title: 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.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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
  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.
authors: Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento.
authors: Clayton B
authors: CB
authors: Hess
authors: Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento.
authors: Dominique L
authors: DL
authors: Rash
authors: Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento.
authors: Megan E
authors: ME
authors: Daly
authors: Department of Otolaryngology-Head and Neck Surgery, University of California Davis Comprehensive Cancer Center, Sacramento.
authors: D Gregory
authors: DG
authors: Farwell
authors: Department of Pathology, University of California Davis Comprehensive Cancer Center, Sacramento.
authors: John
authors: J
authors: Bishop
authors: Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento.
authors: Andrew T
authors: AT
authors: Vaughan
authors: Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento.
authors: Machelle D
authors: MD
authors: Wilson
authors: Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento.
authors: Allen M
authors: AM
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000532:radiotherapy* / Q000821:virology*; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000821:virology*; D027383:Papillomaviridae / Q000302:isolation & purification*; D010349:Patient Compliance; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors