Uchechukwu Megwalu, MD, MPH

All Publications

• Oral cavity cancer in young, non-smoking, and non-drinking patients: a contemporary review. Critical reviews in oncology/hematology Tran, Q., Maddineni, S., Arnaud, E. H., Divi, V., Megwalu, U., Topf, M. C., Sunwoo, J. B. 2023: 104112

  Abstract

  Oral squamous cell carcinoma (OSCC) in non-smoking and non-drinking (NSND) individuals appears to be distinct from the traditional head and neck squamous cell carcinoma (HNSCC). The incidence of this subset is increasing, as are the number of studies examining its characteristics. NSND OSCC individuals tend to be younger (<45 years) compared to traditional HNSCC patients. The proportion of females in the NSND OSCC cohort is also higher. The tongue is the predominantly affected subsite. Studies have revealed several gene mutations and unique epigenomic profiles but no definitive genetic etiology. Transcriptomic analysis has not found any causative viral agents. Other proposed etiologies include chronic dental trauma, microbiome abnormalities, marijuana consumption, and genetic disorders. There are international efforts to determine the relative prognostic outcome of this unique cohort, but no consensus has been reached. Here, we review the incidence, demographics, subsite, possible etiologies, prognosis, and therapy implications of the NSND OSCC cohort.

  View details for DOI 10.1016/j.critrevonc.2023.104112

  View details for PubMedID 37633348

• Nonopioid Versus Opioid Analgesics After Thyroid and Parathyroid Surgery: A Systematic Review. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Moon, P. K., Wei, E. X., Hamid, M. S., Borghi, J. A., Megwalu, U. C. 2023

  Abstract

  To determine whether nonopioid analgesic regimens, taken after discharge for thyroid and parathyroid surgery have noninferior pain outcomes in comparison to opioid analgesic regimens. Secondarily, we sought to determine if nonopioid analgesic regimens decrease the number of opioid medications taken after thyroid and parathyroid surgery, and to assess adverse events associated with opioid versus nonopioid regimens.PubMed, Embase, Cochrane.A comprehensive search of the literature was performed according to the PRISMA guidelines, and identified 1299 nonduplicate articles for initial review of which 2 randomized controlled trials (RCTs) were identified as meeting all eligibility criteria. Meta-analysis was not conducted due to heterogeneity in the data and statistical analyses.Both RCTs included in this systematic review found no significant differences in postoperative pain scores between individuals discharged with a nonopioid only analgesic regimen compared to analgesic regimen that included oral opioid medications. One study reported significantly increased number of postoperative calls related specifically to pain in the nonopioid arm compared to the opioid arm (15.6% vs. 3.2%, P = .045).This systematic review of RCTs revealed a limited number of studies examining nonopioid versus opioid postoperative pain medications among adults who undergo thyroid and parathyroid surgery. Among the 2 RCTs on this topic, there is a shared finding that nonopioid analgesic regimens are noninferior to opioid analgesic regimens in managing postoperative pain after thyroid and parathyroid surgery, supporting the use of nonopioid pain regimens given the risk of opioid dependence associated with prescription opioid medications.

  View details for DOI 10.1002/ohn.503

  View details for PubMedID 37595107

• Association between insurance status and hearing healthcare use in the United States. American journal of otolaryngology Bernstein, I. A., Megwalu, U. C. 2023; 44 (6): 103993

  Abstract

  Despite the high prevalence and morbidity of hearing loss, many individuals with hearing loss do not have access to hearing healthcare. This study aims to assess the relationship between insurance status and prior audiogram, and hearing aid use among subjects with hearing loss.This cross-sectional study of the 2009-10, 2011-12, and 2015-16 cycles of the U.S. National Health and Nutrition Examination Survey (NHANES) included 5270 adult subjects 18 years or older with subjective or audiometric hearing loss. Subjects were stratified by insurance: Medicare, Medicaid, private, uninsured, and 'other or unspecified'.After adjusting for covariates, among subjects with audiometric hearing loss, prior audiogram was not associated with insurance type, including no insurance (OR 0.80, 95 % CI 0.45 to 1.42), Medicare (OR 1.34, 95 % CI 0.69 to 2.59), Medicaid (OR 1.27, 95 % CI 0.55 to 2.93), or 'other or unspecified' (OR 1.73, 95 % CI 0.67 to 4.47). Hearing aid use was not associated with insurance type, including no insurance (OR 0.20, 95 % CI 0.03 to 1.29), Medicare (OR 0.56, 95 % CI 0.27 to 1.14), Medicaid (OR 2.03, 95 % CI 0.47 to 8.71), or 'other or unspecified' (OR 1.76, 95 % CI 0.59 to 5.23).Health insurance status was not associated with hearing healthcare use in our nationally-representative sample of individuals with hearing loss. Given variations in hearing coverage by Medicaid between states, future studies should compare the impact of Medicaid insurance on hearing aid use between states that cover hearing aids and those that do not.

  View details for DOI 10.1016/j.amjoto.2023.103993

  View details for PubMedID 37454432

• Association of Human Papillomavirus Status With Suicide Risk Among Patients With Head and Neck Cancer. JAMA otolaryngology-- head & neck surgery Chakoma, T., Moon, P. K., Osazuwa-Peters, O. L., Megwalu, U. C., Osazuwa-Peters, N. 2023

  Abstract

  Human papillomavirus (HPV) is strongly associated with head and neck cancer, and HPV status is considered a prognostic factor. Being a sexually transmitted infection, HPV-related cancers may have greater risk of stigma and psychological distress; however, the potential association of HPV-positive status with psychosocial outcomes, such as suicide, is understudied in head and neck cancer.To investigate the association between HPV tumor status and suicide risk among patients with head and neck cancer.This population-based retrospective cohort study included adult patients with clinically confirmed cases of head and neck cancer based on HPV tumor status from the Surveillance, Epidemiology, and End Results database from January 1, 2000, to December 31, 2018. Data analysis was conducted from February 1 to July 22, 2022.The outcome of interest was death by suicide. Primary measure was HPV status of tumor site, dichotomized as positive or negative. Covariates included age, race, ethnicity, marital status, cancer stage at presentation, treatment modality, and type of residence. Cumulative risk of suicide among patients with HPV-positive and HPV-negative head and neck cancer was assessed using Fine and Gray competing risk models.Of 60 361 participants, the mean (SD) age was 61.2 (13.65) years, and 17 036 (28.2%) were women; there were 347 (0.6%) American Indian, 4369 (7.2%) Asian, 5226 (8.7%) Black, 414 (0.7%) Native Hawaiian or Other Pacific Islander, and 49 187 (81.5%) White individuals. A competing risk analysis showed a significant difference in the cumulative incidence of suicide between HPV-positive cancers (5-year suicide-specific mortality, 0.43%; 95% CI, 0.33%-0.55%) and HPV-negative cancers (5-year suicide-specific mortality, 0.24%; 95% CI, 0.19%-0.29%). Tumor status that was HPV positive was associated with increased suicide risk in the unadjusted model (hazard ratio [HR], 1.76; 95% CI, 1.28-2.40), but not the fully adjusted model (adjusted HR, 1.18; 95% CI, 0.79-1.79). Among people with oropharyngeal cancer only, HPV status was associated with increased suicide risk, but the width of the confidence interval prevented definitive conclusion (adjusted HR, 1.61; 95% CI 0.88-2.94).The results of this cohort study suggest that patients with HPV-positive head and neck cancer have similar risk of suicide as patients with HPV-negative cancer, despite differences in overall prognosis. Early mental health interventions may be associated with reduced suicide risk in all patients with head and neck cancer and should be assessed in future work.

  View details for DOI 10.1001/jamaoto.2022.4839

  View details for PubMedID 36795392

• Disparities in Outcomes for Pacific Islander Patients vs Asian and non-Hispanic White Patients With Head and Neck Cancer-Reply. JAMA otolaryngology-- head & neck surgery Moon, P. K., Megwalu, U. C. 2022

  View details for DOI 10.1001/jamaoto.2022.3373

  View details for PubMedID 36301566

• In Reference to: How Many Nodes to Take? Lymph Node Ratio Below 1/3 Reduces Papillary Thyroid Cancer Nodal Recurrence. The Laryngoscope Megwalu, U. C. 2022

  View details for DOI 10.1002/lary.30460

  View details for PubMedID 36271915

• Associations of Hearing Loss Severity and Hearing Aid Use With Hospitalization Among Older US Adults. JAMA otolaryngology-- head & neck surgery Thai, A., Khan, S. I., Choi, J., Ma, Y., Megwalu, U. C. 2022

  Abstract

  Hearing loss is associated with higher hospitalization risk among older adults. However, evidence on whether hearing aid use is associated with fewer hospitalizations among individuals with hearing loss remains limited.To assess the association between audiometric hearing loss severity and hearing aid use and hospitalization.This population-based cross-sectional study used audiometric and health care utilization data for respondents aged 65 years or older from 4 cycles of the National Health and Nutrition Examination Survey from 2005 to 2016. Data were analyzed from February 23, 2021, to March 22, 2022.Audiometric hearing loss severity and participant-reported hearing aid use.The main outcome was respondent-reported hospitalization in the past 12 months. Multivariable logistic regression was performed to assess the association of hearing loss severity with hospitalization. To assess the association of hearing aid use with hospitalization, propensity score matching was performed with 2:1 nearest neighbor matching without replacement.Of 2060 respondents (mean [SD] age, 73.9 [5.9] years; 1045 [50.7%] male), 875 (42.5%) had normal hearing, 653 (31.7%) had mild hearing loss, 435 (21.1%) had moderate hearing loss, and 97 (4.7%) had severe to profound hearing loss. On multivariable analysis, moderate and severe hearing loss were associated with hospitalization (moderate hearing loss: odds ratio [OR], 1.50; 95% CI, 1.01-2.24; severe hearing loss: OR, 1.71; 95% CI, 1.03-2.84). Of 1185 respondents with at least mild hearing loss, 200 (16.9%) reported using a hearing aid. Propensity score-matched analysis showed that hearing aid use was not associated with hospitalization (OR, 1.17; 95% CI, 0.74-1.84), including among respondents with moderate or severe hearing loss (OR, 1.17; 95% CI, 0.71-1.92).In this cross-sectional study, hearing loss was associated with higher risk of hospitalization, but hearing aid use was not associated with a reduction in hospitalization risk in the population with hearing loss. The association of hearing aid use with hospitalization should be evaluated in larger prospective studies with reliable data on the frequency of hearing aid use.

  View details for DOI 10.1001/jamaoto.2022.2399

  View details for PubMedID 36048464

• Thyroid Cancer Incidence, Clinical Presentation, and Survival Among Native Hawaiian and Other Pacific Islanders. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Moon, P. K., Chakoma, T., Ma, Y., Megwalu, U. C. 2022: 1945998221118538

  Abstract

  OBJECTIVE: To assess the incidence, clinical presentation, and survival in Native Hawaiian and other Pacific Islander (NHPI) patients with well-differentiated thyroid cancer.STUDY DESIGN: This population-based incidence analysis and retrospective cohort study utilized data from the Surveillance, Epidemiology, and End Results database.SETTING: Incidence analysis included patients diagnosed between 1990 and 2014, while the cohort to study clinical presentation and survival comprised patients diagnosed between 2004 and 2015.METHODS: Incidence rates and trends were compared among NHPI, Asian, and non-Hispanic White (NHW) populations. Clinical presentation was assessed via multivariable logistic regression. Survival was assessed per Cox regression.RESULTS: Recent incidence trends (2009-2014) show that the rate of increase remained consistent among NHPI patients (annual percentage change, 3.67%; 95% CI, 2.66%-4.69%), while it slowed in the NHW population and plateaued among Asians as compared with previous years. NHPI patients were more likely to present with distant metastasis than NHW patients (odds ratio, 3.37; 95% CI, 1.97-5.36) and Asian patients (odds ratio, 1.82; 95% CI, 1.05-2.97). NHPI race was also associated with advanced T stage and nodal metastasis as compared with the NHW race. Survival outcomes were similar among NHPI, NHW, and Asian patients.CONCLUSION: Well-differentiated thyroid cancer incidence has increased at a higher rate for the NHPI population as opposed to the NHW and Asian populations in recent years. NHPI patients are more likely to present with advanced disease when compared with NHW and Asian patients. These results highlight the importance of disaggregating the often-combined Asian/Pacific Islander group in epidemiologic studies.

  View details for DOI 10.1177/01945998221118538

  View details for PubMedID 35943808

• Head and Neck Cancer Among Native Hawaiian and Other Pacific Islander Patients-Disparities in Cancer Stage at Presentation and Survival Outcomes Compared With Other Races: A Population-Based Cohort Study. JAMA otolaryngology-- head & neck surgery Moon, P. K., Ma, Y., Megwalu, U. C. 2022

  Abstract

  Importance: Research studies often group Native Hawaiian and Other Pacific Islander individuals together with Asian individuals despite being consistently identified as having worse health outcomes and higher rates of comorbidities and mortality. Native Hawaiian and Other Pacific Islander individuals also have high incidence rates of oral cavity and pharyngeal cancer compared with the general population; however, disparities in clinical presentation and survival outcomes of head and neck cancer squamous cell carcinoma (HNSCC) among this population have not been investigated nor compared with those of other races.Objective: To determine the association of race with cancer stage at diagnosis and survival outcomes among Native Hawaiian and Other Pacific Islander patients with HNSCC compared with Asian and non-Hispanic White patients.Design, Setting, and Participants: This was a retrospective population-based cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) 18 database. Asian, Native Hawaiian or Other Pacific Islander, and non-Hispanic White adult patients diagnosed in 1988 through 2015 with HNSCC of the oral cavity, oropharynx, nasopharynx, larynx, and hypopharynx were included; any patient whose record was missing data on disease or demographic information was excluded.Main Outcomes and Measures: Cancer stage at presentation was compared among Asian, Native Hawaiian and Other Pacific Islander, and non-Hispanic White patients using a multivariable logistic regression model. Survival outcomes were compared among these racial groups using Cox regression models. Data analyses were performed from July 1, 2021, to March 20, 2022.Results: The total study population comprised 76 473 patients: 4894 Asian (mean [SD] age at presentation, 60.7 [14.6] years), 469 Native Hawaiian and Other Pacific Islander (57.8 [12.3] years), and 71 110 non-Hispanic White (62.2 [12.1] years) individuals. Native Hawaiian and Other Pacific Islander patients were more likely to present with advanced-stage HNSCC (odds ratio [OR] 1.38; 95% CI, 1.12 -1.72) compared with non-Hispanic White patients. Asian patients presented with similar stage disease (OR, 1.04; 95% CI, 0.97-1.11) compared with non-Hispanic White patients. Native Hawaiian and Other Pacific Islander patients had worse disease-specific survival (HR, 1.18; 95% CI, 1.02-1.36) compared with non-Hispanic White patients after adjusting for clinical and demographic factors. In contrast, Asian patients had improved disease-specific survival (HR, 0.93; 95% CI, 0.88-0.98) compared with non-Hispanic White patients.Conclusions and Relevance: This retrospective population-based cohort study suggests that Native Hawaiian and Other Pacific Islander race was associated with more advanced HNSCC, and worse disease-specific survival compared with non-Hispanic White race, while Asian race was associated with improved survival. This study highlights the importance of disaggregating Asian from Pacific Islander data when assessing health disparities, and the need for culturally sensitive interventions to promote earlier detection of head and neck cancer and improved survival among the Native Hawaiian and Other Pacific Islander population.

