title: Oropharyngeal squamous cell carcinoma in the veteran population: Association with traditional carcinogen exposure and poor clinical outcomes.
abstract: BACKGROUND
  A significant fraction of oropharyngeal squamous cell carcinoma (SCC) cases is associated with traditional carcinogens; in these patients, treatment response and clinical outcomes remain poor.
  
  
  METHODS
  We evaluated patient, tumor, and treatment characteristics for 200 veterans with oropharyngeal SCC treated at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) between 2000 and 2012.
  
  
  RESULTS
  Most patients (77%) were white and heavy smokers. Twenty-seven patients required tracheostomy and 63 required gastrostomy placement during treatment. Overall survival (OS) at 5 years was 40%. Survival was impacted by T classification, treatment intensity, completion of treatment, and p16 tumor status. Almost 30% of patients were unable to complete a treatment regimen consistent with National Comprehensive Cancer Network (NCCN) guidelines.
  
  
  CONCLUSIONS
  Oropharyngeal SCC in veterans is associated with traditional carcinogens and poor clinical outcomes. Despite heavy smoking exposure, p16 tumor status significantly impacts survival. Careful consideration must be given to improving treatment paradigms for this cohort given their limited tolerance for treatment escalation.
authors.affiliation: Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Vlad C
authors.initials: VC
authors.lastname: Sandulache
authors.affiliation: Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: John
authors.initials: J
authors.lastname: Hamblin
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.|Houston Veterans Affairs Health Services Research and Development Center, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Syeling
authors.initials: S
authors.lastname: Lai
authors.affiliation: Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Todd
authors.initials: T
authors.lastname: Pezzi
authors.affiliation: Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas.
authors.forename: Heath D
authors.initials: HD
authors.lastname: Skinner
authors.affiliation: Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Numan A
authors.initials: NA
authors.lastname: Khan
authors.affiliation: Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Shayan M
authors.initials: SM
authors.lastname: Dioun
authors.affiliation: Department of Pathology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Christine
authors.initials: C
authors.lastname: Hartman
authors.affiliation: Department of Pathology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kramer
authors.affiliation: Department of Pathology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chiao
authors.affiliation: Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Jose P
authors.initials: JP
authors.lastname: Zevallos
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D002273:Carcinogens; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D015331:Cohort Studies; D018572:Disease-Free Survival; D006787:Hospitals, Veterans; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects; D016019:Survival Analysis; D014728:Veterans / Q000706:statistics & numerical data
chemical_list: D002273:Carcinogens
keywords: gastrostomy; oropharyngeal cancer; smoking; tracheostomy; veteran