• Alcohol
• Body mass index
• Head and neck cancer
• Immunotherapy
• Smoking
• Taxanes

• NSQIP
• disparities
• equity
• laryngectomy
• race

• I01 BX006380 BLRD VA
• U54 CA274321 NCI NIH HHS

• Humans
• Head and Neck Neoplasms/therapy
• Head and Neck Neoplasms/surgery

• Adult
• Aged
• Female
• Humans
• Male
• Middle Aged
• Bone Transplantation/methods
• Fibula/transplantation
• Free Tissue Flaps/transplantation
• Mandibular Reconstruction/methods
• Quality of Life

• duration of smoking abstinence
• epidemiology
• head and neck cancer
• smoking cessation
• survival

• Head and neck cancer
• Linear mixed-effects model
• Oral function
• SWAL-QOL
• Swallowing

• Humans
• Female
• Deglutition
• Quality of Life
• Cohort Studies
• Deglutition Disorders/diagnosis
• Deglutition Disorders/etiology
• Head and Neck Neoplasms/complications
• Head and Neck Neoplasms/therapy
• Weight Loss

• 3As model of care
• Behavioural framework
• Cancer care
• Implementation
• Intervention mapping
• Smoking cessation

• National Health and Medical Research Council
• The University of Newcastle (Australia)

The impact of smoking on cancer treatment efficacy and toxicity regardless of cancer type was investigated in this meta-analysis. Smoking during radiotherapy/chemoradiotherapy was associated with worse outcomes and a higher risk for toxicity. Smoking during treatment with EGFR tyrosine kinase inhibitors in lung cancer patients was associated with a worse prognosis, whereas smoking was associated with better outcomes in patients treated with checkpoint inhibitors. No association between smoking and treatment efficacy of chemotherapy was observed, though with low certainty of evidence. Our results can be used by oncology and radiotherapy staff to give patients more convincing information on the benefits that can be derived from smoking cessation before cancer treatment.

Aim: The aim of the present systematic review and meta-analysis was to summarize the current evidence on the potential impact of smoking during cancer treatment on treatment efficacy and toxicity irrespective of cancer type. Methods: A systematic literature search was performed using two electronic databases for potentially eligible studies. Only studies based on multivariable analysis for the association between smoking, compared to non-smokers (never or former), and treatment efficacy or toxicity were included. Pooled Hazard Ratios (HRs) or Odds Ratios (ORs) and corresponding 95% Confidence Intervals (CIs) were estimated through random-effects meta-analyses. Results: In total, 97 eligible studies were identified, of which 79 were eligible for the pooled analyses. Smoking during radiation therapy, with or without chemotherapy, was associated with an increased risk of locoregional recurrence (pooled HR: 1.56; 95% CI: 1.28–1.91 for radiation therapy; pooled HR: 4.28; 95% CI: 2.06–8.90 for chemoradiotherapy) and worse disease-free survival (pooled HR: 1.88; 95% CI: 1.21–2.90 for radiation therapy; pooled HR: 1.92; 95% CI: 1.41–2.62 for chemoradiotherapy) as well as a higher risk for radiation-induced toxicity (pooled OR: 1.84; 95% CI: 1.32–2.56 for radiation therapy; pooled OR: 2.43; 95% CI: 1.43–4.07 for chemoradiotherapy) with low-to-moderate certainty of evidence. Smoking during treatment with EGFR tyrosine kinase inhibitors (EGFR-TKIs) in patients with lung cancer was associated with worse progression-free survival compared to non-smokers (pooled HR: 1.43; 95% CI: 1.14–1.80; moderate certainty of evidence), whereas smoking was associated with improved progression-free survival in patients treated with checkpoint inhibitors (HR: 0.70; 95% CI: 0.58–0.84; moderate certainty of evidence). No statistically significant associations were observed between smoking and treatment efficacy or toxicity to chemotherapy. Conclusion: The present meta-analysis confirms earlier evidence of the negative impact of smoking during radiation therapy, with or without chemotherapy, on treatment efficacy and radiation-induced toxicity as well as a negative impact of smoking on the efficacy of EGFR-TKIs and a positive impact on the efficacy of checkpoint inhibitors. The evidence is too weak to draw firm conclusions on the potential association between smoking and chemotherapy, whereas there is no evidence for pooled analyses regarding other types of systemic oncological therapy.