  View details for DOI 10.1001/jamaoto.2022.1086

  View details for PubMedID 35616952

• Moving Beyond Detection: Charting a Path to Eliminate Health Care Disparities in Otolaryngology. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Bowe, S. N., Megwalu, U. C., Bergmark, R. W., Balakrishnan, K. 2022: 1945998221094460

  Abstract

  The coronavirus pandemic has illuminated long-standing inequities in America's health care system and societal structure. While numerous studies have identified health care disparities within our specialty, few have progressed beyond detection. Otolaryngologists have the opportunity and the responsibility to act. Within this article, leaders from otolaryngology share their experience and perspective on health care disparities, including (1) a discussion of disparities in otolaryngology, (2) a summary of health care system design and incentives, (3) an overview of implicit bias, and (4) practical recommendations for providers to advance their awareness of health care disparities and the actions to mitigate them. While the path forward can be daunting, it should not be a deterrent. Throughout the course of this article, numerous resources are provided to support these efforts. To move ahead, our specialty needs to advance our level of understanding and develop, implement, and disseminate successful interventions toward the goal of eliminating health care disparities.

  View details for DOI 10.1177/01945998221094460

  View details for PubMedID 35439090

• Systemic Steroids for Otolaryngology-Head and Neck Surgery Disorders: An Evidence-Based Primer for Clinicians. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery McCoul, E. D., Megwalu, U. C., Joe, S., Gray, R., O'Brien, D. C., Ference, E. H., Lee, V. S., Patel, P. S., Figueroa-Morales, M. A., Shin, J. J., Brenner, M. J. 2022: 1945998221087664

  Abstract

  OBJECTIVE: To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders.DATA SOURCES: PubMed, Cochrane Library, and American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guidelines.REVIEW METHODS: A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings.CONCLUSIONS: Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell's palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Meniere's disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss.IMPLICATIONS FOR PRACTICE: Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration-such as sprays, drops, inhalers, and intralesional injections-may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.

  View details for DOI 10.1177/01945998221087664

  View details for PubMedID 35349383

• Risk of Second Primary Malignancies After External Beam Radiotherapy for Thyroid Cancer. Anticancer research Jin, M. C., Qian, Z. J., Megwalu, U. C. 2022; 42 (3): 1359-1365

  Abstract

  AIM: To investigate the association between external beam radiotherapy (EBRT) and the incidence of second primary tumors in patients with thyroid cancer.MATERIALS AND METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results 9 database. The study cohort included patients diagnosed with thyroid cancer between 1973 and 2017. Risk factors for second primary malignancies were identified with Cox proportional hazards models. Propensity score-matched analyses were used to assess the association between EBRT and second primary malignancies.RESULTS: Out of 72,392 patients with thyroid cancer, 7,684 (10.6%) developed a subsequent primary malignancy. Propensity score-matched analysis demonstrated patients receiving EBRT were more likely to develop second primary malignancies [30-year cumulative incidence=35.3% (95% confidence interval (CI)=30.4-39.8% vs. 28.1% (95% CI=27.0-29.2%); hazard ratio=1.17 (95% CI=1.03-1.33)].CONCLUSION: In patients with thyroid cancer, EBRT is associated with an increased incidence of second primary malignancies.

  View details for DOI 10.21873/anticanres.15605

  View details for PubMedID 35220228

• Benign Ectopic Thyroid in the Lateral (Level II) Neck Compartment CUREUS JOURNAL OF MEDICAL SCIENCE Liu, G. S., Berry, G. J., Desai, K., Megwalu, U. C. 2022; 14 (2)

  View details for DOI 10.7759/cureus.22140

  View details for Web of Science ID 000755197000018

• Thyroid Cancer Incidence and Mortality Trends in the United States: 2000 - 2018. Thyroid : official journal of the American Thyroid Association Megwalu, U., Moon, P. K. 2022

  Abstract

  BACKGROUND: Thyroid cancer incidence has significantly increased in the United States over the past few decades. Recent studies have suggested a change in thyroid cancer incidence trends following 2013. The objective of this study was to update the data on thyroid cancer incidence and mortality trends in the US.METHODS: Thyroid cancer incidence and incidence-based mortality trends were evaluated using the Surveillance, Epidemiology, and End Results-18 cancer registry. Cases of thyroid cancer diagnosed in 2000-2018, and thyroid cancer deaths during 2000-2018 were included. Annual percent change (APC) was calculated using joinpoint regression analysis.RESULTS: Among 197,070 patients, female (75.6%) and white (81.0%) patients comprised the majority of cases. Papillary thyroid carcinoma (PTC) was the most common histology (89.1%). Incidence rates increased during 2000 - 2009 (APC 6.80, 95% CI 6.46 to 7.13) and 2009-2014 (APC 2.58, 95% CI 1.71 to 3.47), then decreased during 2014-2018 (APC -2.33, 95% CI -3.15 to -1.51). The incidence trends for PTC overall, localized disease, and tumors ≤ 1.0 cm mirrored the overall thyroid cancer trends, while incidence rates for regional disease stabilized during 2015-2018 (APC -1.65, 95% CI -4.09 to 0.84). The incidence of distant disease decreased during 2015-2018 (APC (APC -17.86, 95% CI -26.47 to -8.25). The incidence of tumors ≤ 1.0 cm decreased (APC -5.83, 95% CI -7.24 to -4.40), while the incidence of tumors 1.1 - 2.0 cm (APC -0.10, 95% CI -1.16 to 0.96), 2.1 - 4.0 cm (APC 1.12, 95% CI -0.17 to 2.43), and > 4.0 cm (APC -1.13, 95% CI -4.58 to 2.45) stabilized during the most recent 4 - 6 years. Incidence-based mortality increased throughout 2000-2018 (average APC 1.35, 95% CI 0.88 to 1.82).CONCLUSION: Thyroid cancer incidence rates have declined since 2014. Similar declines are noted for PTC, localized disease, and tumors ≤ 1.0 cm, but not for tumors > 2.0 cm. Incidence-based mortality rates continue to increase. These findings suggest that changing patterns in the management of thyroid nodules may have led to a decrease in diagnosis of small indolent tumors, but not more advanced tumors.

  View details for DOI 10.1089/thy.2021.0662

  View details for PubMedID 35132899

• Benign Ectopic Thyroid in the Lateral (Level II) Neck Compartment. Cureus Liu, G. S., Berry, G. J., Desai, K., Megwalu, U. C. 2022; 14 (2): e22140

  Abstract

  Ectopic thyroid most commonly presents in the midline and is typically associated with the absence of an orthotopic thyroid. Less commonly, ectopic thyroid can present in the lateral neck, typically with a coexisting orthotopic thyroid and abnormal pathology in either the ectopic or orthotopic thyroid tissue. This paper describes a rare case of a benign, ectopic thyroid in the lateral neck (level II) associated with a normal, benign orthotopic thyroid. This report illustrates clinical pearls for the management of this unusual entity.

  View details for DOI 10.7759/cureus.22140

  View details for PubMedID 35308702

  View details for PubMedCentralID PMC8920790

• Evidence-Based Medicine in Otolaryngology, Part XIII: Health Disparities Research and Advancing Health Equity. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Megwalu, U. C., Raol, N. P., Bergmark, R., Osazuwa-Peters, N., Brenner, M. J. 2022: 1945998221087138

  Abstract

  To provide a contemporary resource for clinicians and researchers on health equity research and implementation strategies to mitigate or eliminate disparities in health care.Published studies and literature on health disparities, applicable research methodologies, and social determinants of health in otolaryngology.Literature through October 2021 was reviewed, including consensus statements, guidelines, and scientific publications related to health care equity research. This research focus provides insights into existing disparities, why they occur, and the outcomes of interventions designed to resolve them. Progress toward equity requires intentionality in implementing quality improvement initiatives, tracking data, and fostering culturally competent care. Priority areas include improving access, removing barriers to care, and ensuring appropriate and effective treatment. Although research into health care disparities has advanced significantly in recent years, persistent knowledge gaps remain. Applying the lens of equity to data science can promote evidence-based practices and optimal strategies to reduce health inequities.Health disparities research has a critical role in advancing equity in otolaryngology-head and neck surgery. The phases of disparities research include detection, understanding, and reduction of disparities. A multilevel approach is necessary for understanding disparities, and health equity extensions can improve the rigor of evidence-based data synthesis. Finally, applying an equity lens is essential when designing and evaluating health care interventions, to minimize bias.Understanding the data and practices related to disparities research may help promote an evidence-based approach to care of individual patients and populations, with the potential to eventually surmount the negative effects of health care disparities.

  View details for DOI 10.1177/01945998221087138

  View details for PubMedID 35316118

• Differential Outcomes Among Survivors of Head and Neck Cancer Belonging to Racial and Ethnic Minority Groups. JAMA otolaryngology-- head & neck surgery Taylor, D. B., Osazuwa-Peters, O. L., Okafor, S. I., Boakye, E. A., Kuziez, D., Perera, C., Simpson, M. C., Barnes, J. M., Bulbul, M. G., Cannon, T. Y., Watts, T. L., Megwalu, U. C., Varvares, M. A., Osazuwa-Peters, N. 1800

  Abstract

  Importance: Approximately 1 in 5 new patients with head and neck cancer (HNC) in the US belong to racial and ethnic minority groups, but their survival rates are worse than White individuals. However, because most studies compare Black vs White patients, little is known about survival differences among members of racial and ethnic minority groups.Objective: To describe differential survival and identify nonclinical factors associated with stage of presentation among patients with HNC belonging to racial and ethnic minority groups.Design, Setting, and Participants: This population-based retrospective cohort study used data from the 2007 to 2016 Surveillance, Epidemiology, and End Results (SEER) database and included non-Hispanic Black, Asian Pacific Islander, American Indian/Alaska Native, and Hispanic patients with HNC. The data were analyzed from December 2020 to May 2021.Main Outcomes and Measures: Outcomes were time to event measures: (HNC-specific and all-cause mortality) and stage of presentation. Covariates included nonclinical (age at diagnosis, sex, race and ethnicity, insurance status, marital status, and a composite socioeconomic status [SES]) and clinical factors (stage, cancer site, chemotherapy, radiation, and surgery). A Cox regression model was used to adjust associations of covariates with the hazard of all-cause death, and a Fine and Gray competing risks proportional hazards model was used to estimate associations of covariates with the hazard of HNC-specific death. A proportional log odds ordinal logistic regression identified which nonclinical factors were associated with stage of presentation.Results: There were 21 966 patients with HNC included in the study (mean [SD] age, 56.02 [11.16] years; 6072 women [27.6%]; 9229 [42.0%] non-Hispanic Black, 6893 [31.4%] Hispanic, 5342 [24.3%] Asian/Pacific Islander, and 502 [2.3%] American Indian/Alaska Native individuals). Black patients had highest proportion with very low SES (3482 [37.7%]) and the lowest crude 5-year overall survival (46%). After adjusting for covariates, Hispanic individuals had an 11% lower subdistribution hazard ratio (sdHR) of HNC-specific mortality (sdHR, 0.89; 95% CI, 0.83-0.95), 15% lower risk for Asian/Pacific Islander individuals (sdHR, 0.85; 95% CI, 0.78-0.93), and a trending lower risk for American Indian/Alaska Native individuals (sdHR, 0.85; 95% CI, 0.71-1.01), compared with non-Hispanic Black individuals. Race, sex, insurance, marital status, and SES were consistently associated with all-cause mortality, HNC-specific mortality, and stage of presentation, with non-Hispanic Black individuals faring worse compared with individuals of other racial and ethnic minority groups.Conclusions and Relevance: In this cohort study that included only patients with HNC who were members of racial and ethnic minority groups, Black patients had significantly worse outcomes that were not completely explained by stage of presentation. There may be unexplored multilevel factors that are associated with social determinants of health and disparities in HNC outcomes.

