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Oropharyngeal cancer incidence on the rise among elderly patients
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Oropharyngeal squamous cell cancer incidence has increased among younger and older adults, according to the results of a SEER analysis.
This increasing incidence appeared driven by HPV–associated cancers, whereas the incidence of tobacco-associated oropharyngeal cancer decreased.
The landscape of head and neck cancer has experienced a radical transformation in economically developed regions due to the declining use of tobacco and the increasing prevalence of HPV. However, most studies have indicated that the increasing incidence of oropharyngeal squamous cell carcinoma has occurred among middle-aged individuals.
“HPV–associated cancers in elderly patients may be more common contemporary clinical practice than suggested by early reports,” Zachary S. Zumsteg, MD, radiation oncologist at Samuel Oschin Comprehensive Cancer Center of Cedars-Sinai Medical Center, and colleagues wrote. “The elderly represent a unique subset of patients with head and neck cancer given that they do not generally benefit from intensification strategies, such as concomitant chemoradiotation therapy, concomitant cetuximab-based bioradiation therapy, or altered fractionation in comparison with radiotherapy alone.”
Zumsteg and colleagues sought to evaluate trends in oropharyngeal squamous cell cancer incidence with particular focus on age-specific trends for patients aged 65 years or older. Researchers used the SEER database to identify 40,264 patients (80.3% men) — 33.1% of whom were aged 65 years or older — diagnosed with oropharyngeal squamous cell cancer between 2002 and 2012.
Researchers evaluated oropharyngeal squamous cell cancer occurring in the tonsil, base of tongue, Waldeyer ring, vallecula, soft palate, uvula, oropharyngeal wall or other oropharynx site. To account for other alcohol- and tobacco-associated cancers, the researchers analyzed changes in the incidence of other head and neck sites, such as the larynx, hypopharynx and oral cavity. They also evaluated the incidence of lung and anal cancers due to their association with tobacco and HPV.
The age-adjusted incidence of oropharyngeal cancers increased significantly between 2002 and 2012 among patients aged 45 to 64 years (annual percentage change [APC] = 2.31; 95% CI, 1.76-2.86) and patients aged 65 years or older (APC = 2.92; 95% CI, 2.32-3.51). These increases were primarily driven by tonsil and base-of-tongue cancers in men.
Anal cancer incidence also increased among elderly individuals (APC = 4.42; 95% CI, 3.28-5.57).
However, elderly patients demonstrated a decrease in tobacco-related head and neck cancers of the larynx (APC = –1.54; 95% CI, –2 to –1.08), oral cavity (APC = –1.23; 95% CI, –1.84 to –0.64) and hypopharynx (APC = –2.44; 95% CI, –3.01 to –1.86).
Three-year OS and cancer-specific survival probabilities significantly increased over the study period for patients with oropharyngeal squamous cell cancer aged younger than 45 years (P = .03), 45 to 64 years (P < .001) and 65 years or older (P = .003). Still, significantly fewer older patients achieved 3-year cancer-specific survival than patients aged 45 to 64 years (60.8% vs. 75.7%; P < .001).
Researchers acknowledged the possibility that the survival trends observed in the study may have been influenced by treatment-related improvements in radiation therapy, systemic therapy or supportive care.
“The ramifications of these changes in the incidence of oropharyngeal squamous cell cancer among elderly patients will be amplified by concomitant changes in the demographic characteristics of the U.S. population over the next several decades,” Zumsteg and colleagues wrote. “A multiplicative effect on the absolute number of elderly patients with oropharyngeal squamous cell cancer would thus be expected to result from the combination of a growing number of elderly Americans and an increased proportion harboring oral HPV infections.” – by Nick Andrews
Disclos ure: Zumsteg reports advisory roles with Scripps Proton Therapy Center. Other researchers report advisory board and consultant roles with Johnson and Johnson, Merck and Vertex Pharmaceuticals.
Perspective
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David L. Jennings II
Contrary to findings from previous research, new data suggest that the incidence of oropharyngeal squamous cell carcinoma (OPSCC) in patients aged 65 years and older has significantly increased in recent years, most notably among white men. Interestingly, rates of tobacco use have decreased, whereas prevalence of HPV in OPSCC has increased.
The increased incidence of OPSCC could perhaps be explained by a variety of factors. Presently, people are generally living longer with increased health awareness, and technology is constantly improving, leading to more cancer diagnoses.
With 72 million adults aged 65 years and older projected to be alive in 2030 — an increase from 35 million in 2000 — oncology clinicians should be aware that the number of those diagnosed with OPSCC would similarly increase. This surge in patients with head and neck cancer has implications not only for the oncology community, but other areas of healthcare as well; there will be more head and neck cancer survivors than ever before with their own specific health needs resulting from their disease and its treatment.
The elderly represent an untapped source of oncologic research data, as this population has been historically excluded from clinical trials in head and neck cancer. The oncology community would benefit from research aimed at this population and the impact of immunohistochemical markers (such as p16) and HPV status on treatment toleration, including deintensification strategies, as well as on OS. Additionally, new treatment research areas surely exist with the advent of immunotherapy approval for second-line treatment for head and neck cancer.
Disclosure: Jennings reports no relevant financial disclosures.
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