OC has declined. The overall survival rates are poor, with 5-year survival at approximately 62% for all patients with OPC and as low as 38% for patients with HP cancer. Multiple factors impact Veterans with HNSCC, including BMI, smoking, alcohol consumption, ADI, and medical comorbidities. Further investigation into the specific impact of these factors on survival is warranted and currently underway.