  View details for DOI 10.1001/jamaoto.2021.3425

  View details for PubMedID 34940784

• Thyroid Cancer Incidence Trends Among Filipinos in the United States. The Laryngoscope Megwalu, U. C., Osazuwa-Peters, N., Moon, P., Palaniappan, L. P. 1800

  Abstract

  OBJECTIVE: To analyze thyroid cancer incidence trends among Filipinos relative to non-Filipino Asians and non-Hispanic Whites in the US.STUDY DESIGN: Population-based analysis of cancer incidence data.METHODS: Population-based analysis of cancer incidence data from Surveillance, Epidemiology, and End Results 9 detailed Asian/Pacific Islander subgroup incidence and population datasets. Adult patients aged 20 and older with thyroid cancer diagnosed in 2004 to 2014 were included. Annual percent change (APC) of the incidence rates were calculated using joinpoint regression analysis.RESULTS: The incidence rates were 19.57 (95% CI 19.03-20.12) per 100,000 for Filipinos, 10.45 (95% CI 10.22-10.68) per 100,000 for non-Filipino Asians, and 13.94 (95% CI 13.85-14.02) per 100,000 for non-Hispanic Whites. The highest increase was seen among non-Hispanic Whites (average APC 5.04, 95% CI 4.61-5.46). Incidence rates of tumors≤2cm remained stable among Filipinos but increased in non-Filipino Asians (average APC 5.38, 95% CI 2.51-8.34) and non-Hispanic Whites (average APC 5.81 95% CI 4.52-7.11).CONCLUSION: Filipinos have high incidence of thyroid cancer compared with other racial/ethnic groups. However, non-Hispanic Whites have the highest increase in incidence rates, resulting in a significant narrowing of the gap in incidence rates between Filipinos and non-Hispanic Whites. This is most likely due to enhanced detection of small tumors in non-Hispanic Whites. Laryngoscope, 2021.

  View details for DOI 10.1002/lary.29986

  View details for PubMedID 34910822

• Associations of Hearing Loss and Hearing Aid Use with Hospitalization in the Elderly Thai, A., Khan, S. I., Choi, J., Megwalu, U. C. ELSEVIER SCIENCE INC. 2021: S170-S171

  View details for Web of Science ID 000718303100317

• Racial/Ethnic Disparities in Use of High-Quality Hospitals Among Oral Cancer Patients in California. The Laryngoscope Megwalu, U. C., Ma, Y. 2021

  Abstract

  OBJECTIVES/HYPOTHESIS: To examine racial/ethnic differences in use of high-quality hospitals in patients treated for oral cancer in California.STUDY DESIGN: Retrospective cancer database cohort study.METHODS: Data were extracted from the California Cancer Registry data set linked with discharge records and hospital characteristics from the California Office of Statewide Health Planning and Development, and with neighborhood characteristics from the California Neighborhoods Data System. The study cohort comprised adult patients with oral cavity malignancy diagnosed between 2004 and 2015. Principal component analysis was used to generate the composite oral cancer-specific hospital quality score. The impact of hospital quality on survival was assessed using Cox regression models with robust standard error using sandwich variance estimators. Poisson regression models with robust error variance were used to assess the association between race/ethnicity and use of high-quality hospitals.RESULTS: Patients treated in hospitals ranked in the top quartile for quality had improved overall survival (hazard ratio 0.86, 95% confidence intervals [CI] 0.76-0.98), after adjusting for tumor stage, Charlson comorbidity score, neck dissection, radiotherapy, age, sex, race, and insurance status. Black patients (risk ratio 0.87, 95% CI 0.77-0.98) were less likely to be treated in high-quality hospitals compared with non-Hispanic White patients.CONCLUSION: Treatment in high-quality hospitals is associated with improved survival for patients with oral cancer. However, black patients are less likely to be treated in high-quality hospitals compared with non-Hispanic white patients.LEVEL OF EVIDENCE: 3 Laryngoscope, 2021.

  View details for DOI 10.1002/lary.29830

  View details for PubMedID 34405895

• Clinical presentation and survival outcomes of well-differentiated thyroid cancer in Filipinos. Cancer medicine Megwalu, U. C., Ma, Y., Osazuwa-Peters, N., Orloff, L. A. 2021

  Abstract

  BACKGROUND: Filipinos have higher recurrence rates compared to other racial/ethnic groups, which might suggest a higher propensity for aggressive disease. The goal of this study was to perform a population-based analysis of disease extent at diagnosis and survival outcomes in Filipino patients with well-differentiated thyroid cancer relative to other racial/ethnic groups.METHODS: The study cohort comprised adult patients with well-differentiated thyroid cancer diagnosed between 2004 and 2015, identified in the California Cancer Registry. Rates of extrathyroidal extension, nodal metastasis, and distant metastasis were compared between Filipinos, Non-Filipino Asians, and Non-Asians using multilevel logistic regression models. Survival outcomes were compared using Cox regression models, utilizing a sequential modeling approach.RESULTS: Filipino ethnicity was associated with extrathyroidal extension (OR 1.35, 95% CI 1.11-1.63) compared with non-Asians and non-Filipino Asians. Filipino ethnicity was also associated with nodal metastasis (OR 1.32, 95% CI 1.18-1.46), and with worse OS (Hazard Ratio [HR] 1.45, 95% CI 1.20-1.75) and DSS (HR 1.51, 95% CI 1.12-2.04). After adjusting for demographic and clinical factors, Filipino ethnicity was no longer associated with OS (HR 1.03, 95% CI 0.84-1.25) or DSS (HR 0.93, 95% CI 0.68-1.28).CONCLUSION: Filipino patients with thyroid cancer are more likely to present with locoregionally advanced disease compared with non-Filipino Asians and non-Asians. Furthermore, Filipino patients have worse survival outcomes compared with non-Filipino Asians and non-Asians. However, this appears to be driven by the higher rates of locoregionally advanced disease in Filipino patients.

  View details for DOI 10.1002/cam4.4149

  View details for PubMedID 34288520

• The role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Shukla, N., Ma, Y., Megwalu, U. C. 2021

  Abstract

  To assess the role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes.This was a population-based retrospective cohort study. Data were extracted from the Surveillance, Epidemiology, and End Results 18 database. The study cohort included 11 627 patients diagnosed with oropharyngeal squamous cell carcinoma between 2010 and 2015.The association between black race and increased risk of unresectable disease was slightly attenuated, but persistent, after including insurance status as a covariate (odds ratio [OR] 1.34, 95%CI 1.10-1.63). Likewise, black race was no longer associated with worse disease-specific survival (hazard ratio [HR] 1.11, 95%CI 0.99-1.26), but remained associated with worse overall survival with a slightly decreased effect size (HR 1.13, 95%CI 1.01-1.25).Insurance status plays a significant role in, but does not completely account for, the persistent racial disparities in oropharyngeal cancer outcomes.

  View details for DOI 10.1002/hed.26807

  View details for Web of Science ID 000672491800001

  View details for PubMedID 34254715

• Racial/ethnic Disparities in use of High-Quality Hospitals among Thyroid Cancer Patients. Cancer investigation Megwalu, U. C., Ma, Y. 2021: 1-16

  Abstract

  This study examined racial/ethnic differences in use of high-quality hospitals among thyroid cancer patients. The study included adult patients diagnosed between 2004 and 2015 identified in the California Cancer Registry linked with hospital discharge records. Hospital quality was defined using a composite thyroid cancer-specific hospital quality score. Black (risk ratio [RR] 0.75, 95% CI 0.70 to 0.80), Hispanic (RR 0.73, 95% CI 0.71 to 0.75), and Asian/Pacific Islander patients (RR 0.86, 95% CI 0.84 to 0.89) were less likely to be treated in high-quality hospitals than non-Hispanic White patients. This disparity persisted after adjusting for insurance status and socioeconomic status.

  View details for DOI 10.1080/07357907.2021.1938108

  View details for PubMedID 34077307

• Association of self-reported hearing loss severity and healthcare utilization outcomes among Medicare beneficiaries. American journal of otolaryngology Thai, A., Megwalu, U. C. 2021; 42 (4): 102943

  Abstract

  PURPOSE: Understanding health utilization trends in the elderly population is pivotal for Medicare and policymakers. This study evaluates the association between hearing status and health utilization outcomes in a representative sample of elderly Medicare beneficiaries.MATERIALS AND METHODS: We employed the 2017 Medicare Current Beneficiary Survey (MCBS), which includes self-reported hearing loss data and weighted health utilization information. Analyses were limited to Medicare beneficiaries aged 65 and older without hearing aids. Multivariable logistic regression was performed to assess association between self-reported hearing loss and health utilization outcomes.RESULTS: Of 7160 respondents, 55.1%, 39.9% and 4.9% reported no trouble hearing, little trouble hearing, and a lot of trouble hearing, respectively. On multivariable logistic regression, both a little and a lot of trouble hearing were associated with trouble accessing care (little trouble hearing: odds ratio [OR]=1.79, 95% confidence interval [CI]: 1.33-2.40, p<0.001; lot of trouble hearing: OR=2.89, 95% CI: 1.81-4.60, p<0.001) and emergency room (ER) visits (little trouble hearing: OR=1.24, 95% CI: 1.08-1.42, p=0.002; lot of trouble hearing: OR=1.44, 95% CI: 1.10-1.89, p=0.01). A lot of trouble hearing was associated with avoiding doctor visits (OR=1.63 95% CI: 1.21-2.21, p=0.002). Self-reported hearing status was not associated with inpatient or skilled nursing facility (SNF) admission on adjusted analyses.CONCLUSIONS: Increasing reported hearing loss severity is associated with decreased access to and avoidance of routine medical visits, and increased utilization of ER visits. These findings have important implications for Medicare, clinicians and policymakers. Further studies should evaluate if hearing aids can mitigate these outcomes.

  View details for DOI 10.1016/j.amjoto.2021.102943

  View details for PubMedID 33550025

• Parotid gland incidentalomas: A single-institution experience. American journal of otolaryngology Moon, P. K., Tusty, M., Megwalu, U. C. 2021; 43 (2): 103296

  Abstract

  Parotid gland incidentaloma (PGI) management has not been well characterized in the literature. This study assesses clinicopathologic features, initial evaluation, management, and outcomes of PGIs discovered on various imaging modalities.This is a retrospective case series from a single academic institution. The study cohort included 34 patients with parotid gland incidentalomas discovered between January 2009 and December 2019.Parotid gland incidentalomas were most frequently identified on magnetic resonance imaging (16 patients, 47.1%). Most patients (26 patients, 76.5%) underwent further evaluation with subsequent imaging, most often magnetic resonance imaging (18 patients, 69.2%), and fine needle aspiration biopsy (33 patients, 97.1%). Most tumors were benign on fine needle aspiration biopsy (19 patients, 57.6%). Most cases (21 patients, 61.8%) were managed with observation without parotidectomy. Malignant findings on fine needle aspiration cytology were associated with increased likelihood of undergoing parotidectomy (25% vs 0%; p = 0.04). Among the patients who received a parotidectomy, most (8 patients, 61.5%) had benign findings on final histopathology.Parotid gland incidentalomas were discovered across a diverse set of imaging modalities in our institution. Magnetic resonance imaging and fine needle aspiration were often performed for further evaluation. Most cases were found to be benign on fine needle aspiration and were managed with observation. These findings highlight the necessity of appropriate work-up for these tumors, and the need for shared decision making between the patient and the physician in selecting the appropriate treatment strategy.

  View details for DOI 10.1016/j.amjoto.2021.103296

  View details for PubMedID 34894452

• Outpatient healthcare use and outcomes after pediatric tracheostomy. International journal of pediatric otorhinolaryngology Qian, Z. J., Megwalu, U. C., Cheng, A. G., Balakrishnan, K. 2021; 151: 110963

  Abstract

  To 1) describe health outcomes and outpatient healthcare use after pediatric tracheostomy, and 2) identify populations with higher morbidity that may benefit from improved post-operative monitoring.Optum's commercial insurance database was queried from 2003 to 2019. Children aged 0-18 who received tracheostomy identified. Mortality, decannulation, tracheostomy complications, and home ventilator dependence were determined, as well as physician office visits and specialty type. The effect that patient characteristics (age, sex, ethnicity, prematurity, and presence versus absence of chronic lung disease [CLD], congenital heart disease [CHD], neurologic impairment [NI], and upper airway obstruction [UAO]) had on outcomes were compared.1231 children were identified. Infants accounted for 33% of patients and 40% of the cohort was premature. The most common comorbid conditions were NI (76%), UAO (69%), CLD (48%), and CHD (35%). Within 5 years postoperatively, 25% died, 45% had home ventilator dependence, 53% had a complication, and 10% were decannulated. CHD was associated with higher risk of death (HR,1.98; 95% CI 1.22, 3.21), while UAO was associated with lower risk of death (HR,0.51; 95% CI 0.32, 0.83) and higher probability of decannulation (HR,3.56, 95% CI 1.08, 11.74). The median number of physician office visits was 6 per year (IQR 3,10). The most common specialty types were pediatrics (32%), pulmonary medicine (10%), and otolaryngology (8%). NI was associated with greater number of office visits (mean difference/year, 4.10; 95% CI 2.00, 6.19) while Hispanic ethnicity was associated with fewer visits (mean difference/year, -2.94; 95%CI -5.42, -0.45).UAO was associated with lower risk of mortality and higher probability of decannulation, while NI was associated with greater outpatient healthcare utilization. Social disparities in outpatient tracheostomy care were observed.

  View details for DOI 10.1016/j.ijporl.2021.110963

  View details for PubMedID 34736006

• Association Between Age and Nodal Metastasis in Papillary Thyroid Carcinoma. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Shukla, N., Osazuwa-Peters, N., Megwalu, U. C. 2020: 194599820966995

  Abstract

  OBJECTIVE: To determine the relationship between age and rate of lymph node metastasis, nodal burden of disease, as well as rate of lateral neck disease in papillary thyroid cancer, especially in patients aged <30 years.STUDY DESIGN: Population-based cross-sectional study.SETTING: Population-based cancer database.METHODS: Data were extracted from the SEER 18 database (Surveillance, Epidemiology, and End Results) of the National Cancer Institute. The study cohort included 59,330 patients diagnosed with papillary thyroid cancer between 1988 and 2015. Patients aged 0 to 10 years, 11 to 20 years, and 21 to 30 years old were compared with those >30 years. All analyses were adjusted for sex, race, and T classification.RESULTS: The overall rate of lymph node metastasis was 26.11%, which increased with decreasing age. Adjusted odds ratios of lymph node metastasis were 7.19 (95% CI, 3.76-13.75) for the 0- to 10-year-old group, 3.45 (95% CI, 3.08-3.87) for the 11- to 20-year-old group, and 2.28 (95% CI, 2.15-2.41) for the 21- to 30-year-old group, relative to the group >30 years old. Decreased age was also associated with increased total positive nodes, increased lymph node ratio, and increased risk of lateral neck disease.CONCLUSION: Pediatric and early young adult patients with papillary thyroid carcinoma have a greater risk of lymph node metastasis, greater burden of nodal disease, and a greater risk of lateral neck metastases.

