Field Based Meeting on Oropharynx Cancer in Veterans
In May of 2019, Dr. Sandulache co-hosted the Field Based Meeting titled “Innovations in risk-stratification and treatment of Veterans with oropharynx cancer” as a joint event between the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine. The meeting was co-sponsored by the Biomedical Laboratory Research and Development Service of the Department of Veterans Affairs and the National Institute of Dental and Craniofacial Research.
Meeting Executive Summary
Over 60 thought leaders from hospitals and academic cancer centers across the country and within the Veterans Health Administration convened at the Baylor College of Medicine for a highly interactive “Field-Based Meeting” (FBM) focused on oropharyngeal squamous cell carcinoma (OPSCC). Participants agreed that OPSCC in the US, the Veteran population poses unique challenges, due to higher relative incidence and poorer treatment outcomes than those observed in the civilian population. Human papillomavirus (HPV)-related OPSCC has more favorable outcome relative to tobacco-associated head and neck cancer, making survivorship a significant issue in this population. However, due to high rates of tobacco use in the Veteran population, there is a large cohort of “dual exposed” OPSCC patients who have HPV-related disease in the setting of a significant history of tobacco use. While these patients clearly have worse outcomes than non-tobacco users with HPV-related OPSCC, many details about prognosis and optimum treatment strategy in this group of patients are not known. The high level of medical comorbidities in the Veteran population, and poor social support for many Veterans pose additional challenges to treatment of OPSCC in this population. Furthermore, there are few cross-VA consortia to coordinate multi-center clinical trials for Veterans with OPSCC, and care delivery sites for OPSCC in the VA system are very heterogeneous and vary widely in terms of services available (e.g. radiation oncology) and infrastructure to support research and clinical trials.
The participants rapidly identified a critical gap in clinical knowledge, namely a thorough understanding of HPV-related OPSCC epidemiology within the Veteran population. They identified utilization of both the Million Veteran Program and cross-institutional collaborations, as critical elements in the first steps to leveraging existing Veterans Health Administration (VHA) database resources towards better understanding disease incidence and prevalence in the modern era. The participants identified unmet needs with respect to basic and translational OPSCC research including: 1) appropriate preclinical models, and 2) an improved understanding of the genomic and epigenetic landscape of HPV-related OPSCC in smokers. In large part, this is because of a lack of studies focused on patient specimens derived from the Veteran population generally, and HPV-positive OPSCC smokers more specifically.
There was consensus that Veterans with HPV-positive OPSCC have reduced access to clinical trials, and that the HPV-positive OPSCC smoker subset is specifically underrepresented across existing and planned clinical trials. Furthermore, the participants identified survivorship as a critical unmet clinical need in both the Veteran and non-Veteran populations. To address the HPV-positive OPSCC cohort, the participants have proposed formation of an active, multi-disciplinary working group to vet and coordinate multi-institutional clinical trials within the VHA to target OPSCC in particular and head and neck cancer more broadly. With respect to the latter patient cohort, the participants identified the VHA as a uniquely positioned health care delivery system to conduct the first, multi-institutional prospective OPSCC survivorship registry study designed to understand the oncologic, functional and quality of life outcomes associated with HPV-positive OPSCC smokers.”
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