Abstract A33: Head and neck squamous cell carcinoma in adolescents and young adults: Survivorship patterns and disparities
Authors: Challapalli Sai D. , Boakye Eric Adjei , Simpson Matthew C. , Osazuwa-Peters Nosayaba 
Published: February 2019

Abstract
Introduction: Head and neck squamous cell carcinoma (HNSCC) incidence and survivorship has been thoroughly described in the literature. Most of the literature has mainly focused on older adults. However, there are documented cases of early-onset HNSCC, typically in adolescents and young adults (AYA) aged 15-39 years. In fact, 12% of all pediatric cancers are in the head and neck region. As individuals live longer in the general population, it will become more important to track AYA cancer cases due to the potential for treatment effects, late toxicities, and comorbidities after cancer survivorship. Additionally, the emergence of the human papillomavirus (HPV)-associated oropharyngeal cancer as a dominant head and neck cancer means that more HNSCC patients are diagnosed at a younger age than previously known. These patients with HPV-associated oropharyngeal cancer are likely to live longer since HPV-associated HNSCC typically has better prognosis than other HNSCC. While numerous studies have investigated HNSCC survivorship in older adults and the elderly, limited research exists describing the incidence and survivorship in adolescents and young adults. The aim of this study is to characterize survivorship of HNSCC in the AYA population.
Methods: In this retrospective study, we utilized a patient cohort of 3,366 first primary HNSCC cases from the Surveillance, Epidemiology, and End Results (SEER) 18 database diagnosed between ages 15-39 and the years 2000-2014. Actuarial survival curves stratified by age group (15-29, 30-34, 35-39) indicated differences in HNSCC survival among groups with a log-rank test. Patient characteristics including age, sex, race/ethnicity, HNSCC site, stage, and treatment modality were utilized in a Fine and Gray competing risk proportional hazard model to examine their impact on HNSCC death in this cohort.
Results: The cohort was mostly male (65.1%) with an average age of 33.6. There was no significant HNSCC survival difference between the age-stratified survival curves (log-rank p=0.83). The Fine and Gray model also did not find a significant effect for age. All race/ethnicity groups had a significantly increased hazard of HNSCC death compared with non-Hispanic whites, with non-Hispanic American Indians/Alaska Natives having the highest increased hazard (aHR=4.01, 95% CI: 2.18, 7.38). Each increasing year of diagnosis was associated with a 5% decrease in hazard of death from HNSCC (aHR=0.95, 95% CI: 0.93, 0.97). Regional (aHR=3.90, 95% CI: 3.13, 4.86) and distant (aHR=6.77, 95% CI: 5.27, 8.70) stage had a higher HNSCC death hazard compared with localized stage. Patients who did not receive surgery had a 93% (aHR=1.93, 95% CI: 1.60, 2.33) increased hazard of HNSCC death compared with those who received surgery. Compared with oropharyngeal cancer, hypopharyngeal, oral cavity, and sinonasal cancers were associated with significantly increased hazard of HNSCC death, while nasopharynx was associated with a decreased hazard (aHR=0.68, 95% CI 0.52, 0.90).
Conclusions: We found no survival differences between adolescents and young adults based on age at diagnosis; however, minorities, especially American Indians/Alaskan Natives, had the worst survival outcomes. Also, patients who did not have the definite treatment of surgery and had regional or distant stage faced increased death from HNSCC. More research needs to be done to understand the mechanisms underlying the survival disparities noted among minorities, especially American Indians/Alaskan Natives. Efforts should also focus on establishing risk factor awareness and educational interventions, earlier screening measures, and patient navigator programs to improve prognosis of HNSCC in the American Indian/Alaskan Natives and other high-risk populations.
Citation Format: Sai D. Challapalli, Eric Adjei Boakye, Matthew C. Simpson, Nosayaba Osazuwa-Peters. Head and neck squamous cell carcinoma in adolescents and young adults: Survivorship patterns and disparities [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A33.