Patient Immunosuppression and the Association With Cancer-Specific Outcomes After Treatment of Squamous Cell Carcinoma of the Oropharynx

Volume 94  Number 4  2016 45 years of age. Relevant demographic, tumor, and survival variables were extracted for analysis. Hospitals were divided into community cancer programs (100-500 annual cancer cases) and comprehensive community or academic/research programs (500 annual cancer cases). Cox regression was used to identify predictors of survival. Results: We identified 54,565 OCSCC patients, 7.6% of whom are younger than 45 years of age (nZ3828). Of these patients, 80% were between 35 and 44 years of age. More males were affected (65.7%) than females. Caucasians represented 86.3% of cases, followed by African Americans (9.5%) and patients of “other” races (4.2%). Private insurance (65.6%) was most common, with Medicaid (17.6%), uninsured (11.7%), and Medicare (5.1%) comprising the rest. Overall survival at 2 and 5 years was 76% and 66%, respectively. The oral tongue subsite was most common (55.4%), followed by floor of mouth (FOM; 28.5%), gingiva/retromolar trigone (15.4%), and buccal mucosa (0.7%). An increasing incidence of oral tongue cancers was seen, while FOM cancers showed a decreasing trend over the study period. A minority of cases was treated at low-volume community cancer centers, which saw more stage I-II disease. Uninsured and Medicaid patients had more advanced stage III-IV disease (P<.001), while those with private insurance had more early-stage disease. Further analysis including treatment, insurance, demographics, and survival was performed. cStage I-II patients without private insurance were more likely to receive some form of chemotherapy. Ethnicity, insurance status, income, age group, pathologic stage, and positive surgical margins are significant prognosticators on univariate analysis. In multivariate analysis, high pathologic stage, nonprivate insurance, treatment at a low-volume community center, and positive margins remained predictors of worse survival. Conclusion: In young patients with oral cavity cancers, differences in treatment, presentation, and survival were seen in those with health disparities. In addition to staging and surgical margins, treatment at low-volume community cancer centers and nonprivate insurance status predicted worse survival. Author Disclosure: K. Zhan: None. E.A. Nicolli: None. T. Day: None.

207 Geographic Variation in the Costs and Outcomes of Treatment for Head and Neck Cancer V. Divi,1 L. Tao,2 A. Whittemore,1 and I. Oakley-Girvan2; 1 Stanford University, Stanford, CA, 2Cancer Prevention Institute of California, Fremont, CA Purpose/Objective(s): Advanced head and neck cancer (HNC) is a complex group of diseases that requires the input and coordination of multiple providers. While there are general guidelines for treatment, there is also considerable variation in how patients are treated and how long they survive after treatment. It is unclear how the treatment variations relate to treatment costs and survival. Materials/Methods: We identified Medicare patients with advanced HNC treated in 12 states between 2004 and 2009 using the linked database containing Medicare and Surveillance Epidemiology and End Results (SEER) data. Average cost per patient during the year following diagnosis was calculated for each state. Costs included inpatient hospital, outpatient, physician, and durable medical equipment charges. Three-year overall survival was also calculated for each of the states. Results: A total of 3678 patients were included in the final study. There was significant cost variation among the states. Utah incurred the lowest total costs within 1 year of HNC diagnosis ($51,857 per patient; standard deviation [SD], $4,797), whereas New Jersey had the highest costs ($81,071 per patient; SD, $2,347). Three-year overall survival also varied among the states, ranging from 45 months in Kentucky to 58 months in Washington. There was no correlation between expenditures and length of survival. Conclusion: Despite significant variation in both expenditures and survival among the states, we found no correlation between costs and mean survival time, suggesting that more costly care did not lead to improved outcomes. Author Disclosure: V. Divi: None. L. Tao: None. A. Whittemore: None. I. Oakley-Girvan: None.

