6th ICHNO Abstract Book

6th ICHNO 6 th ICHNO Conference International Conference on innovative approaches in Head and Neck Oncology 16 – 18 March 2017 Barcelona, Spain __________________________________________________________________________________________ medical oncologists, otolaryngologists, pathologists, radiation therapists and radiologists. page 65

Oncology, Villejuif, France 4 Centre Jean Bernard, Oncology, Le Mans, France 5 MSD France, Market access, Courbevoie, France 6 Institut de Cancérologie de Lorraine - Alexis Vautrin, Medical oncology, Vandoeuvre Les Nancy, France Purpose or Objective Costing studies of head and neck (H&N) cancer care are scarce. The study objective was to estimate monthly hospital costs associated with H&N cancer by phase-of-care in France. Material and Methods We completed a retrospective cohort study using the French National Hospital Discharge (PMSI) database that contains all public and private claims for acute care (MCO) and post-acute care (SSR and HAD) in 2008-2013. Of all adult patients identified with squamous cell carcinoma at hospital (ICD-10: C00-C06; C09-C14; C30.0; C31; C32), we selected all 53,257 incident cases in 2010-2012 without a personal history of cancer. Hospital stays were valued from a societal perspective using national public tariffs and out-of-pocket expenses at hospital. Hospital stays attributable to cancer care were identified using French guidelines (INCA 2013) and summed over 3 phases-of-care: 1) initial care (first 6 months after diagnosis), by cancer stage (early I/II; locally advanced III/IVb; distant metastatic IVc); 2) continuing care without relapse (6 months after diagnosis); 3) relapse care in patients without distant metastasis at diagnosis. Mean monthly costs were computed by phase-of-care with use of two-part models taking into account the probability of hospitalization during continuing care and a log-normal distribution of costs. Results Patients were 78.2% male with a median (IQR) age of 61 (54-71) at diagnosis and 20,582 (38.6%) patients died in the follow-up. During initial care (first 6 months), mean (std) monthly hospital costs attributable to cancer care increased with a worse cancer stage at diagnosis: 1,878 (3,277) euros in 15,747 (29.6%) patients with early cancer; 5,199 (3,434) euros in 32,723 (61.4%) patients with locally advanced cancer; 6,999 (2,626) euros in 4,785 (9.0%) patients with distant metastasis. In the follow-up (6 months after diagnosis), continuing care was associated with hospital costs of 423 (1,259) euros per month, while relapse care increased monthly hospital costs to 5,069 (3,353) euros. In multivariate analyses by phase-of-care, mean monthly hospital costs significantly varied by cancer site (min: lip cancer ; max: laryngeal cancer). The presence of primary cancers other than H&N or Charlson comorbidities other than cancer almost all significantly increased monthly costs at all phases-of-care. Death at any phase-of-care doubled mean hospital costs per month. Conclusion Monthly hospital costs were maximum in patients diagnosed with distant metastasis, and still very high in patients with locally advanced stage at diagnosis or relapsing in he follow-up. Less than one third patients with H&N cancer were diagnosed at early stage during the study period in France. Increasing early diagnosis would substantially decrease hospital costs associated with H&N cancer care.

Poster: Epidemiology and prevention

PO-135 Head and neck squamous cell carcinoma of unknown primary treated in the era of FDG-PET and IMRT M. De Ridder 1 , W.M.C. Klop 2 , O. Hamming-Vrieze 1 , J.P. De Boer 3 , W. Vogel 4 , M.W.M. Van den Brekel 2 , A. Al- Mamgani 1 1 Netherlands Cancer Institute, Radiotherapy, Amsterdam, The Netherlands 2 Netherlands Cancer Institute, Head and Neck surgery, Amsterdam, The Netherlands 3 Netherlands Cancer Institute, Medical Oncology, Amsterdam, The Netherlands 4 Netherlands Cancer Institute, Nuclear medicine, Amsterdam, The Netherlands Purpose or Objective Head and neck carcinoma of unknown primary (HNCUP) is a diagnosis of exclusion after an extensive workup. Since the introduction of PET-CT in the diagnostic arsenal the area of true unknown primaries narrowed. Most literature available nowadays describes cohorts of patients before the era of PET-CT and IMRT. This cohort thus represents a more applicable patient selection for current medical practice. Material and Methods Retrospective analyses of 80 PET-staged patients that were curatively treated with intensity-modulated radiotherapy (IMRT) between 2006 and 2016. Patient, tumor and treatment demographics were recorded and oncologic outcomes were analyzed. Results Half of the patients underwent upfront neck dissection, mostly (super)selective. Of all, 97% received mucosal irradiation. Unilateral irradiation of the neck was done in 18% of the patients. Overall survival at 5 year was 62% and disease specific survival 78%. Extracapsular extension (ECE), N3 neck, multiple levels of positive lymph nodes (PLN) and PLN in the lower neck were associated with worse prognosis. Local control was 100% in the mucosal irradiated patients. Neck control was 90%. In total 10 patients developed distant metastases, N3, ECE and lower neck PLN were associated with DM. Patients treated unilaterally had significantly less acute dysphagia grade III (0% vs. 33%). Conclusion This series gives a current overview of the HNCUP patients treated over the last 10 years in the Netherlands Cancer Institute by IMRT in the era of FDG-PET. Five-year disease specific survival is fairly good with 78%, however ECE, N3 and lower neck PLN are factors associated with a worse prognosis. These patients are prone for distant metastasis and future research need to focus on identification of these patients and development of new strategies to improve the outcome of this group of patients. PO-136 Hospital costs associated with head and neck cancer by phase-of-care in France (EPICORL study) M. Schwarzinger 1 , F. Huguet 2 , L. Sagaon Teyssier 1 , S. Témam 3 , Y. Pointreau 4 , M. Bec 5 , C. Even 3 , L. Lévy- Bachelot 5 , L. Geoffrois 6 1 THEN Translational Health Economics Network, Public health, Paris, France 2 Tenon Hospital, Radiation Oncology, Paris, France 3 Institut Gustave Roussy, Head & Neck Surgical & Medical