Problem alcohol and tobacco use in patients with head and neck cancer (HNC) frequently co-occur and each are associated with poor outcomes including health-related quality of life (HRQOL). The purpose of this descriptive exploratory study was to identify the prevalence of these co-occurring behaviors and associations with HNC-specific HRQOL within the first year of diagnosis in a large sample of patients with HNC.

Cross-sectional study examined prevalence of co-occurring problem alcohol and tobacco use at diagnosis in a large sample of patients with HNC (N = 1327). Problem alcohol use was assessed using the Short Michigan Alcoholism Screening Test (SMAST); patients were classified as current/previous/never smokers based on self-reported tobacco use. HNC-specific HRQOL was assessed using the Head and Neck Cancer Inventory (HNCI), measured at diagnosis and 3 and 12 months postdiagnosis.

Three hundred twenty-five of 1327 (24.5%) scored 3 + on the SMAST at diagnosis, suggesting problem alcohol use and nearly 30% (28.4%) were current smokers. Of those with problem alcohol use, 173 (53.2%) were also current smokers. In total, 173 of 1327 (13.0%) exhibited both behaviors at diagnosis. Covariate-adjusted mean HNCI scores suggest that patients classified as both problem drinkers and current smokers have lower HRQOL scores during the first year postdiagnosis in multiple HNC-specific domains.

HNC patients should be screened for alcohol and tobacco use at diagnosis. Multimodal behavioral health interventions may provide one avenue for improved access and outcomes, particularly for patients at distance, and deserve further study in HNC.

• Alcohol consumption
• Cancer survivorship
• Head and neck cancer
• Health-related quality of life
• Tobacco use

No studies, to date, have scrutinized the role of a priori dietary patterns on prognosis following a head and neck squamous cell carcinoma (HNSCC) diagnosis. The purpose of this analysis was to evaluate the associations between adherence to six a priori defined diet quality indices (including AHEI-2010, aMED, DASH, and three low-carbohydrate indices) throughout the first 3 years of observation and all-cause and cancer-specific mortalities in 468 newly diagnosed HNSCC patients from the University of Michigan Head and Neck Specialized Program of Research Excellence (UM-SPORE). The dietary intake data were measured using a food frequency questionnaire administered at three annual time points commencing at study entry. Deaths and their causes were documented throughout the study using various data sources. Marginal structural Cox proportional hazards models were used to evaluate the role of diet quality, as a time-varying covariate, on mortality. There were 93 deaths from all causes and 74 cancer-related deaths adjudicated throughout the observation period. There was a strong inverse association between adherence to the AHEI-2010, all-cause mortality (HR_Q5–Q1:0.07, 95% CI:0.01–0.43, p_trend:0.04), and cancer-specific mortality (HR_Q5–Q1:0.15, 95% CI:0.02–1.07, p_trend:0.04). Other more modest associations were noted for the low-carbohydrate indices. In sum, higher adherence to the AHEI-2010 and a plant-based low-carbohydrate index throughout the first 3 years since diagnosis may bolster survival and prognosis in newly diagnosed patients with HNSCC.

• cancer
• diet quality
• marginal structural model
• nutritional epidemiology
• survivorship

• Metastasis
• Otorhinolaryngologic surgical procedures
• Quality of life
• Recurrence
• Squamous cell carcinoma

Squamous cell carcinomas affect different head and neck subsites and, although these tumors arise from the same epithelial lining and share risk factors, they differ in terms of clinical behavior and molecular carcinogenesis mechanisms. Differences between HPV-negative and HPV-positive tumors are those most frequently explored, but further data suggest that the molecular heterogeneity observed among head and neck subsites may go beyond HPV infection. In this review, we explore how alterations of DNA methylation and microRNA expression contribute to head and neck squamous cell carcinoma (HNSCC) development and progression. The association of these epigenetic alterations with risk factor exposure, early carcinogenesis steps, transformation risk, and prognosis are described. Finally, we discuss the potential application of the use of epigenetic biomarkers in HNSCC.