Posters

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208 Patient Immunosuppression and the Association With CancerSpecific Outcomes After Treatment of Squamous Cell Carcinoma of the Oropharynx D.N. Margalit,1 J.D. Schoenfeld,1 B. Rawal,2 M. Puzanov,3 R.I. Haddad,4 G. Rabinowits,2 N. Chau,2 J. Lorch,5 A. Lavigne,3 L.A. Goguen,1 D.J. Annino,1 T. Thomas,1 P.J. Catalano,2 and R.B. Tishler1; 1Dana-Farber Cancer Institute / Brigham and Women’s Hospital, Boston, MA, 2DanaFarber Cancer Institute, Boston, MA, 3Brigham & Women’s Hospital, Boston, MA, 4Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School and Department of Medicine, Brigham and Women’s Hospital, Boston, MA, 5Dana Farber Cancer Institute, Boston, MA Purpose/Objective(s): Patients (pts) with a history of immunosuppression such as hematologic malignancy or transplant have previously been shown to have an increased risk of a second malignancy and worse cancer-specific outcomes particularly with respect to oral cavity cancers. We aimed to determine the impact of immunosuppression on recurrence and survival after treatment for squamous cell carcinoma of the oropharynx (OPSCC). Materials/Methods: We analyzed 336 pts with OPSCC treated with definitive intensity modulated radiation therapy (IMRT) to a median dose of 70 Gy (median 2 Gy/fraction) at a single institution. We identified all pt comorbidities at the initial consultation prior to therapy. Pts were considered to be immunosuppressed if they had a history of hematologic malignancy, stem-cell or solid-organ transplant, or AIDS. The association of immunosuppression with overall survival (OS) and recurrence was assessed with single and multivariable Cox proportional hazard regression models. Predictors that were significant in the univariate model with a P value of .05 were included in the multivariable model. The Fine & Gray method was used to adjust for competing risks. Results: The primary cohort comprised 336 pts with OPSCC of whom 85% were male, the median age was 57.3 years, and primary sites were tonsil (49.4%), base of tongue (46.7%), and other (3.9%). Most pts were HPV positive (72.3%) with stage IVA being the most common American Joint Committee on Cancer stage (71.5%) followed by IVB (9.2%) and other. Pts received upfront concurrent chemoradiation (58%) or sequential therapy (38.4%); 3.6% received radiation alone. With a median follow-up of 3.8 years, pts with a history of immunosuppression had a 3-year OS of 71.4% with a cumulative incidence of local-regional failure (LRF) and distant failure of 32.1%. They had worse OS (adjusted hazard ratio [HR] 3.95; 95% confidence interval [CI] 1.13-13.80), worse recurrence-free survival (adjusted HR 3.72; 95% CI 1.18-11.75), and increased risk of LRF (unadjusted HR 3.80; 95% CI 1.31-11.09; adjusted HR 3.27; 95% CI 0.9711.01) and increased risk of distant failure (adjusted HR 3.72; 95% CI 1.18-11.73) compared with the primary cohort of pts. Conclusion: Patients with a diagnosis associated with immunosuppression prior to definitive treatment for OPSCC have worse OS and recurrence-free survival and increased rates of local and distant failure after treatment. This clinical finding lends support to exploring the role of optimal immune function for cancer clearance and survival after treatment for oropharyngeal cancer. Author Disclosure: D.N. Margalit: None. J.D. Schoenfeld: None. B. Rawal: None. M. Puzanov: None. R.I. Haddad: None. G. Rabinowits: None. N. Chau: None. J. Lorch: None. A. Lavigne: None. L.A. Goguen: None. D.J. Annino: None. T. Thomas: None. P.J. Catalano: None. R.B. Tishler: None.

209 WITHDRAWN

210 Compliance to Radiation Therapy for Head and Neck Cancer in a Safety-Net Health System B.P. O’Donnell,1 M.S. Ludwig,2 H.J. Manley,3 J.A. Asper,2 and M. Bonnen2; 1The University of Texas Health Science Center at Houston, Houston, TX, 2Baylor College of Medicine, Houston, TX, 3 Southern Methodist University, Dallas, TX