  View details for DOI 10.1177/0194599820966995

  View details for PubMedID 33076796

• Prioritizing Diversity in Otolaryngology-Head and Neck Surgery: Starting a Conversation. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Truesdale, C. M., Baugh, R. F., Brenner, M. J., Loyo, M., Megwalu, U. C., Moore, C. E., Paddock, E. A., Prince, M. E., Strange, M., Sylvester, M. J., Thompson, D. M., Valdez, T. A., Xie, Y., Bradford, C. R., Taylor, D. J. 2020: 194599820960722

  Abstract

  Academic centers embody the ideals of otolaryngology and are the specialty's port of entry. Building a diverse otolaryngology workforce-one that mirrors society-is critical. Otolaryngology continues to have an underrepresentation of racial and ethnic minorities. The specialty must therefore redouble efforts, becoming more purposeful in mentoring, recruiting, and retaining underrepresented minorities. Many programs have never had residents who are Black, Indigenous, or people of color. Improving narrow, leaky, or absent pipelines is a moral imperative, both to mitigate health care disparities and to help build a more just health care system. Diversity supports the tripartite mission of patient care, education, and research. This commentary explores diversity in otolaryngology with attention to the salient role of academic medical centers. Leadership matters deeply in such efforts, from culture to finances. Improving outreach, taking a holistic approach to resident selection, and improving mentorship and sponsorship complement advances in racial disparities to foster diversity.

  View details for DOI 10.1177/0194599820960722

  View details for PubMedID 33045901

• Comparison of Parotidectomy With Observation for Treatment of Pleomorphic Adenoma in Adults. JAMA otolaryngology-- head & neck surgery Kligerman, M. P., Jin, M., Ayoub, N., Megwalu, U. C. 2020

  Abstract

  Importance: There is no consensus regarding optimal management of pleomorphic adenoma in adults.Objectives: To compare parotidectomy with observation for the management of pleomorphic adenoma in patients 50 years or older by age.Design and Setting: This decision analytical model was performed from November 21, 2019, to June 15, 2020, using a Markov model. Model variables and ranges were selected based on a literature review. A 1-way sensitivity analysis was performed to evaluate the age threshold at which each algorithm, either upfront elective parotidectomy or observation, would be favored. A Monte Carlo probabilistic sensitivity analysis using variable ranges was then performed 5 times with patients in the model assigned a starting age of 50, 60, 70, 80, and 90 years to assess how age at diagnosis would be associated with the model results.Main Outcomes and Measures: Model outcomes were measured with quality-adjusted life-years (QALYs).Results: In the study models, the age thresholds at which observation became more beneficial than parotidectomy were 88.5 years for patients with superficial lobe tumors (5.37 QALYs in favor of parotidectomy below this age, and 5.37 QALYs in favor of observation above this age) and 83.4 years for patients with deep lobe tumors (7.51 QALYs in favor of surgery below this age, and 7.51 QALYs in favor of observation above this age). There was no significant difference in outcomes between parotidectomy and observation among patients aged 70 to 80 years.Conclusions and Relevance: This study suggests that the outcomes associated with parotidectomy and observation are similar at 70 years or older among patients with pleomorphic adenoma and that observation may be the favorable treatment in that age group.

  View details for DOI 10.1001/jamaoto.2020.2944

  View details for PubMedID 32970111

• Significance of Nodal Metastasis in Parotid Gland Acinar Cell Carcinoma. The Laryngoscope Moon, P., Tusty, M., Divi, V., Megwalu, U. C. 2020

  Abstract

  OBJECTIVES: To evaluate the rate of lymph node metastasis in parotid gland acinar cell carcinoma, to identified factors associated with increased risk of metastasis, and to evaluate the effect of nodal metastasis on survival.METHODS: This is a retrospective cohort study utilizing data from a large population-based cancer database. Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 18 database. The study cohort included patients with parotid gland acinar cell carcinoma diagnosed between 2000 and 2015.RESULTS: The overall rate of lymph node metastasis was 6.8%. T3/T4 (OR 6.17, 95% CI, 3.03 to 13.16) disease along with High Grade (OR 15.95) disease were associated with increased risk of nodal metastasis. Non-white, non-Black race was associated with decreased risk. Age and sex were not associated with nodal metastasis. Nodal metastasis was associated with worse OS (HR 6.27, 95% CI, 3.85 to 10.20) and DSS (HR 6.96, 95% CI, 3.81 to 12.73) after adjusting for covariates.CONCLUSION: Parotid gland acinar cell carcinoma carries a low risk of nodal metastasis. Both advanced T stage and high grade are associated with increased risk of nodal metastasis. Nodal metastasis is associated with decreased overall survival.LEVEL OF EVIDENCE: 3 Laryngoscope, 2020.

  View details for DOI 10.1002/lary.28966

  View details for PubMedID 32770798

• External Beam Radiotherapy for Medullary Thyroid Cancer Following Total or Near-Total Thyroidectomy. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Jin, M., Megwalu, U. C., Noel, J. E. 2020: 194599820947696

  Abstract

  OBJECTIVES: Medullary thyroid carcinoma (MTC) often presents with advanced disease and takes an aggressive course as compared with more well-differentiated thyroid cancers. The role of adjuvant therapy, specifically external beam radiotherapy (EBRT), remains disputed. This study investigated the impact of EBRT on survival in MTC.STUDY DESIGN: Cross-sectional analysis of a national database.SETTING: Patients with MTC were identified from the SEER program (Surveillance, Epidemiology, and End Results).METHODS: Collected variables included age, sex, race, T and N stages, lymph node yield, and use of EBRT. Propensity score matching was performed to determine the association of EBRT with overall and disease-specific survival.RESULTS: A total of 2046 patients with locoregional MTC were identified. Of these, 152 received EBRT. Patients receiving EBRT were older and had more advanced disease. EBRT was not associated with differences in overall survival (hazard ratio, 1.12; 95% CI, 0.76-1.65) or disease-specific survival (1.66; 0.93-2.95), as well as in subset analysis of age and disease extent. Long-term overall survival was similar, with 77.3% (95% CI, 70.1%-85.3%) and 58.3% (48.2%-70.5%) of patients without EBRT alive at 5 and 10 years, respectively (vs 70.7% [63.2%-79.1%] and 52.3% [43.3%-63.2%] of patients with EBRT). There were no differences in 5- and 10-year disease-specific survival.CONCLUSION: EBRT was not associated with improved overall or disease-specific survival in patients with MTC. Decisions regarding EBRT must be made with consideration of morbidity relative to benefit for individual patients.

  View details for DOI 10.1177/0194599820947696

  View details for PubMedID 32746731

• State Medicaid expansion status, insurance coverage and stage at diagnosis in head and neck cancer patients. Oral oncology Osazuwa-Peters, N., Barnes, J. M., Megwalu, U., Adjei Boakye, E., Johnston, K. J., Gaubatz, M. E., Johnson, K. J., Panth, N., Sethi, R. K., Varvares, M. A. 2020; 110: 104870

  Abstract

  OBJECTIVES: Only one in three head and neck cancer (HNC) patients present with early-stage disease. We aimed to quantify associations between state Medicaid expansions and changes in insurance coverage rates and stage at diagnosis of HNC.METHODS: Using a quasi-experimental difference-in-differences (DID) approach and data from 26,330 cases included in the Surveillance, Epidemiology, and End Results program (2011-2015), we retrospectively examined changes in insurance coverage and stage at diagnosis of adult HNC in states that expanded Medicaid (EXP) versus those that did not (NEXP).RESULTS: There was a significant increase in Medicaid coverage in EXP (+1.6 percentage point (PP) versus) vs. NEXP (-1.8 PP) states (3.36 PP, 95% CI = 1.32, 5.41; p = 0.001), and this increase was mostly among residents of low income and education counties. We also observed a reduction in uninsured rates among HNC patients in low income counties (-4.17 PP, 95% CI = -6.84, -1.51; p = 0.002). Overall, early stage diagnosis rates were 28.3% (EXP) vs. 26.7% (NEXP), with significant increases in early stage diagnosis post-Medicaid expansion among young adults, 18-34 years (17.2 PP, 95% CI - 1.34 to 33.1, p = 0.034), females (7.54 PP, 95% CI = 2.00 to 13.10, p = 0.008), unmarried patients (3.83 PP, 95% CI = 0.30-7.35, p = 0.033), and patients with lip cancer (13.5 PP, 95% CI = 2.67-24.3, p = 0.015).CONCLUSIONS: Medicaid expansion is associated with improved insurance coverage rates for HNC patients, particularly those with low income, and increases in early stage diagnoses for young adults and women.

  View details for DOI 10.1016/j.oraloncology.2020.104870

  View details for PubMedID 32629408

• Effect of state Medicaid expansion status on insurance coverage and stage at diagnosis in head and neck cancer patients Osazuwa-Peters, N., Barnes, J. M., Boakye, E., Gaubatz, M. E., Johnston, K. J., Panth, N., Sethi, R. K., Megwalu, U., Varvares, M. A. AMER ASSOC CANCER RESEARCH. 2020

  View details for DOI 10.1158/1538-7755.DISP19-A121

  View details for Web of Science ID 000580647800102

• The Impact of Hospital Quality on Thyroid Cancer Survival. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Megwalu, U. C., Ma, Y. n., Hernandez-Boussard, T. n., Divi, V. n., Gomez, S. L. 2020: 194599819900760

  Abstract

  To develop a composite measure of thyroid cancer-specific hospital quality and to evaluate the association between hospital quality and survival in patients with well-differentiated thyroid cancer.Retrospective cohort study.Population-based cancer database.Data were extracted from the California Cancer Registry data set linked with discharge records and hospital characteristics from the California Office of Statewide Health Planning and Development. The study cohort comprised adult patients with well-differentiated thyroid cancer diagnosed between January 1, 2004, and December 31, 2015. Principal component analysis, incorporating hospital volume, adherence to national guidelines, and accreditation/certification status, was used to generate a composite thyroid cancer-specific hospital quality score.Treatment in hospitals ranked in the highest quartile of quality was associated with improved overall survival (OS) (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.67-0.98) and disease-specific survival (DSS) (HR, 0.72; 95% CI, 0.54-0.98). Treatment in hospitals meeting the combined metric of 10 or more thyroid cancer cases/year and 80% of patients with high-risk tumors treated with total/near-total thyroidectomy was associated with improved OS (HR, 0.80; 95% CI, 0.70-0.90) and DSS (HR, 0.77; 95% CI, 0.64-0.94).Treatment in high-quality hospitals is associated with improved survival outcomes in patients with thyroid cancer. These findings are important because they help identify hospitals that are better suited to treat patients with thyroid cancer and provide actionable targets for quality improvement.

  View details for DOI 10.1177/0194599819900760

  View details for PubMedID 31961755

• Radiographic surveillance of abdominal free fat graft in complex parotid pleomorphic adenomas: A case series. Heliyon Lee, Y. J., Fischbein, N. J., Megwalu, U. n., Baik, F. M., Divi, V. n., Kaplan, M. J., Sirjani, D. B. 2020; 6 (5): e03894

  Abstract

  Free abdominal fat transfer is commonly used to restore facial volume and improve cosmesis after parotidectomy for pleomorphic adenomas. We describe the radiographic characteristics of these grafts on follow-up imaging.Medical records of four patients who underwent parotidectomy with abdominal fat graft in 2016 and had follow up imaging available were retrospectively analyzed. An otolaryngologist and neuroradiologist reviewed imaging studies, evaluated the fat grafts, and monitored for residual or recurrent disease.The abdominal fat was successfully grafted in all four patients. Post-operative baseline magnetic resonance imaging and additional surveillance imaging showed fat grafts with minimal volume loss. However, there was development of irregular enhancement consistent with fat necrosis in two of the four patients.Radiographic surveillance of free fat graft reconstruction after pleomorphic adenoma resection shows minimal contraction in size but development of fat necrosis. Recognition of expected changes should help avoid confusion with residual or recurrent disease, reassuring both patient and treating physician.

  View details for DOI 10.1016/j.heliyon.2020.e03894

  View details for PubMedID 32395660

  View details for PubMedCentralID PMC7210407

• Cost-Effectiveness of Depression Screening for Otolaryngology-Head and Neck Surgery Residents. The Laryngoscope Kligerman, M. P., Devine, E. E., Bentzley, J. P., Megwalu, U. C. 2020

  Abstract

  This study aims to determine the cost-effectiveness of screening and treating otolaryngology-head and neck surgery residents for depression.A Markov model was built using TreeAgePro, version 2019 (TreeAge Software Inc.; Williamstown, MA) to assess the cost-effectiveness of five potential treatment algorithms: 1) treat all residents with psychotherapy, 2) screen and treat depressed residents with psychotherapy, 3) screen and treat depressed residents with pharmacotherapy, 4) screen and treat depressed residents with combination psychotherapy/pharmacotherapy, and 5) no intervention. A Monte Carlo probabilistic sensitivity analysis (PSA), consisting of 1 thousand simulations over a cumulative 5-year period, was performed to evaluate both base case values and a range of values for model variables.Screening residents for depression and treating with combination psychotherapy/pharmacotherapy was cost-effective and the optimal strategy at a willingness-to-pay threshold of $50 thousand per quality-adjusted life year (QALY). This option demonstrated an incremental cost-effectiveness ratio of $27,578 per QALY for base case values. PSA confirmed these results and demonstrated that screening residents for depression and treating with either combination pharmacotherapy/psychotherapy, pharmacotherapy alone, or psychotherapy alone were cost-effective options in 94.9% of simulations.Depression and burnout remain crucial issues among resident physicians. This study demonstrates that actively screening residents for depression is cost-effective. Based on these results, residency programs may consider trialing standardized depression screening protocols.I and II. Laryngoscope, 2020.

