Differences in Lifestyle Habits and Poorer Adherence to Radiation Therapy in Patients With HPV-Negative vs HPV-Positive Oropharyngeal Carcinoma
Different mechanisms of carcinogenesis and molecular characteristics have been proposed for human papillomavirus (HPV)-positive and HPV-negative oropharyngeal carcinomas, and better outcomes have been observed in patients with HPV-positive tumors. Some experts advocate classification of the two as distinct tumors. In a retrospective single-institution study reported in JAMA Otolaryngology-Head & Neck Surgery, Hess et al identified differences in lifestyle habits, comorbidities, and adherence to radiation therapy between HPV-positive and HPV-negative patients that are likely to contribute to disparities in outcome.
Study Details
The study was a retrospective analysis of data from 162 consecutive patients with locally advanced squamous cell carcinoma of the oropharynx treated at University of California Davis Comprehensive Cancer Center with primary chemoradiation (n = 95) or primary surgery followed by adjuvant radiation (n = 67). HPV-positive (n = 111) and HPV-negative (n = 51) patients were compared for alcohol, tobacco, and marijuana use, prevalence of diabetes mellitus, chronic obstructive pulmonary disease (COPD), anxiety disorder, and major depression, and number of missed days of radiation treatment.
HPV-positive patients were significantly younger (median, 56 vs 59 years, P = .04), more likely to be aged < 50 years (22% vs 8%, P = .04), more likely to have T1 disease (36% vs 14%, P < .001), and less likely to have T3 (15% vs 22%, P = .003) and T4 disease (19% vs 41%, P = .003).
Lifestyle Habits and Comorbidities
HPV-negative patients were significantly more likely to report heavy alcohol use (47% vs 16%, P = .02), any marijuana use (47% vs 23%, P = .003), and ever smoking cigarettes (88% vs 46%, P < .001). HPV-negative patients had nonsignificantly higher rates of COPD (12% vs 7%, P = .37) and anxiety disorder (12% vs 6%, P = .35), with no differences observed in rates of diabetes (10% vs 9%) or major depressive disorder (10% vs 9%).
Missed Days of Treatment
HPV-negative patients missed more days of radiation therapy (mean = 2.8 vs 1.7 days, P = .02) and more HIV-negative patients had ≥ 5 missed days (24% vs 10%, P = .03), with both of these differences retaining significance on multivariate analysis controlling for COPD, depression, anxiety, smoking status, alcohol use, and age (P = .02 and P = .04, respectively).
HPV-positive patients had longer 2-year overall survival (86% vs 71%, P = .04) and a lower rate of locoregional recurrence (4% vs 30%, P < .001).
The investigators concluded, “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.”
Allen M. Chen, MD, of the David Geffen School of Medicine, University of California, Los Angeles, is the corresponding author for the JAMA Otolaryngology-Head & Neck Surgery article.
The study was supported by a National Institutes of Health grant. The authors reported no conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
