The following is a summary of “Extra imaging beyond NCCN surveillance guidelines is cost effective for HPV− but not HPV+ oropharyngeal cancer,” published in the November 2023  issue of Oncology by Shah, et al.

The number of oropharyngeal squamous cell carcinoma (OPSCC) cases is rising very quickly in high-income countries. It was linked to risk factors like HPV infection, smoking, and drinking alcohol. The rising number of OPSCC cases is putting a lot of stress on the healthcare system. Each year in the US, about $4.2 billion is spent on head and neck cancer. Both HPV-positive and HPV-negative OPSCC cases have been going up, but HPV-positive OPSCC cases have been going up more quickly and will likely keep going up for a long time. It is important to keep in mind that HPV-negative (HPV-) and HPV-positive (HPV+) OPSCC act differently and have different grading standards, according to the American Joint Committee on Cancer (AJCC). It is worse to have HPV-OPSCC than HPV+ cancer in terms of total and progression-free survival. 

On the other hand, people with HPV+ head and neck cancer tend to be younger and respond better to treatment. Because the number of people impacted by OPSCC is growing and changing, we must make the best choices about long-term follow-up and take HPV status into mind. However, the rules for images after treatment in OPSCC aren’t always in line with how things are done in practice. The National Comprehensive Cancer Network (NCCN) standards say imaging should be done within 6 months of treatment. However, regular reimaging was not suggested unless there was a clinical concern since there was no proven life benefit. 

Still, many doctors continue to do regular monitoring imaging on head and neck cancer patients who don’t have any symptoms. This costs the healthcare system a lot and doesn’t help the patients much. To make sense of the discrepancies between standards and clinical practice, it is important to look into the situations where more post-treatment monitoring imaging is necessary and worth the money. Knowing that HPV+ and HPV-OPSCC have different rates of return means that they may need different ways to be monitored. It was the first study to compare the cost and value of extra imaging to the existing oropharyngeal cancer standards from the NCCN. We use cost-effectiveness models to determine if continuing to do imaging for monitoring after OPSCC is worth the money while considering the patient’s HPV status.

Source: sciencedirect.com/science/article/abs/pii/S1368837523002609