Head and neck squamous cell carcinomas (HNSCC) are among the ten most frequent types of cancer worldwide and, despite all efforts, are still diagnosed at late stages and show poor overall survival. Furthermore, HNSCC patients often experience relapses and the development of second primary tumors, as a consequence of the field cancerization process. Therefore, a better comprehension of the molecular mechanisms involved in HNSCC development and progression may enable diagnosis anticipation and provide valuable tools for prediction of prognosis and response to therapy. However, the different biological behavior of these tumors depending on the affected anatomical site and risk factor exposure, as well as the high genetic heterogeneity observed in HNSCC are major obstacles in this pursue. In this context, epigenetic alterations have been shown to be common in HNSCC, to discriminate the tumor anatomical subsites, to be responsive to risk factor exposure, and show promising results in biomarker development. Based on this, this review brings together the current knowledge on alterations of DNA methylation and microRNA expression in HNSCC natural history, focusing on how they contribute to each step of the process and on their applicability as biomarkers of exposure, HNSCC development, progression, and response to therapy.

• DNA methylation
• HPV
• alcohol
• biomarker
• field cancerization
• head and neck cancer
• microRNA
• tobacco

• oral cancer
• post-treatment nicotine dependence
• restarted smoking
• smoking cessation

• chimeric flaps
• complication management
• free flaps
• pedicled flaps
• tracheoesophageal fistula

We report the case of a patient with smoking‐induced radiation laryngeal necrosis (RLN) after undergoing definitive radiotherapy (RT) alone for T1a glottic squamous cell carcinoma.

The patient was a 63‐year‐old man who had a history of heavy smoking. He quit smoking when he was diagnosed with glottic squamous cell carcinoma. The RT dose was 63 Gy, delivered in 28 fractions with the three‐dimensional conventional RT technique for the larynx. After RT completion, the initial treatment response was complete response. He then underwent follow‐up examinations. At 13 months after RT, the patient resumed smoking. At 2 months after resuming smoking, he had severe sore throat and hoarseness. Laryngoscopy revealed a large tumor in the glottis. Surgical excision was performed, and the patient was histologically diagnosed with RLN, as late toxicity without cancer recurrence. At 3 weeks postoperatively, the patient had dyspnea, and laryngoscopy revealed total laryngeal paralysis. Thus, he underwent an emergent tracheostomy. The administration of steroids affected RLN, and laryngeal paralysis gradually improved.

This case suggests that smoking may have the potential to induce RLN after RT. Moreover, continuing smoking cessation is significantly important for patients with glottic cancer who receive RT. Rather than leaving smoking cessation up to the patient, it would be necessary for clinicians to actively intervene to help patients continue their effort to quit smoking.

• glottic cancer
• laryngeal necrosis
• late toxicity
• radiotherapy
• smoking

• KTP laser
• glottic cancer
• microlaryngoscopy
• vocal fold cyst

• FFF failure rate
• FFF success rate
• fibula free flap
• head and neck cancer
• reconstructive surgery

• Cox regression model
• nomogram
• pituitary adenoma
• transnasal sphenoidal surgery
• tumor recurrence

• Adenoma/diagnosis
• Adenoma/surgery
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Disease Progression
• Disease-Free Survival
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local/diagnosis
• Nomograms
• Pituitary Neoplasms/diagnosis
• Pituitary Neoplasms/surgery
• Prognosis
• Retrospective Studies
• Sphenoid Sinus/surgery
• Treatment Outcome
• Young Adult

• Cancer
• Cancer registries
• Smoking
• Smoking cessation
• Survival

• NCDB
• National Cancer Database
• comorbidity
• head and neck cancer
• oral cavity cancer
• overall survival
• squamous cell carcinoma
• staging

The purpose of this study was to examine the prevalences of CVD, CVD risk factors. and health behaviors among cancer survivor‐spouse dyads, assess how these prevalences differ by role (survivor vs spouse) and gender, and report congruences in health behaviors between survivors and their spouses.