  View details for DOI 10.1002/lary.28780

  View details for PubMedID 32510589

• COVID-19 pandemic and health care disparities in head and neck cancer: Scanning the horizon. Head & neck Graboyes, E. n., Cramer, J. n., Balakrishnan, K. n., Cognetti, D. M., López-Cevallos, D. n., de Almeida, J. R., Megwalu, U. C., Moore, C. E., Nathan, C. A., Spector, M. E., Lewis, C. M., Brenner, M. J. 2020

  Abstract

  The COVID-19 pandemic has profoundly disrupted head and neck cancer (HNC) care delivery in ways that will likely persist long term. As we scan the horizon, this crisis has the potential to amplify preexisting racial/ethnic disparities for patients with HNC. Potential drivers of disparate HNC survival resulting from the pandemic include (a) differential access to telemedicine, timely diagnosis, and treatment; (b) implicit bias in initiatives to triage, prioritize, and schedule HNC-directed therapy; and (c) the marked changes in employment, health insurance, and dependent care. We present four strategies to mitigate these disparities: (a) collect detailed data on access to care by race/ethnicity, income, education, and community; (b) raise awareness of HNC disparities; (c) engage stakeholders in developing culturally appropriate solutions; and (d) ensure that surgical prioritization protocols minimize risk of racial/ethnic bias. Collectively, these measures address social determinants of health and the moral imperative to provide equitable, high-quality HNC care.

  View details for DOI 10.1002/hed.26345

  View details for PubMedID 32562325

• Health Literacy and Hearing Healthcare Use. The Laryngoscope Tran, E. D., Vaisbuch, Y. n., Qian, Z. J., Fitzgerald, M. B., Megwalu, U. C. 2020

  Abstract

  To assess whether health literacy is associated with: 1) degree of hearing loss at initial presentation for audiogram and 2) hearing aid adoption for hearing aid candidates.We identified 1376 patients who underwent audiometric testing and completed a brief health literacy questionnaire at our institution. The association between health literacy and degree of hearing loss at initial presentation was examined using linear regression, adjusted for age, gender, marital status, education level, race, language, employment status, and insurance coverage. The association between health literacy and hearing aid adoption was examined in the subset of patients identified as hearing aid candidates using logistic regression, adjusted for demographic factors and insurance coverage.Patients with inadequate health literacy were more likely to present with more severe hearing loss (adjusted mean pure-tone average [PTA] difference, 5.38 dB, 95% confidence interval [CI] 2.75 to 8.01). For hearing aid candidates (n = 472 [41.6%]), health literacy was not associated with hearing aid adoption rate (odds ratio [OR] 0.85, 95% CI 0.40 to 1.76). Hearing aid coverage through Medicaid (OR 2.22, 95% CI 1.13 to 4.37), and moderate (OR 2.70, 95% CI 1.58 to 4.69) or moderate-severe (OR 2.23, 95% CI 1.19 to 4.16) hearing loss were associated with hearing aid adoption.In our population, patients with low health literacy are more likely to present with higher degrees of hearing loss, but no less likely to obtain hearing aids compared with patients with adequate health literacy. Hearing loss severity and hearing aid coverage by insurance appear to be the main drivers of hearing aid adoption.3 Laryngoscope, 2020.

  View details for DOI 10.1002/lary.29313

  View details for PubMedID 33305829

• Risks of Neoplasia and Malignancy in Surgically Resected Cystic Parotid Lesions. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Boursiquot, B. C., Fischbein, N. J., Sirjani, D., Megwalu, U. C. 2019: 194599819889699

  Abstract

  OBJECTIVES: To evaluate the risks of neoplasm and malignancy in surgically treated cystic parotid masses compared with solid or mixed lesions and to evaluate the performance of fine-needle aspiration (FNA) in parotid cysts.STUDY DESIGN: Retrospective cross-sectional study.SETTING: Single-institution academic tertiary care center.SUBJECTS AND METHODS: Patients without a history of human immunodeficiency virus or head and neck cancer who underwent parotidectomy for parotid masses and had preoperative imaging to characterize lesions as cystic, solid, or mixed (ie, partially cystic and partially solid). We assessed the risks of neoplasia and malignancy, adjusting for age, sex, race/ethnicity, facial nerve weakness, and history of malignancy. We also evaluated the sensitivity and specificity of FNA.RESULTS: We included 308 patients, 27 of whom had cystic parotid masses (5 simple and 22 complex). Cystic masses were less likely to be neoplastic compared to solid or mixed masses (44% vs 97%; odds ratio [OR], 0.03; 95% confidence interval [CI], 0.01-0.07); however, there was no difference in the risk of malignancy (22% vs 26%; OR, 0.81; 95% CI, 0.32-2.10). Cystic masses were more likely to yield nondiagnostic FNA cytology results, but for diagnostic samples, FNA was 86% sensitive and 33% specific for diagnosing neoplasia and 75% sensitive and 83% specific for diagnosing malignancy.CONCLUSION: In our population, cystic masses undergoing surgery were less likely to be neoplastic but had a similar risk of malignancy as solid masses. The risk of malignancy should be considered in the management of cystic parotid masses.

  View details for DOI 10.1177/0194599819889699

  View details for PubMedID 31791199

• Visual Vignette ENDOCRINE PRACTICE Vukkadala, N., Desai, K., Megwalu, U. 2019; 25 (12): 1366

  View details for DOI 10.4158/EP-2019-0054

  View details for Web of Science ID 000505055300017

• Harms of Pediatric Thyroid Cancer Overdiagnosis-Reply. JAMA otolaryngology-- head & neck surgery Qian, Z. J., Megwalu, U. C. 2019

  View details for DOI 10.1001/jamaoto.2019.3054

  View details for PubMedID 31621811

• Impact of lymph node sampling on survival in cN0 major salivary gland adenoid cystic carcinoma HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Qian, Z., Chen, M. M., Divi, V., Megwalu, U. C. 2019; 41 (6): 1903–7

  View details for DOI 10.1002/hed.25628

  View details for Web of Science ID 000468629500045

• Adjuvant external beam radiotherapy for locally invasive papillary thyroid cancer HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Megwalu, U. C., Orloff, L. A., Ma, Y. 2019; 41 (6): 1719–24

  View details for DOI 10.1002/hed.25639

  View details for Web of Science ID 000468629500024

• Regionalization of head and neck cancer surgery may fragment care and impact overall survival LARYNGOSCOPE Chen, M. M., Megwalu, U. C., Liew, J., Sirjani, D., Rosenthal, E. L., Divi, V. 2019; 129 (6): 1413–19

  View details for DOI 10.1002/lary.27440

  View details for Web of Science ID 000468091400035

• Pediatric Thyroid Cancer Incidence and Mortality Trends in the United States, 1973-2013. JAMA otolaryngology-- head & neck surgery Qian, Z. J., Jin, M. C., Meister, K. D., Megwalu, U. C. 2019

  Abstract

  The incidence of thyroid cancer is increasing by 3% annually. This increase is often thought to be attributable to overdiagnosis in adults. A previous study reported a 1.1% annual increase in the incidence of pediatric thyroid cancer. However, the analysis was limited to the period from 1973 to 2004 and was performed in a linear fashion, which does not account for changes in incidence trends over time.To analyze trends in pediatric thyroid cancer incidence based on demographic and tumor characteristics at diagnosis.This cross-sectional study included individuals younger than 20 years who had a diagnosis of thyroid cancer in the Surveillance, Epidemiology, and End Results (SEER) 9 database from 1973 to 2013. Cases of thyroid cancer were identified using the International Classification of Diseases for Oncology, Third Edition and were categorized by histologic type, stage, and tumor size.Annual percent change (APC) in the incidence rates was calculated using joinpoint regression analysis.Among 1806 patients included in the analysis, 1454 (80.5%) were female and 1503 (83.2%) were white; most patients were aged 15 to 19 years. The overall incidence rates of thyroid cancer increased annually from 0.48 per 100 000 person-years in 1973 to 1.14 per 100 000 person-years in 2013. Incidence rates gradually increased from 1973 to 2006 (APC, 1.11%; 95% CI, 0.56%-1.67%) and then markedly increased from 2006 to 2013 (APC, 9.56%; 95% CI, 5.09%-14.22%). The incidence rates of large tumors (>20 mm) gradually increased from 1983 to 2006 (APC, 2.23%; 95% CI, 0.93%-3.54%) and then markedly increased from 2006 to 2013 (APC, 8.84%; 95% CI, 3.20%-14.79%); these rates were not significantly different from incidence rates of small (1-20 mm) tumors. The incidence rates of regionally extended thyroid cancer gradually increased from 1973 to 2006 (APC, 1.44%; 95% CI, 0.68%-2.21%) and then markedly increased from 2006 to 2013 (APC, 11.16%; 95% CI, 5.26%-17.40%); these rates were not significantly different from the incidence rates of localized disease.The incidence rates of pediatric thyroid cancer increased more rapidly from 2006 to 2013 than from 1973 to 2006. The findings suggest that there may be a co-occurring increase in thyroid cancer in the pediatric population in addition to enhanced detection.

  View details for DOI 10.1001/jamaoto.2019.0898

  View details for PubMedID 31120475

• Patient preferences regarding the communication of biopsy results in the general otolaryngology clinic AMERICAN JOURNAL OF OTOLARYNGOLOGY Saraswathula, A., Lee, J. Y., Megwalu, U. C. 2019; 40 (1): 83–88

  View details for DOI 10.1016/j.amjoto.2018.10.002

  View details for Web of Science ID 000453638400016

• Intraoperative Corticosteroids for Voice Outcomes among Patients Undergoing Thyroidectomy: A Systematic Review and Meta-analysis OTOLARYNGOLOGY-HEAD AND NECK SURGERY Noel, J. E., Kligerman, M. P., Megwalu, U. C. 2018; 159 (5): 811–16

  View details for DOI 10.1177/0194599818793414

  View details for Web of Science ID 000450349700002

• Insurance Status and Survival of Patients with Salivary Gland Cancer. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Saraswathula, A., Megwalu, U. C. 2018: 194599818791798

  Abstract

  Objectives To evaluate the impact of insurance status on survival among patients with major salivary gland cancer. Study Design Retrospective cohort study. Setting SEER program. Subjects and Methods We included patients aged <65 years diagnosed with major salivary gland cancers from 2007 to 2013. Those aged ≥65 years were excluded due to issues ascertaining insurance status. The independent variable was insurance status (insured, uninsured, or Medicaid); the primary outcome measure was overall survival (OS); and the secondary outcome measure was disease-specific survival (DSS). Results Compared with insured patients, uninsured and Medicaid patients were more likely to present with stage III-IV disease (uninsured: odds ratio [OR], 1.57; 95% CI, 1.09-2.27; Medicaid: OR, 1.67; 95% CI, 1.27-2.20) and with distant metastasis (uninsured: OR, 2.10; 95% CI, 1.18-3.57; Medicaid: OR, 1.96; 95% CI, 1.25-3.01) after adjusting for demographic and tumor variables. Uninsured and Medicaid patients also had worse OS (uninsured: hazard ratio [HR], 1.62; 95% CI, 1.14-2.29; Medicaid: HR, 1.74; 95% CI, 1.33-2.38) and DSS (uninsured: HR, 1.57; 95% CI, 1.08-2.29; Medicaid: HR, 1.68; 95% CI, 1.25-2.25) after adjusting for demographic and tumor variables. After further adjusting for treatment variables, only Medicaid status was significantly associated with worse OS (HR, 1.71; 95% CI, 1.30-2.26) and DSS (HR, 1.65; 95% CI, 1.23-2.23). Conclusions Insurance status is associated with stage at presentation and survival among patients with salivary gland cancer.

  View details for PubMedID 30324868

• Survival benefit of post-operative chemotherapy for intermediate-risk advanced stage head and neck cancer differs with patient age ORAL ONCOLOGY Chen, M. M., Colevas, A., Megwalu, U., Divi, V. 2018; 84: 71–75

  Abstract

  The National Comprehensive Cancer Network (NCCN) guidelines state that surgical patients with advanced-stage head and neck cancer (HNC) and risk factors other than extranodal extension (ENE) or positive margins should consider post-operative chemoradiation (POCRT). The goal of our study was to determine if POCRT is associated with overall survival (OS) compared with post-operative radiation therapy (PORT) and whether this varies with patient age.We conducted a retrospective study of 5319 adult patients with stage III-IV HNC who received primary surgical treatment with POCRT or PORT in the National Cancer Database (2010-2013). Patients with distant metastases, ENE, and positive margins were excluded. Intermediate risk features included pT3-T4, pN2-N3 disease, and lymphovascular invasion. Our main outcome was overall survival (OS). Statistical analysis included chi-squared tests and Cox proportional hazards regressions.On multivariable analysis for non-oropharyngeal cancer patients <70 years, POCRT was associated with improved OS for T1-4N2-3 disease (hazard ratio [HR], 0.73, 95% confidence interval [CI]; 0.58-0.93) but was not associated with OS for T3-4N0-1 disease (HR, 0.92; 95% CI, 0.71-1.19). For patients ≥70 years, POCRT was not associated with improved OS for patients with T1-4N2-3 disease (HR, 1.21; 95% CI, 0.79-1.86) or T3-4N0-1 disease (HR, 1.08; 95% CI, 0.71-1.65). For oropharyngeal cancer patients with HPV-positive disease, POCRT was associated with decreased OS (HR, 9.52; 95% CI, 2.38-38.08).Chemoradiation may offer a survival benefit for non-oropharyngeal intermediate-risk advanced-stage HNC patients <70 years of age with T1-4N2-3 disease, but may not benefit those ≥70 years of age or those with T3-4N0-1 disease.

