TY - JOUR
T1 - Management of Head and Neck Cancers With or Without Comorbid HIV Infection in Botswana
AU - McGinnis, Gwendolyn J.
AU - Ning, Matthew S.
AU - Bvochora-Nsingo, Memory
AU - Chiyapo, Sebathu
AU - Balang, Dawn
AU - Ralefala, Tlotlo
AU - Lin, Alexander
AU - Zetola, Nicola M.
AU - Grover, Surbhi
N1 - Publisher Copyright:
© 2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA)
PY - 2021/5
Y1 - 2021/5
N2 - Objectives/Hypothesis: Head and neck cancer (HNC) is the fifth most common malignancy in sub-Saharan Africa, a region with hyperendemic human immunodeficiency virus (HIV)-infection. HIV patients have higher rates of HNC, yet the effect of HIV-infection on oncologic outcomes and treatment toxicity is poorly characterized. Study Design: Prospective observational cohort study. Methods: HNC patients attending a government-funded oncology clinic in Botswana were prospectively enrolled in an observational cohort registry from 2015 to 2019. Clinical characteristics were analyzed via Cox proportional hazards and logistic regression followed by secondary analysis by HIV-status. Overall survival (OS) was evaluated via Kaplan–Meier. Results: The study enrolled 149 patients with a median follow-up of 23 months. Patients presented with advanced disease (60% with T4-primaries), received limited treatment (19% chemotherapy, 8% surgery, 29% definitive radiation [RT]), and had delayed care (median time from diagnosis to RT of 2.5 months). Median OS was 36.2 months. Anemia was associated with worse survival (HR 2.74, P =.001). Grade ≥ 3 toxicity rate with RT was 30% and associated with mucosal subsite (OR 4.04, P =.03) and BMI < 20 kg/m2 (OR 6.04, P =.012). Forty percent of patients (n = 59) were HIV-infected; most (85%) were on antiretroviral therapy, had suppressed viral loads (90% with ≤400 copies/mL), and had immunocompetent CD4 counts (median 400 cells/mm3). HIV-status was not associated with decreased receipt or delays of definitive RT, worse survival, or increased toxicity. Conclusions: Despite access to government-funded care, HNC patients in Botswana present late and have delays in care, which likely contributes to suboptimal survival outcomes. While a disproportionate number has comorbid HIV infection, HIV-status does not adversely affect outcomes. Level of Evidence: 2c Laryngoscope, 131:E1558–E1566, 2021.
AB - Objectives/Hypothesis: Head and neck cancer (HNC) is the fifth most common malignancy in sub-Saharan Africa, a region with hyperendemic human immunodeficiency virus (HIV)-infection. HIV patients have higher rates of HNC, yet the effect of HIV-infection on oncologic outcomes and treatment toxicity is poorly characterized. Study Design: Prospective observational cohort study. Methods: HNC patients attending a government-funded oncology clinic in Botswana were prospectively enrolled in an observational cohort registry from 2015 to 2019. Clinical characteristics were analyzed via Cox proportional hazards and logistic regression followed by secondary analysis by HIV-status. Overall survival (OS) was evaluated via Kaplan–Meier. Results: The study enrolled 149 patients with a median follow-up of 23 months. Patients presented with advanced disease (60% with T4-primaries), received limited treatment (19% chemotherapy, 8% surgery, 29% definitive radiation [RT]), and had delayed care (median time from diagnosis to RT of 2.5 months). Median OS was 36.2 months. Anemia was associated with worse survival (HR 2.74, P =.001). Grade ≥ 3 toxicity rate with RT was 30% and associated with mucosal subsite (OR 4.04, P =.03) and BMI < 20 kg/m2 (OR 6.04, P =.012). Forty percent of patients (n = 59) were HIV-infected; most (85%) were on antiretroviral therapy, had suppressed viral loads (90% with ≤400 copies/mL), and had immunocompetent CD4 counts (median 400 cells/mm3). HIV-status was not associated with decreased receipt or delays of definitive RT, worse survival, or increased toxicity. Conclusions: Despite access to government-funded care, HNC patients in Botswana present late and have delays in care, which likely contributes to suboptimal survival outcomes. While a disproportionate number has comorbid HIV infection, HIV-status does not adversely affect outcomes. Level of Evidence: 2c Laryngoscope, 131:E1558–E1566, 2021.
KW - Global oncology
KW - HIV-related neoplasms
KW - HPV-related malignancies
KW - Head and neck neoplasms
KW - Radiotherapy
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U2 - 10.1002/lary.29206
DO - 10.1002/lary.29206
M3 - Article
C2 - 33098322
AN - SCOPUS:85093980188
SN - 0023-852X
VL - 131
SP - E1558-E1566
JO - Laryngoscope
JF - Laryngoscope
IS - 5
ER -