We identified 1026 survivor‐spouse dyads from the 2010‐2015 Medical Expenditure Panel Survey. We used weighted multivariable logistic and linear regressions to analyze the data related to CVD, CVD risk factors, and health behaviors.

Survivors and spouses reported high prevalences of CVD and CVD risk factors but low engagement in healthy behaviors, including non‐smoking, physical activity, and maintaining a healthy weight (proxy for healthy diet). Gender and role differences were significantly related to the prevalence of CVD, CVD risk factors, and health behaviors among survivors and spouses. From 39% to 88% of survivors and spouses were congruent in their current smoking status, physical activity engagement/disengagement, and BMI.

Cancer survivors and spouses have high rates of CVD and CVD risk factors and poor engagement in healthful lifestyle behaviors. A high proportion of survivors and spouses were congruent in their current smoking status, physical activity engagement/disengagement, and BMI. Effective lifestyle interventions are needed for this high‐risk population. Couple‐focused interventions may be well‐suited for these dyads and warrant further study.

Both cancer survivors and their spouses need to be non‐moking, more physically active, and maintain normal BMI in order to reduce their high risk of CVD and CVD risk factors.

• Medical Expenditure Panel Survey (MEPS)
• cancer
• cardiovascular disease (CVD)
• family
• health behavior
• quality of life

• biomarkers
• fluorescence spectroscopy

• Carcinoma, Squamous Cell/etiology
• Carcinoma, Squamous Cell/metabolism
• Carcinoma, Squamous Cell/mortality
• Carcinoma, Squamous Cell/pathology
• Elements
• Female
• Humans
• Male
• Middle Aged
• Mouth Neoplasms/etiology
• Mouth Neoplasms/metabolism
• Mouth Neoplasms/mortality
• Mouth Neoplasms/pathology
• Neoplasm Recurrence, Local/etiology
• Neoplasm Recurrence, Local/metabolism
• Neoplasm Recurrence, Local/mortality
• Neoplasm Recurrence, Local/pathology
• Prognosis
• Smoking/adverse effects
• Survival Rate

Although many studies have shown the association between smoking and the increased incidence and adverse prognosis of head and neck squamous cell carcinoma (HNSCC), the mechanisms and pharmaceutical targets involved remain unclear. Here, we integrated gene expression signatures, genetic alterations, and survival analyses to identify prognostic indicators and therapeutic targets for smoking HNSCC patients, and we discovered that the FDA-approved drug varenicline inhibits the target for cancer cell migration/invasion. We first identified 18 smoking-related and prognostic genes for HNSCC by using RNA-Seq and clinical follow-up data. One of these genes, CHRNB4 (neuronal acetylcholine receptor subunit beta-4), increased the risk of death by approximately threefold in CHRNB4-high expression smokers compared to CHRNB4-low expression smokers (log rank, p = 0.00042; hazard ratio, 2.82; 95% CI, 1.55–5.14), former smokers, and non-smokers. Furthermore, we examined the functional enrichment of co-regulated genes of CHRNB4 and its 246 frequently occurring copy number alterations (CNAs). We found that these genes were involved in promoting angiogenesis, resisting cell death, and sustaining proliferation, and contributed to much worse outcomes for CHRNB4-high patients. Finally, we performed CHRNB4 gene editing and drug inhibition assays, and the results validate these observations. In summary, our study suggests that CHRNB4 is a prognostic indicator for smoking HNSCC patients and provides a potential new therapeutic drug to prevent recurrence or distant metastasis.