  View details for PubMedID 30115479

• Jaw Opening Decreases Window to the Deep Parotid Lobe OTOLARYNGOLOGY-HEAD AND NECK SURGERY Lee, Y., Megwalu, U., Melara, E., Divi, V., Fernandes, V. T., Sirjani, D. 2018; 159 (3): 439–41

  View details for DOI 10.1177/0194599818766317

  View details for Web of Science ID 000443735400005

• Oropharyngeal Squamous Cell Carcinoma Incidence and Mortality Trends in the United States, 1973-2013 LARYNGOSCOPE Megwalu, U. C., Sirjani, D., Devine, E. E. 2018; 128 (7): 1582–88

  View details for DOI 10.1002/lary.26972

  View details for Web of Science ID 000440007000029

• Dysphagia and Pharyngeal Obstruction in a Nonsmoker JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Nuyen, B. A., Berry, G., Megwalu, U. 2018; 144 (2): 171–72

  View details for PubMedID 29222562

• Surrogate for oropharyngeal cancer HPV status in cancer database studies HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Megwalu, U. C., Chen, M. M., Ma, Y., Divi, V. 2017; 39 (12): 2494–2500

  Abstract

  The utility of cancer databases for oropharyngeal cancer studies is limited by lack of information on human papillomavirus (HPV) status. The purpose of this study was to develop a surrogate that can be used to adjust for the effect of HPV status on survival.The study cohort included 6419 patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012, identified in the National Cancer Database (NCDB). The HPV surrogate score was developed using a logistic regression model predicting HPV-positive status.The HPV surrogate score was predictive of HPV status (area under the curve [AUC] 0.73; accuracy of 70.4%). Similar to HPV-positive tumors, HPV surrogate positive tumors were associated with improved overall survival (OS; hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.59-0.91; P = .005), after adjusting for important covariates.The HPV surrogate score is useful for adjusting for the effect of HPV status on survival in studies utilizing cancer databases.

  View details for PubMedID 28963794

• Oropharyngeal squamous cell carcinoma incidence and mortality trends in the United States, 1973-2013. The Laryngoscope Megwalu, U. C., Sirjani, D., Devine, E. E. 2017

  Abstract

  OBJECTIVE: To analyze oropharyngeal squamous cell carcinoma incidence and mortality trends in the United States for the years 1973 through 2013.STUDY DESIGN: Cross-sectional study using a large population-based cancer database.METHODS: Data on incidence and mortality rates were extracted from the Surveillance, Epidemiology, and End Results (SEER) 9 Database. Annual percentage change in rates was calculated using Joinpoint regression analysis (National Cancer Institute, Bethesda, MD).RESULTS: Incidence rates increased (annual percent change [APC]; 1.52, 95% confidence interval [CI] 0.17 to 2.88) from 1973 to 1983, remained stable (APC -0.52, 95% CI -1.30 to 0.26) from 1983 to 1997, and increased (APC 1.32, 95% CI 0.83 to 1.81) from 1997 to 2013. Overall, incidence rates increased for males (APC 0.73, 95% CI 0.22 to 1.25) but not females (APC -0.77, 95% CI -0.68 to 0.82). Incidence rates increased in the white population (APC 0.79, 95% CI 0.33 to 1.25) but decreased in the black population (APC -0.72, 95% CI -1.41 to -0.02). The incidence rates increased for tongue-base tumors (APC 1.17, 95% CI 0.42 to 1.92) and tonsil tumors (APC 0.47, 95% CI 1.10 to 4.96) but decreased for other sites. Incidence-based mortality decreased (APC -0.78, 95% CI -1.13 to -0.42) from 1993 to 2013.CONCLUSION: Oropharyngeal squamous cell carcinoma incidence rates increased in a nonlinear fashion from 1973 to 2013, whereas mortality rates declined. This, along with variation in trends by demographic and tumor factors, suggest that human papilloma virus is the main driver of the recent rise in incidence.LEVEL OF EVIDENCE: 2b. Laryngoscope, 2017.

  View details for PubMedID 29086431

• Retrograde Parotidectomy and facial nerve outcomes: A case series of 44 patients AMERICAN JOURNAL OF OTOLARYNGOLOGY Kligerman, M. P., Song, Y., Schoppy, D., Divi, V., Megwalu, U. C., Haughey, B. H., Sirjani, D. 2017; 38 (5): 533–36

  Abstract

  The most common surgical method to remove benign parotid tumors remains the prograde approach. We examined if a retrograde surgical technique offers better outcomes than historical prograde controls.A retrospective chart review at Stanford Hospital was conducted to identify retrograde parotidectomies between February 2012 and October 2014 that were staffed by the senior author (DS) with resident involvement. Facial nerve (FN) outcomes and other post-surgical parameters were recorded.We identified 44 consecutive cases and found that 18.2% (n=8) of patients experienced temporary paresis and 2.3% (n=1) experienced minor (HB 2) permanent paresis limited to one branch. The average hospital length of stay was 0.64 days and complication rate was 6.8%.The retrograde technique has complication rates comparable to historical rates for the prograde technique and is amenable to minimally invasive outpatient superficial parotidectomy.

  View details for PubMedID 28647300

• Health Literacy in Patients With Head and Neck Cancer: An Understudied Issue. JAMA otolaryngology-- head & neck surgery Megwalu, U. C. 2017

  View details for DOI 10.1001/jamaoto.2017.0242

  View details for PubMedID 28494059

• Survival Outcomes in Oropharyngeal Small-Cell Carcinoma Compared With Squamous Cell Carcinoma: A Population-based Study. JAMA otolaryngology-- head & neck surgery Megwalu, U. C., Nuyen, B. A. 2017

  View details for DOI 10.1001/jamaoto.2017.0025

  View details for PubMedID 28301632

• Health Literacy. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Megwalu, U. C. 2017; 156 (3): 395-396

  Abstract

  Health literacy has been shown to affect outcomes in a number of medical conditions. Despite the complexity of care that is often required among otolaryngology patients, the literature on health literacy in this field is sparse. Otolaryngologists need to be aware of issues related to health literacy due to the changing health care environment. The increased complexity of medical care, the greater involvement of patients in shared decision making, and the higher administrative burden on patients have increased their health literacy requirements. Assessing health literacy in clinical practice may help identify patients who might require additional help in navigating the health care system. The Brief Health Literacy Screen and the Newest Vital Sign are 2 measures that are easy to apply in clinical practice.

  View details for DOI 10.1177/0194599816683664

  View details for PubMedID 28248601

• Risk of Malignancy in Thyroid Nodules 4 cm or Larger. Endocrinology and metabolism (Seoul, Korea) Megwalu, U. C. 2017: -?

  Abstract

  Several authors have questioned the accuracy of fine-needle aspiration cytology (FNAC) in large nodules. Some surgeons recommend thyroidectomy for nodules ≥4 cm even in the setting of benign FNAC, due to increased risk of malignancy and increased false negative rates in large thyroid nodules. The goal of our study was to evaluate if thyroid nodule size is associated with risk of malignancy, and to evaluate the false negative rate of FNAC for thyroid nodules ≥4 cm in our patient population.This is a retrospective study of 85 patients with 101 thyroid nodules, who underwent thyroidectomy for thyroid nodules measuring ≥4 cm.The overall risk of malignancy in nodules ≥4 cm was 9.9%. Nodule size was not associated with risk of malignancy (odds ratio, 1.02) after adjusting for nodule consistency, age, and sex (P=0.6). The false negative rate for FNAC was 0%.Nodule size was not associated with risk of malignancy in nodules ≥4 cm in our patient population. FNAC had a false negative rate of 0. Patients with thyroid nodules ≥4 cm and benign cytology should not automatically undergo thyroidectomy.

  View details for PubMedID 28181427

• Racial disparities in oropharyngeal cancer survival ORAL ONCOLOGY Megwalu, U. C., Ma, Y. 2017; 65: 33-37

  Abstract

  Oropharyngeal cancer is an important cause of mortality and morbidity. Several studies have revealed racial disparities in head and neck cancer outcomes. The goal of our study was to evaluate the impact of race on survival in patients with oropharyngeal cancer, using a large population-based cancer database.This was a retrospective cohort study. Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 18 Database of the National Cancer Institute. The study cohort included patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012. The outcomes of interest were overall survival (OS) and disease-specific survival (DSS).After adjusting for age, sex, marital status, tumor site, and year of diagnosis, black race was associated with worse OS (HR 1.67, p<0.0001) and DSS (HR 1.67, p<0.0001).Black race is associated with worse survival in patients with oropharyngeal cancer. Further research is needed to elucidate the mechanism by which race impacts survival in oropharyngeal cancer. This may reveal potential areas of opportunity for public health interventions aimed at addressing disparities in cancer outcomes.

  View details for DOI 10.1016/j.oraloncology.2016.12.015

  View details for Web of Science ID 000392641100007

  View details for PubMedID 28109465

• Risk of Nodal Metastasis in Major Salivary Gland Adenoid Cystic Carcinoma. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Megwalu, U. C., Sirjani, D. 2017: 194599817690138-?

  Abstract

  Objective To determine the risk of nodal metastasis, examine risk factors for nodal metastasis, and evaluate the impact of nodal metastasis on survival in patients with major salivary gland adenoid cystic carcinoma. Study Design Retrospective cohort study from a large population- based cancer database. Methods Data were extracted from the SEER 18 database (Surveillance, Epidemiology, and End Results) of the National Cancer Institute. The study cohort included 720 patients diagnosed with major salivary gland adenoid cystic carcinoma between 1988 and 2013. Results The overall rate of lymph node metastasis was 17%. T3 disease (odds ratio, 4.74) and T4 disease (odds ratio, 9.24) were associated with increased risk of nodal metastasis. Age, sex, and site were not associated with nodal metastasis. Nodal metastasis was associated with worse overall survival (hazard ratio, 2.56) and disease-specific survival (hazard ratio, 3.27), after adjusting for T stage, presence of distant metastasis, site, surgical resection, radiotherapy, neck dissection, age, sex, race, marital status, and year of diagnosis. Conclusion Major salivary gland adenoid cystic carcinoma carries significant risk of nodal metastasis. Advanced T stage is associated with increased risk of nodal metastasis. Nodal metastasis is associated with worse survival.

  View details for DOI 10.1177/0194599817690138

  View details for PubMedID 28168897

• Impact of County-Level Socioeconomic Status on Oropharyngeal Cancer Survival in the United States. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Megwalu, U. C. 2017: 194599817691462-?

  Abstract

  Objective To evaluate the impact of county-level socioeconomic status on survival in patients with oropharyngeal cancer in the United States. Study Design Retrospective cohort study via a large population-based cancer database. Methods Data were extracted from the SEER 18 database (Surveillance, Epidemiology, and End Results) of the National Cancer Institute. The study cohort included 18,791 patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012. Results Patients residing in counties with a low socioeconomic status index had worse overall survival (56.5% vs 63.0%, P < .001) and disease-specific survival (62.7% vs 70.3%, P < .001) than patients residing in counties with a high socioeconomic status index. On multivariable analysis, residing in a county with a low socioeconomic status index was associated with worse overall survival (hazard ratio, 1.21; 95% CI, 1.14-1.29; P < .001) and disease-specific survival (hazard ratio, 1.21; 95% CI, 1.12-1.30; P < .001), after adjusting for race, age, sex, marital status, year of diagnosis, site, American Joint Committee on Cancer stage group, presence of distant metastasis, presence of unresectable tumor, histologic grade, surgical resection of primary site, treatment with neck dissection, and radiation therapy. Conclusion Residing in a county with a low socioeconomic status index is associated with worse survival. Further research is needed to elucidate the mechanism by which socioeconomic status affects survival in oropharyngeal cancer.

  View details for DOI 10.1177/0194599817691462

  View details for PubMedID 28195022

• Observation versus thyroidectomy for papillary thyroid microcarcinoma in the elderly. journal of laryngology and otology Megwalu, U. C. 2017; 131 (2): 173-176

  Abstract

  To compare the effectiveness of non-surgical versus surgical therapy in elderly patients with papillary thyroid microcarcinoma.The study cohort included 2323 elderly patients (aged 65 years and over) diagnosed with papillary thyroid microcarcinoma between 1988 and 2009, identified in the Surveillance, Epidemiology, and End Results 18 database of the National Cancer Institute.The five-year overall survival rate was 23 per cent for non-surgical patients compared with 91 per cent for surgical patients (p < 0.0001). Unadjusted analysis revealed significantly improved survival in surgical patients compared with non-surgical patients (hazard ratio = 0.06; p < 0.0001). Propensity score analysis also revealed significantly improved survival in surgical patients compared with non-surgical patients (hazard ratio = 0.11; p < 0.0001).Thyroidectomy appears to provide a survival benefit for elderly patients with papillary thyroid microcarcinoma. High-quality prospective studies are needed to better evaluate the comparative effectiveness of immediate thyroidectomy versus observation for elderly patients with papillary thyroid microcarcinoma.

  View details for DOI 10.1017/S0022215116009762

  View details for PubMedID 28007045

• Racial disparities in papillary thyroid microcarcinoma survival. journal of laryngology and otology Megwalu, U. C., Saini, A. T. 2017; 131 (1): 83-87

  Abstract

  To evaluate the impact of race on survival in patients with papillary thyroid microcarcinoma.The study cohort included 17 668 patients diagnosed with papillary thyroid microcarcinoma between 1988 and 2009, identified in the Surveillance, Epidemiology, and End Results 18 database of the National Cancer Institute.Black patients had lower overall survival than other racial groups (p < 0.001). Black patients had significantly worse overall survival (hazard ratio = 2.59) after adjusting for sex, marital status, age, year of diagnosis, multifocal disease and type of surgery. A subset analysis of Black patients revealed no significant difference in overall survival for total thyroidectomy versus lobectomy (p = 0.15).Black race is a negative prognostic factor in thyroid cancer, which cannot be explained by advanced disease stage. Further research on mechanisms by which race affects survival is needed to reveal areas of opportunity for interventions aimed at reducing health disparities in cancer care.

