Immunotherapy is altering the treatment paradigm for recurrent and metastatic head and neck squamous cell carcinomas (HNSCC). However, epidemiological data in this population are currently limited. The objective of this study was to determine yearly prevalence, treatment rates, and patterns of care for patients with recurrent and metastatic HNSCC.
We conducted a retrospective observational study of all new HNSCC patients presenting to a head and neck multidisciplinary oncology center within a regionalized system between January 1st, 2017 to December 31st, 2018.
Of 373 patients, 291 (78.0%) underwent primary treatment without subsequent locoregional recurrence or distant metastasis (NED). 20 (5.3%) patients undergoing primary treatment during the study period experienced 3-year locoregional failure (LRR) and 26 (6.9%) developed distant metastatic recurrence (MR). 36 (9.6%) patients were diagnosed with distant metastatic disease (DM) at the time of initial consultation. Consultation rates for medical oncology (NED 34.3%, LRR 50.0%, MR 63.9%, DM 84.6%) and palliative care (NED 5.5%, LRR 45.0%, MR 69.2%, DM 86.1%) were correlated with prognosis. Over a three year follow up period, 61 deaths (NED 15, LRR 6, MR 14, DM 26) were documented.
Recurrent and metastatic HNSCC patients are increasingly being referred for management by medical oncologists. Our results may inform estimations of HNSCC treatment burden, in the setting of a single payer healthcare system.