• drug repurposing
• head and neck squamous cell carcinoma (HNSCC)
• nicotine
• prognostic biomarker
• smoking

• COVID-19
• adverse respiratory outcomes
• head and neck squamous cell carcinoma (HNSCC)
• pulmonary comorbidities
• respiratory infections and complications

• Adult
• Aged
• Aged, 80 and over
• Alcohol Drinking/adverse effects
• Alcohol Drinking/epidemiology
• Alcohol Drinking/genetics
• Biomarkers, Tumor/genetics
• Body Mass Index
• Cohort Studies
• DNA Methylation
• Educational Status
• Epigenesis, Genetic
• Female
• Humans
• Male
• Middle Aged
• Oropharyngeal Neoplasms/etiology
• Oropharyngeal Neoplasms/genetics
• Oropharyngeal Neoplasms/mortality
• Prognosis
• ROC Curve
• Risk Assessment
• Tobacco Smoking/adverse effects
• Tobacco Smoking/epidemiology
• Tobacco Smoking/genetics

• MC_UU_00011/5 Medical Research Council
• MC_UU_12013/3 Medical Research Council
• MC_UU_00011/1 Medical Research Council
• C18281/A20988 Cancer Research UK
• 25350 Cancer Research UK
• WT099874MA Wellcome Trust
• C18281/A19169 Cancer Research UK
• 15954 Cancer Research UK
• MC_UU_12013/2 Medical Research Council
• Wellcome Trust
• MC_UU_12013/1 Medical Research Council
• 19169 Cancer Research UK

Background: As the sixth most common cancer of worldwide, head and neck cancers (HNC) are springing from oral cavity, pharynx and larynx and there is no strong biomarker for prognosis. Rates of 5 years survival with HNC remain relatively low in decades with improvement of treatments. Evidence that single nucleotide polymorphisms (SNPs) play a part in cancer prognosis is growing.

Methods: We conducted an exome-wide association study among 261 patients with head and neck squamous cell carcinoma (HNSCC) and then validated in The Cancer Genome Atlas (TCGA) database for survival by using the Cox proportional hazards regression models and Kaplan–Meier analyses.

Results: After combining the result of the two stages, 4 SNPs were significantly associated with HNSCC survival (rs16879870 at 6q14.3: adjusted HR = 2.02, 95%CI = 1.50–2.73, P = 3.88 × 10⁻⁶; rs2641256 at 17p13.2: adjusted HR = 0.67, 95%CI = 0.56–0.80, P = 7.51 × 10⁻⁶; rs2761591 at 11p13: adjusted HR = 2.07, 95%CI = 1.50–2.87, P = 1.16 × 10⁻⁵; and rs854936 at 22q11.21: adjusted HR = 1.92, 95%CI = 1.43–2.57, P = 1.27 × 10⁻⁵). Besides, we constructed a receiver operating characteristic (ROC) model to estimate predictive effect of the novel SNPs combined with clinical stage in HNSCC prognosis (AUC = 0.715). We also found the genotype of rs16879870 and rs854936 was significantly associated with the expression of gene GJB7 (P = 0.013) and RTN4R (P = 0.047) in cancer tissues of TCGA, respectively.

Conclusion: Our findings suggested that the SNPs (rs16879870, rs2641256, rs2761591, rs854936) might play a crucial role in prognosis of HNSCC.

• cancer survival
• cox regression
• genetic variant
• head and neck squamous cell cancer
• single nucleotide polymorphism

• Head and neck neoplasms
• human papillomavirus
• oropharynx
• smoking
• survival

• Aged
• Female
• Head and Neck Neoplasms/mortality
• Head and Neck Neoplasms/pathology
• Head and Neck Neoplasms/virology
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Papillomaviridae
• Papillomavirus Infections/complications
• Prognosis
• Proportional Hazards Models
• Prospective Studies
• Smoking/adverse effects
• Squamous Cell Carcinoma of Head and Neck/mortality
• Squamous Cell Carcinoma of Head and Neck/pathology
• Squamous Cell Carcinoma of Head and Neck/virology
• Survival Rate

• 001 World Health Organization
• R01 CA090731 NCI NIH HHS
• T32 CA009156 NCI NIH HHS
• R01 CA90731 NCI NIH HHS

Cancers of the head and neck have a high mortality rate, and roughly 10% of the patients die within six months of diagnosis. To our knowledge little has been written about this group.