  View details for PubMedID 27917722

• Racial Disparities in Oropharyngeal Cancer Stage at Diagnosis. Anticancer research Megwalu, U. C., Ma, Y. 2017; 37 (2): 835-839

  Abstract

  To evaluate the impact of race on disease stage at diagnosis in patients with oropharyngeal cancer.The cohort included 18,791 adult patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012, from the Surveillance, Epidemiology, and End Results 18 Database.After adjusting for age, sex, marital status, tumor site, and year of diagnosis, black race was associated with increased risk of presenting with Stage III or IV disease (OR 1.24, p=0.016), T3 or T4 tumors (OR 2.16, <0.001), distant metastasis (OR 2, p<0.001), and unresectable tumors (OR 1.65, p<0.001). Race was not associated with risk of presenting with nodal metastasis diagnosis (OR 0.93, p=0.241).Black race is associated with increased risk of advanced disease presentation in oropharyngeal cancer.

  View details for PubMedID 28179339

• The rising incidence of major salivary gland cancer in the United States. Ear, nose, & throat journal Del Signore, A. G., Megwalu, U. C. 2017; 96 (3): E13–E16

  Abstract

  We performed a population-based historical cohort study using the Surveillance, Epidemiology, and End Results (SEER) database to determine trends in the incidence of major salivary gland cancer and to evaluate the effect of sex, tumor size, histology, primary site, and extent of disease. Participants were men and women with major salivary gland cancer, diagnosed 1973-2009. The incidence of major salivary gland cancer increased from 10.4 per 1,000,000 in 1973 to 16 per 1,000,000 in 2009 (annual percent change [APC] 0.99; 95% confidence interval [CI] 0.78 to 1.20; p < 0.05). The incidence of parotid cancers increased (APC 1.13; 95% CI 0.88 to 1.39; p < 0.05) and paralleled the increase in major salivary gland cancer overall. There was an increase in the incidence of tumors measuring 0 to 2.0 cm (APC 1.99; 95% CI 0.61 to 3.38; p < 0.05), but no change in tumors measuring 2.1 to 4.0 cm (APC 1.02; 95% CI -0.46 to 2.52; p > 0.05) and tumors measuring > 4 cm (APC -0.52; 95% CI -1.72 to 0.69; p > 0.05). There was an increase in the incidence of regional (APC 0.77; 95% CI 0.32 to 1.23; p < 0.05) and distant (APC 2.43; 95% CI 1.43 to 3.45; p < 0.05) disease, but not localized disease (APC 0.35; 95% CI 0 to 0.71; p > 0.05). We conclude that the incidence of major salivary gland cancer is increasing, especially small parotid tumors. The incidence of tumors with regional and distant metastasis is also increasing. These findings highlight the need for further research on the etiology of salivary gland cancer, which may reveal opportunities for further public health efforts aimed at prevention.

  View details for PubMedID 28346649

• Health Literacy Assessment in an Otolaryngology Clinic Population OTOLARYNGOLOGY-HEAD AND NECK SURGERY Megwalu, U. C., Lee, J. Y. 2016; 155 (6): 969-973

  Abstract

  To assess health literacy in an adult tertiary care otolaryngology clinic population and to explore potential determinants of inadequate health literacy.Cross-sectional study.Tertiary care otolaryngology clinic.The study population included all adult patients treated at 3 of Stanford University's adult otolaryngology clinic sites between March 1 and 11, 2016. Data were collected via an anonymous questionnaire. Health literacy was assessed with the Brief Health Literacy Screen.Ten percent of patients had inadequate health literacy. White race (odds ratio [OR], 0.23) and having English as the primary language (OR, 0.12) were associated with adequate health literacy, while high school or lower level of education (OR, 3.2) was associated with inadequate health literacy. Age, sex, and Hispanic ethnicity were not associated with health literacy.Our study highlights the need for health literacy screening in the otolaryngology clinic setting and identifies sociodemographic risk factors for inadequate health literacy. Further studies are needed to assess the impact of health literacy on patient outcomes and to test specific interventions to address health literacy and health outcomes.

  View details for DOI 10.1177/0194599816664331

  View details for Web of Science ID 000389146500009

  View details for PubMedID 27554512

• Identifying Intraoperative Nerve Monitoring in Thyroid Surgery Using Administrative Databases. JAMA otolaryngology-- head & neck surgery Megwalu, U. C. 2016

  View details for DOI 10.1001/jamaoto.2016.3653

  View details for PubMedID 27918789

• Migration of an ingested fish bone into the paraglottic space. journal of laryngology and otology Megwalu, U. C. 2016; 130 (10): 973-974

  Abstract

  Ingested foreign bodies are common emergencies encountered in otolaryngology practice. The vast majority can be managed with endoscopic removal. Migration of foreign bodies into the paraglottic space is a rare event that often necessitates using a more invasive procedure for removal.A 68-year-old man presented with sore throat and odynophagia 4 days after ingesting a fish bone.A computed tomography scan revealed a 2.5 cm linear foreign body embedded in the larynx within the right paraglottic space. The patient underwent endoscopic examination and transcervical exploration of the paraglottic space via a posterolateral approach, with successful removal of the foreign body on the second attempt.This is the first case report of an ingested paraglottic space foreign body managed by transcervical exploration using a posterolateral approach to the paraglottic space.

  View details for PubMedID 27499336

• Exploring the Use of Oropharyngeal Cancer Histology to Account for HPV Status in Population-based Studies. Anticancer research Megwalu, U. C. 2016; 36 (10): 5515-5518

  Abstract

  To assess whether poorly differentiated tumors and non-keratinizing tumors have similar demographic and clinical characteristics as human papilloma virus (HPV)-positive tumors in patients with oropharyngeal cancer.The study cohort included patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012 identified in the Surveillance, Epidemiology, and End Results 18 Database.Poorly differentiated tumors were associated with early T stage (odds ratio (OR)=1.23), nodal metastasis (OR=1.66) and tonsil fossa origin (OR=1.22). Non-keratinizing tumors were associated with early T stage (OR=1.23), nodal metastasis (OR=1.66) and tonsil fossa origin (OR=1.22). Poorly differentiated tumors were associated with improved overall survival (OS) (hazard ratio (HR)=0.78, p<0.001). Non-keratinizing tumors were associated with improved OS (HR=0.71, p<0.001).Histological grade and keratinization may be useful surrogates to adjust for the effects of HPV status in oropharyngeal cancer studies utilizing population-based cancer databases.

  View details for PubMedID 27798923

• Adenoid cystic carcinoma of the external ear: a population based study AMERICAN JOURNAL OF OTOLARYNGOLOGY Green, R. W., Megwalu, U. C. 2016; 37 (4): 346-350

  Abstract

  To determine the incidence of adenoid cystic carcinoma of the external ear in the United States, and to evaluate the clinical characteristics and survival outcomes associated with the disease.Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 18 Database of the National Cancer Institute. The study cohort included patients diagnosed with adenoid cystic carcinoma of the external ear from 1973 to 2012.The incidence of adenoid cystic carcinoma of the external ear was 0.004 per 100,000. The SEER database identified 66 patients meeting the inclusion criteria. Nodal metastasis was noted in 13.1% of patients, while 7.9% had distant metastasis. Distant metastasis was associated with worse overall survival (HR 10.18). However, nodal metastasis had no impact on overall survival (HR 0.15, p = 0.09). Surgery alone was associated with improved overall survival (HR 0.26), compared with combination surgery and radiotherapy, while radiotherapy alone was associated with worse overall survival (HR 20.12). Increasing age (HR 1.12) and black race (HR 6.83) were associated with worse overall survival, while female sex (HR 0.26) was associated with improved overall survival.ACC of the external ear is rare. Distant metastasis is a poor prognostic factor. However, nodal metastasis does not appear to impact survival. Advanced age, black race, and male sex are also poor prognostic factors. Surgical resection alone is associated with better survival than combination surgical resection and radiation, or radiotherapy alone.

  View details for DOI 10.1016/j.amjoto.2016.02.001

  View details for Web of Science ID 000378979600011

  View details for PubMedID 27040415

• Survival Outcomes in Early Stage Laryngeal Cancer ANTICANCER RESEARCH Megwalu, U. C., Panossian, H. 2016; 36 (6): 2903-2907

  Abstract

  To evaluate survival outcomes of radiotherapy versus surgical resection in the treatment of early stage laryngeal cancer.Data was extracted from the Surveillance, Epidemiology, and End Results 18 Database. The cohort included 5,301 patients diagnosed with stages I and II laryngeal squamous cell carcinoma between 1992 and 2009, treated with either surgical therapy or radiotherapy.Patients who received surgical therapy had better overall survival (OS) than patients who received radiation therapy (p<0.001). The difference in OS between treatment groups remained after stratification by stage (p<0.001 for Stage I; p=0.03 for Stage II) and subsite (p<0.001). On multivariable analysis, the radiotherapy group had worse OS (hazard ratio (HR)=1.29).Patients with early-stage laryngeal cancer treated with surgical therapy have better survival outcomes than patients treated with non-surgical therapy.

  View details for Web of Science ID 000377464200034

  View details for PubMedID 27272804

• Total Thyroidectomy Versus Lobectomy for the Treatment of Follicular Thyroid Microcarcinoma ANTICANCER RESEARCH Megwalu, U. C., Green, R. W. 2016; 36 (6): 2899-2902

  Abstract

  To compare the effectiveness of total thyroidectomy versus thyroid lobectomy for the treatment of follicular thyroid microcarcinoma.Data were extracted from the Surveillance, Epidemiology, and End Results 18 Database. The study cohort included patients diagnosed with follicular thyroid microcarcinoma between 1988 and 2009, treated with either total thyroidectomy or thyroid lobectomy. Propensity-score analysis using inverse probability weighting was used to control for allocation bias.A total of 203 patients were identified. The 5-year overall survival was 98% for patients treated with lobectomy and 99% for those treated with total thyroidectomy; this difference was not statistically significant (p=0.13). Unadjusted analysis and propensity-score analysis revealed no difference in overall survival between the two treatment groups (p=0.15 and p=0.49, respectively).Total thyroidectomy does not appear to offer any survival advantage over thyroid lobectomy for patients with follicular thyroid microcarcinoma.

  View details for Web of Science ID 000377464200033

  View details for PubMedID 27272803

• Sociodemographic disparities in choice of therapy and survival in advanced laryngeal cancer. American journal of otolaryngology Saini, A. T., Genden, E. M., Megwalu, U. C. 2016; 37 (2): 65-69

  Abstract

  To determine if sociodemographic factors are associated with treatment choice and survival in patients with advanced stage laryngeal cancer in the U.S.Population-based, non-concurrent cohort study of 5381 patients diagnosed with stage III or IV laryngeal squamous cell carcinoma from 1992-2009. Data was extracted from the Surveillance, Epidemiology, and End Results (SEER) database.Choice of therapy (surgical vs. non-surgical) and disease-specific survival (DSS).Age ≥60years (odds ratio [OR]=0.78; 95% CI, 0.70-0.88) and more recent year of diagnosis (OR=0.89; 95% CI, 0.87-0.90) decreased the odds of receiving surgical therapy, while residing in a county with low median household income (OR=1.36; 95% CI, 1.17-1.57) increased the odds of receiving surgical therapy. Age ≥60years (hazard ratio [HR]=1.45; 95% CI, 1.33-1.59) and Black race (HR=1.14; 95% CI, 1.02-1.27) were negatively associated with DSS, while female sex (HR=0.81; 95% CI, 0.72-0.90) and married status (HR=0.69; 95% CI, 0.63-0.75) were positively associated with DSS.For patients with advanced laryngeal cancer, younger age and residing in a low-income county increase the likelihood of receiving surgical therapy. Female sex and married status provide a survival benefit, while Black race appears to be a negative prognostic factor. This highlights the impact of sociodemographic factors on treatment strategies and outcomes and highlights areas for further research on health disparities.

  View details for DOI 10.1016/j.amjoto.2015.10.004

  View details for PubMedID 26954853

• Survival Outcomes in Advanced Laryngeal Cancer JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Megwalu, U. C., Sikora, A. G. 2014; 140 (9): 855-860

  Abstract

  Chemoradiation therapy has become increasingly popular in the treatment of advanced laryngeal cancer as part of an organ preservation protocol. However, several studies have reported a decline in survival, possibly attributable to the increased use of radiation and chemoradiation therapy.To evaluate survival outcomes of laryngeal conservation vs surgical therapy in the treatment of advanced laryngeal cancer in the United States using a large population-based cancer database.Population-based, nonconcurrent cohort study of 5394 patients who received a diagnosis of stage III or IV laryngeal squamous cell carcinoma between 1992 and 2009. Data were extracted from the Surveillance, Epidemiology, and End Results 18 Database.Surgical or nonsurgical therapy.Overall survival (OS) and disease-specific survival (DSS).Patients who received surgical therapy had better 2-year and 5-year DSS (70% vs 64% and 55% vs 51%, respectively; P < .001) and 2-year and 5-year OS (64% vs 57% and 44% vs 39%, respectively; P < .001) than patients who received nonsurgical therapy. The difference in DSS and OS between treatment groups remained after stratification by year-of-diagnosis cohorts (P < .001). The survival gap consistently narrowed with subsequent year-of-diagnosis cohorts. On multivariable analysis, nonsurgical patients had worse DSS (hazard ratio [HR], 1.33 [95% CI, 1.21-1.45]) and OS (HR, 1.32 [95% CI, 1.22-1.43]) after adjustment for year of diagnosis, American Joint Committee on Cancer stage, age, sex, subsite, race, and marital status. Stage III disease (HR, 0.59 [95% CI, 0.54-0.65]), glottic subsite (HR, 0.74 [95% CI, 0.67-0.82]), 2004 to 2009 year-of-diagnosis cohort (HR, 0.79 [95% CI, 0.70-0.90]), female sex (HR, 0.80 [95% CI, 0.72-0.89]), and married status (HR, 0.68 [95% CI, 0.62-0.75]) positively affected DSS. Black race (HR, 1.17 [95% CI, 1.05-1.30]) and increased age (HR, 1.03 [95% CI, 1.02-1.03] for each year) negatively affected DSS.Surgical therapy leads to better survival outcomes than nonsurgical therapy for patients with advanced laryngeal cancer. Patients need to be made aware of the modest but significant survival disadvantage associated with nonsurgical therapy as part of the shared decision-making process during treatment selection.

