Marital status as a predictor of survival in patients with human papilloma virus-positive oropharyngeal cancer

Abstract

Purpose

Determine whether marital status is a significant predictor of survival in human papillomavirus-positive oropharyngeal cancer.

Materials and methods

A single center retrospective study included patients diagnosed with human papilloma virus-positive oropharyngeal cancer at Boston Medical Center between January 1, 2010 and December 30, 2015, and initiated treatment with curative intent at Boston Medical Center. Demographic data and tumor-related variables were recorded. Univariate analysis was performed using a two-sample t-test, chi-squared test, Fisher's exact test, and Kaplan Meier curves with a log rank test. Multivariate survival analysis was performed using a Cox regression model.

Results

A total of 65 patients were included in the study with 24 patients described as married and 41 patients described as single. There was no significant difference in most demographic variables or tumor related variables between the two study groups, except single patients were significantly more likely to have government insurance (p = 0.0431). Furthermore, there was no significant difference in 3-year overall survival between married patients and single patients (married = 91.67% vs single = 87.80%; p = 0.6532) or 3-year progression free survival (married = 79.17% vs single = 85.37%; p = 0.8136). After adjusting for confounders including age, sex, race, insurance type, smoking status, treatment, and AJCC combined pathologic stage, marital status was not a significant predictor of survival [HR = 0.903; 95% CI (0.126,6.489); p = 0.9192].

Conclusions

Although previous literature has demonstrated that married patients with head and neck cancer have a survival benefit compared to single patients with head and neck cancer, we were unable to demonstrate the same survival benefit in a cohort of patients with human papilloma virus-positive oropharyngeal cancer.

Introduction

The overall incidence of oropharyngeal cancer (OPSCC) in the United States has not significantly changed between 1974 and 1999; however, there has been a relative increase in OPSCC incidence compared to other head and neck cancers during the same time period [1]. A likely cause of the relative increase in OPSCC is because of the significant increase in human papilloma virus-positive (HPV +) OPSCC, a sexually transmitted disease, and corresponding decrease in HPV − OPSCC, with up to 70% of newly diagnosed cases of OPSCC attributed to HPV [2], [3]. In addition to the increase in incidence of HPV + OPSCC, it is crucial to note that there are significant differences in risk factors [4], [5], [6], [7], [8], [9], prognosis [9], [10], [11], [12], [13], [14], [15], and demographic and pathologic features that are predictive of survival in HPV + OPSCC compared to HPV- OPSCC [12], [15], [16], [17], [18], [19], [20].

Some of the common risk factors described for HPV + OPSCC include number of sexual partners and number of partners for oral sex in comparison to the more traditional risk factors described for HPV − OPSCC including smoking and EtOH [2], [4], [5], [7], [8], [21]. Therefore, a diagnosis of HPV + OPSCC can be considered both an oncologic and psychosocial diagnosis. Multiple studies have looked at the psychological impact of receiving a diagnoses of HPV + OPSCC, and more specifically, Milbury et al. described that approximately 20% of patients reported that the HPV + diagnosis resulted in a negative impact on their relationship, describing reduced trust in the relationship, problems with intimacy, reduced sexual contact, and concerns regarding infidelity [22]. Furthermore, D'Souza et al. interviewed patients receiving treatment for HPV + OPSCC and determined that 5% of patients reported tension with their partners after discussing the HPV status of their tumor [23].

Patients that are diagnosed with HPV + OPSCC are significantly more likely to be married than patients diagnosed with HPV − OPSCC [7], and previous literature has described marital status as a predictor of improved overall survival and earlier stage at diagnosis in both head and neck cancer [24], [25], [26], [27], [28], and in HPV + cervical cancer [29]. However, there is currently no literature looking at whether marital status is a predictor of survival in patients with HPV + OPSCC. As such, we sought to evaluate whether marital status was a significant predictor of survival for patients diagnosed with HPV + OPSCC at a single institution between 2010 and 2015.