We wished to identify risk factors for early death, to predict and monitor patients at risk better and, if possible, avoid unjustified major treatment.

This population-based nationwide study from the Swedish Head and Neck Cancer Register (SweHNCR) included data from 2008–2015 and 9733 patients at potential risk of early death.

A total of 925 (9.5%) patients died within six months. For every year older the patients became, the risk of early death increased by 2.3% (p<0.001). The relative risk of death was 3.37 times higher (237%) for patients with WHO score 1 compared with WHO score 0. A primary tumour in the hypopharynx correlated with a 24% increased risk over the oral cavity (p<0.024). Patients with stage IV disease had a 3.7 times greater risk of early death than those with stage I (p<0.001). As expected, a 12 times increased risk of early death was noted in the palliative treatment group, compared to the curative group.

Limitations to this study were that the actual cause of death was not recorded in the SweHNCR, and that socioeconomic factors, alcohol consumption, smoking habits, and HPV status, were not reported in SweHNCR until 2015. However, the fact that this is a population-based nationwide study including 9733 patients compensates for some of these limitations.

Identification of patients at increased risk of early death shows that older patients with advanced disease, increased WHO score, primary tumour in the hypopharynx, and those given palliative treatment, are more likely than the others to die from head and neck cancer within six months of diagnosis.

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Female
• Head and Neck Neoplasms/diagnosis
• Head and Neck Neoplasms/mortality
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Staging
• Survival Analysis
• Young Adult

• calculator
• human papillomavirus (HPV)
• oropharyngeal squamous cell carcinoma (OPSCC)
• prediction
• prognosis

• Aged
• Area Under Curve
• Carcinoma, Squamous Cell/mortality
• Carcinoma, Squamous Cell/therapy
• Carcinoma, Squamous Cell/virology
• Female
• Humans
• Male
• Middle Aged
• Oropharyngeal Neoplasms/mortality
• Oropharyngeal Neoplasms/therapy
• Oropharyngeal Neoplasms/virology
• Papillomavirus Infections/mortality
• Papillomavirus Infections/therapy
• Precision Medicine
• Prognosis
• Prospective Studies
• Survival Analysis
• Treatment Outcome

• P50 CA097248 NCI NIH HHS
• P30 CA046592 NCI NIH HHS
• U01 CA183848 NCI NIH HHS
• T32 CA083654 NCI NIH HHS
• R01 CA184153 NCI NIH HHS
• R01 CA129102 NCI NIH HHS

• alcohol
• head and neck cancer
• human papillomavirus
• smoking
• survival

• Aged
• Aged, 80 and over
• Alcohol Drinking/adverse effects
• Female
• Follow-Up Studies
• Head and Neck Neoplasms/diagnosis
• Head and Neck Neoplasms/etiology
• Head and Neck Neoplasms/mortality
• Humans
• Male
• Middle Aged
• Prognosis
• Prospective Studies
• Risk Factors
• Smoking/adverse effects
• Survival Rate

• 19169 Cancer Research UK
• RP-PG-0707-10034 Department of Health
• 110021/Z/15/Z Wellcome Trust
• MC‐UU‐12013/1-9 Medical Research Council

• Copy number alteration
• Genetic signature
• Oral squamous cell carcinoma
• Recurrence
• TCGA

• Alcohol Drinking/adverse effects
• Carcinoma, Squamous Cell/genetics
• Carcinoma, Squamous Cell/pathology
• Carcinoma, Squamous Cell/surgery
• Caspase 8/genetics
• DNA Copy Number Variations
• Female
• Gene Expression Profiling
• Gene Expression Regulation, Neoplastic
• Humans
• Male
• Margins of Excision
• Middle Aged
• Mouth Neoplasms/genetics
• Mouth Neoplasms/pathology
• Mouth Neoplasms/surgery
• Neoplasm Recurrence, Local/genetics
• Neoplasm Recurrence, Local/pathology
• Neoplasm Staging
• Risk Factors
• Telomerase/genetics