  View details for DOI 10.1001/jamaoto.2014.1671

  View details for Web of Science ID 000342358000011

  View details for PubMedID 25144163

• The Impact of Demographic and Socioeconomic Factors on Major Salivary Gland Cancer Survival. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Olarte, L. S., Megwalu, U. C. 2014; 150 (6): 991–98

  Abstract

  This study aimed to investigate the impact of demographic and socioeconomic factors on survival in patients with major salivary gland malignancies.Population-based study using the Surveillance, Epidemiology, and End Results (SEER) cancer database.The study cohort consisted of 10,735 men and women ages 20 and older who were diagnosed with major salivary gland carcinoma from 1973 to 2009.Kaplan-Meier analysis revealed that the overall and disease-specific survival was higher for women than for men (P < .001). Overall and disease-specific survival decreased with increasing age (P < .001) and differed by race (P < .001) and marital status (P < .001). Patients residing in counties with higher rates of high school completion had higher overall and disease-specific survival (P < .001). Patients residing in counties with higher median household incomes had better overall and disease-specific survival than patients from lower income counties (P < .001). On multivariable analysis, male sex (hazard ratio [HR] = 1.41; 95% confidence interval [CI], 1.32-1.50), increasing age, and single status (HR = 1.36; 95% CI, 1.27-1.44) had poor prognostic impact on overall survival. Male sex (HR = 1.38; 95% CI, 1.27-1.49), increasing age, and single status (HR = 1.29; 95% CI, 1.19-1.39) had poor prognostic impact on disease-specific survival.For patients with salivary gland malignancies, there is a survival benefit for younger patients, female patients, and married patients. This highlights the significance of demographic factors on survival outcomes for patients with salivary gland malignancies and highlights areas for further research on health disparities.

  View details for PubMedID 24647644

• A systematic review of proton-pump inhibitor therapy for laryngopharyngeal reflux ENT-EAR NOSE & THROAT JOURNAL Megwalu, U. C. 2013; 92 (8): 364-371

  Abstract

  The author performed a MEDLINE literature search to identify and evaluate all randomized, placebo-controlled trials of the treatment of laryngopharyngeal reflux (LPR) with an oral proton-pump inhibitor (PPI) that have been published since 1966. Eight such trials that included a total of 358 patients were identified. These eight studies contained seven different definitions of LPR. Validity scores (maximum: 9) ranged from 5 to 9 (mean: 7.5). One study investigated low-dose once-daily therapy, two studies investigated low-dose twice-daily therapy, and five studies investigated high-dose twice-daily therapy. Outcomes measures were not consistent among studies, and most studies used unvalidated outcomes measures. Only two studies found that a PPI was significantly better than placebo-one in the low-dose twice-daily group and one in the high-dose twice-daily group. The author concludes that the current body of literature is insufficient to draw reliable conclusions about the efficacy of PPI therapy for the treatment of LPR.

  View details for Web of Science ID 000326904700010

  View details for PubMedID 23975490

• Estrogen-Mediated Angiogenesis in Thyroid Tumor Microenvironment Is Mediated Through VEGF Signaling Pathways ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Kamat, A., Rajoria, S., George, A., Suriano, R., Shanmugam, A., Megwalu, U., Prakash, P. B., Tiwari, R., Schantz, S. 2011; 137 (11): 1146-1153

  Abstract

  To explore the induction of a proangiogenic phenotype in endothelial cells in the thyroid tumor microenvironment by estrogen-treated thyroid cancer cells and to define the role of vascular endothelial growth factor (VEGF) in this interaction.Cell-based in vitro systems analysis.Thyroid tumor cell lines (BCPAP [papillary thyroid cancer] and ML-1 [follicular thyroid cancer]) were cultured with estradiol with and without an estrogen receptor (ER) inhibitor (fulvestrant or ICI) and used to treat human umbilical vein endothelial cells (HUVECs).Immunofluorescence was used to confirm the presence of ERα and ERβ in BCPAP cells. Conditioned medium was then used to evaluate the induction of HUVEC tubulogenesis and migration. Secretion of VEGF in this medium was evaluated by Western blot analysis. The expression of phosphoinositide 3-kinase (PI3K), the initiator of a proangiogenic pathway, was evaluated with Western blot analysis of HUVEC lysates. The subsequent effects of an ER inhibitor (fulvestrant/ICI) and a neutralizing VEGF antibody were also observed.Estrogen receptor α and ERβ are expressed in thyroid cancer cells. Estrogen-stimulated ML-1 cells secreted an increased amount of VEGF likely as a result of ER signaling. In contact with this environment, HUVECs demonstrate enhanced tubulogenesis and migration. Western blot analysis documented estrogen-mediated upregulation of PI3K in HUVECs. These effects were mitigated by an ER inhibitor (fulvestrant/ICI) and a neutralizing VEGF antibody.Our data provide evidence that estrogen can induce a proangiogenic endothelial cell phenotype in the thyroid tumor microenvironment through ER and VEGF signaling. Our findings suggest that the effect of antiestrogenic therapy targeting tumor angiogenesis can be enhanced through VEGF inhibition.

  View details for Web of Science ID 000297228100014

  View details for PubMedID 22106242

• Second Primaries after Major Salivary Gland Cancer OTOLARYNGOLOGY-HEAD AND NECK SURGERY Megwalu, U. C., Shin, E. J. 2011; 145 (2): 254-258

  Abstract

  To evaluate the risk of second primary cancers in patients with major salivary gland cancer using a large population database and to examine the effects of sex, salivary gland cancer histology, and radiation therapy on the risk of second primaries.Population-based study using the Surveillance, Epidemiology, and End Result (SEER) cancer database.The subjects were 15,572 men and women ages 15 and above, diagnosed with cancer of the major salivary glands from 1973 to 2006.There was an increased risk of oral cavity (standardized incidence ratio [SIR] = 3.48, P < .05), salivary (SIR = 9.97, P < .05), lung and bronchus (SIR = 1.60, P < .05), kidney (SIR = 1.68, P < .05), and thyroid (SIR = 2.66, P < .05) cancers. Men had an increased risk of developing kidney cancer (SIR = 1.70, P < .05) compared with women (SIR = 1.64, P > .05). Patients with mucoepidermoid carcinoma had an increased risk of a second salivary gland cancer (SIR = 8.97, P < .05) and thyroid cancer (SIR = 3.97, P < .05). Patients with adenoid cystic carcinoma had an increased risk of oral cavity (SIR = 3.76, P < .05) and nasopharyngeal (SIR = 16.88, P < .05) cancers. Patients with acinar cell carcinoma had an increased risk of salivary (SIR = 31.36, P < .05), kidney (SIR = 2.98, P < .05), and thyroid (SIR = 3.85, P < .05) cancers. Patients who received radiation therapy had a higher incidence of lung and bronchus (SIR = 2.11, P < .05), laryngeal (SIR = 3.08, P < .05), and thyroid (SIR = 2.95, P < .05) cancers compared with patients who did not receive radiation therapy (SIR = 1.18, 0.48, and 2.39, respectively; P > .05). Patients had an increased risk of developing second primaries, even 10 years after diagnosis of primary salivary gland cancer.Patients with major salivary gland cancers are at a risk for certain second primary cancers. This highlights the need for long-term surveillance in these patients, not only for recurrence but also for second primary cancers.

  View details for DOI 10.1177/0194599811402899

  View details for Web of Science ID 000294071200014

  View details for PubMedID 21493280

• 3,3 '-Diindolylmethane Modulates Estrogen Metabolism in Patients with Thyroid Proliferative Disease: A Pilot Study THYROID Rajoria, S., Suriano, R., Parmar, P. S., Wilson, Y. L., Megwalu, U., Moscatello, A., Bradlow, H. L., Sepkovic, D. W., Geliebter, J., Schantz, S. P., Tiwari, R. K. 2011; 21 (3): 299-304

  Abstract

  The incidence of thyroid cancer is four to five times higher in women than in men, suggesting a role for estrogen (E₂) in the pathogenesis of thyroid proliferative disease (TPD) that comprises cancer and goiter. The objective of this study was to investigate the antiestrogenic activity of 3,3'-diindolylmethane (DIM), a bioactive compound derived from cruciferous vegetables, in patients with TPD.In this limited phase I clinical trial study, patients found to have TPD were administered 300 mg of DIM per day for 14 days. Patients subsequently underwent a total or partial thyroidectomy, and tissue, urine, and serum samples were collected. Pre- and post-DIM serum and urine samples were analyzed for DIM levels as well as estrogen metabolites. DIM levels were also determined in thyroid tissue samples.DIM was detectable in thyroid tissue, serum, and urine of patients after 14 days of supplementation. Urine analyses revealed that DIM modulated estrogen metabolism in patients with TPD. There was an increase in the ratio of 2-hydroxyestrones (C-2) to 16α-hydroxyestrone (C-16), consistent with antiestrogenic activity that results in more of C-2 product compared with C-16.Our data suggest that DIM enhances estrogen metabolism in TPD patients and can potentially serve as an antiestrogenic dietary supplement to help reduce the risk of developing TPD. The fact that DIM is detected in thyroid tissue implicates that it can manifest its antiestrogenic activity in situ to modulate TPD.

  View details for DOI 10.1089/thy.2010.0245

  View details for Web of Science ID 000288021200013

  View details for PubMedID 21254914

  View details for PubMedCentralID PMC3048776

• Methodological and statistical problems in uvulopalatopharyngoplasty research - A follow-up study ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Megwalu, U. C., Piccirillo, J. F. 2008; 134 (8): 805-809

  Abstract

  To review the published literature on uvulopalatopharyngoplasty (UPPP) and assess the methodological quality of the research and compare it with a similar article published in 1995; and to determine what, if any, improvement in the methodological quality of the research resulted during the ensuing 10 years.Methodological and statistical evaluation of the published literature on UPPP. Thirty articles representing the clinical studies on UPPP and related procedures written from January 1996 to August 2005 were reviewed. Only articles reporting polysomnography data were included.Overall, the articles demonstrated fair methodological and statistical quality. Compared with the previous review by Schechtman et al, there was a slight increase in the number of articles that discussed statistical power and reported confidence intervals. There were increases in the mean sample size, the percentage of randomized controlled studies, the number of end points, and the use of validated subjective outcome measures; longer mean follow-up time; and more complete reporting of age and sex information. There was no increase in the percentage of published studies that used a prospective study design. None of the studies that required minimum acceptable baseline values of objective sleep parameter measures for enrollment indicated the use of separate screening and baseline assessments. There were 7 different definitions of sleep apnea and 17 different definitions of success in treatment.There has been an overall improvement in the quality of the articles published on UPPP since 1995. Several areas still need improvement: use of more prospective studies, decrease in number of end points, use of separate screening and baseline assessments, and consensus in the definitions of sleep apnea and success.

  View details for Web of Science ID 000258389000002

  View details for PubMedID 18711052

• The effects of melatonin on tinnitus and sleep OTOLARYNGOLOGY-HEAD AND NECK SURGERY Megwalu, U. C., Finnell, J. E., Piccirillo, J. F. 2006; 134 (2): 210-213

  Abstract

  To determine if melatonin improves tinnitus and if this improvement is related to improvement in sleep.Prospective open-label study of 24 patients with tinnitus. The patients took 3 mg of melatonin per day for 4 weeks, followed by 4 weeks of observation. The Tinnitus Handicap Inventory (THI) and the Pittsburgh Sleep Quality Index (PSQI) were administered.The mean THI score decreased significantly between weeks 0 and 4, and between weeks 0 and 8. The mean PSQI significantly decreased between weeks 0 and 4 (P < 0.0001), and between weeks 0 and 8 (P = 0.0003). The change in PSQI was significantly associated with the change in THI between weeks 0 and 4. The change in PSQI was not significantly associated with the change in THI between weeks 0 and 8. The change in the PSQI in the first 4 weeks was associated with the initial PSQI. There was no association between the initial THI and the change in the THI in the first 4 weeks.Melatonin use is associated with improvement of tinnitus and sleep. There was an association between the amount of improvement in sleep and tinnitus. The impact of melatonin on sleep was greatest among patients with the worst sleep quality, but its impact on tinnitus was not associated with the severity of the tinnitus.Melatonin may be a safe treatment for patients with idiopathic tinnitus, especially those with sleep disturbance due to tinnitus.

  View details for DOI 10.1016/j.otohns.2005.10.007

  View details for Web of Science ID 000235293600005

  View details for PubMedID 16455366

• Evaluation of a laryngopharyngeal reflux management protocol. American journal of otolaryngology Gupta, N. n., Green, R. W., Megwalu, U. C. ; 37 (3): 245–50

  Abstract

  To evaluate the effectiveness of a protocol for management of patients with laryngopharyngeal reflux (LPR) in a multi-provider clinic.This is a retrospective cohort study of 188 patients treated for LPR. A standardized clinical protocol for diagnosis and management was instituted in 2012. Two cohorts were established: those managed according to the protocol, and those who were not. For patients managed with the LPR protocol, diagnosis was made using clinical judgment, guided by the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). Patients were treated with proton pump inhibitors (PPI) with the goal of weaning therapy after symptom resolution. Response to therapy was rated using a global rating scale with three response levels: no response, partial response, and complete response. The primary outcome measure was complete response to therapy and the secondary outcome measures were any response (complete or partial) and successful wean off PPI therapy.The patients treated with the LPR protocol had higher rates of complete response (p<0.001). There was no statistically significant difference in rates of any response (complete or partial) between the two groups (p=0.08). Patients treated using the LPR protocol were more likely to be successfully weaned off PPI therapy (p=0.006).The use of an LPR protocol improved treatment effectiveness in our clinic, highlighting the role of clinical protocols in reducing variability in care, thereby improving patient outcomes.

  View details for PubMedID 27178517