• Depression
• Disfigurement
• Head and neck cancer
• Psychosocial issues
• Suicide

The objective of this article is to review and summarize the extant literature on head and neck cancer (HNC) patients’ informational needs and to characterize emerging issues in this patient population in order to define priorities for future research. HNC patients may undergo challenging treatment regimens and experience treatment-related alterations in primary daily functions such as speech and eating. These changes often persist following treatment and may lead to significant deficits in quality of life and interpersonal relations. Despite empirical evidence demonstrating that receipt of adequate information and support is predictive of improved outcomes post-treatment, relatively limited attention has been paid to the informational and support needs of HNC patients. This review focuses primarily on three topic domains: (1) managing treatment-related side effects; (2) addressing alcohol and tobacco dependence; and (3) informational needs in the areas of human papillomavirus (HPV) and clinical trials. While there is increasing awareness of the rehabilitation and survivorship needs in this patient population, patients note that the impact of treatment on social activities and interactions is under-discussed and of key concern. In addition, there is a significant gap in addressing communication and informational needs of caregivers and family members who are integral for promoting healthy behaviors and self-care post-treatment. Greater integration of programs that address tobacco or alcohol dependency within a comprehensive treatment and support plan may increase patient motivation to seek help and enhance patient success in maintaining long-term abstinence. Finally, emerging patient-provider communication needs, particularly in the context of decision making about clinical trials or surrounding an HPV-related diagnosis, have been noted among both patients and healthcare providers. Future research on the development of novel programs that offer feasible and acceptable methods for addressing unmet informational and support needs is warranted and may yield benefit for improving patient-reported outcomes.

• HPV
• Informational needs
• caregivers
• communication
• health behaviors
• treatment side effects

Epithelial cadherin (encoded by the CDH1 gene) is a tumor suppressor glycoprotein that plays a role in the invasion and metastasis of human cancers. As previous studies regarding the association between CDH1 promoter methylation and head and neck squamous cell carcinoma (HNSCC) have yielded inconsistent conclusions, a meta-analysis was performed. A systematic literature review was undertaken from four databases: PubMed, Embase, Google Scholar, and Web of Science. Finally, a total of 23 studies (including 1,727 cases of HNSCC and 555 normal controls) were included in the present study. Our results showed that the frequency of CDH1 promoter methylation in HNSCC was statistically greater than in controls (odds ratio [OR] =5.94, 95% confidence interval [CI]: 3.36–10.51, P<0.001). In reported cases of HNSCC, CDH1 promoter methylation was statistically associated with tumor stage (OR =0.46, 95% CI: 0.27–0.78, P=0.004) and a history of alcohol consumption (OR =6.04, 95% CI: 2.41–15.14, P<0.001). Moreover, the sensitivity, specificity, and area under the curve of the summary receiver operator characteristic for the included studies were 0.50 (95% CI: 0.4–0.61), 0.89 (95% CI: 0.79–0.95), and 0.74 (95% CI: 0.70–0.78), respectively. In conclusion, our meta-analyses indicated that CDH1 promoter methylation was associated with HNSCC risk, and may be utilized as a valuable diagnostic biomarker for HNSCC.

• CDH1
• HNSCC
• diagnosis
• head and neck squamous cell carcinoma
• methylation

• Advanced larynx cancer
• head and neck cancer
• lymph node metastasis
• radiation therapy
• treatment outcome

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Squamous Cell/mortality
• Carcinoma, Squamous Cell/radiotherapy
• Carcinoma, Squamous Cell/surgery
• Female
• Humans
• Laryngeal Neoplasms/mortality
• Laryngeal Neoplasms/radiotherapy
• Laryngeal Neoplasms/surgery
• Laryngectomy
• Male
• Middle Aged
• Neck Dissection
• Radiotherapy, Adjuvant
• Republic of Korea/epidemiology
• Retrospective Studies

• Chemoradiotherapy
• Head and neck neoplasms
• Intensity modulated radiotherapy
• Microbiota
• Periodontitis