Board Preparation: Head and Neck Cancers, Disparities in Cancer Care

Oct 27, 2015

Test your knowledge to assist your preparations for Board examinations with questions from two popular courses on ASCO University®: Head and Neck Cancers and Disparities in Cancer Care.

Take a comprehensive approach to your Board preparations with the latest edition of ASCO-SEP®. The fourth edition features more than 180 self-assessment questions and 21 chapters that provide the most current information on all major cancer types, cancer prevention and epidemiology, the molecular biology of cancer, palliative care, symptom management, and geriatric care, as well as overviews of clinical pharmacology, biologic therapies, and statistics.

Correct answers are listed at the bottom of the page.

1. A 45-year-old woman presents with swelling in the left submandibular gland. Fine-needle aspiration favors adenoid cystic carcinoma. The metastatic workup is negative. She undergoes an appropriate resection and is staged with a T3N0 adenoid cystic carcinoma of the submandibular gland.

The next most appropriate step is:

  1. Observation
  2. Adjuvant chemotherapy
  3. Adjuvant radiation therapy
  4. Clinical trial of molecularly targeted agent

2. Although cancer incidence rates are decreasing in the United States, the absolute number of patients with cancer will increase due to population growth and an aging population. With improved cancer treatment, the number of cancer survivors is also increasing. As a result, the total number of people living with cancer or after a cancer diagnosis is expected to increase in the coming years. A recent study suggests that the United States will face an acute shortage of medical oncologists by 2020.

By age, which patients are at highest risk of inadequate access to oncologists?

  1. Patients age 50 to 65
  2. Patients age 65 to 69
  3. Patients age 70 to 84
  4. Patients age 85 or older

 

Rationales

1: C

The patient has a completely resected adenoid cystic carcinoma. This tumor has a propensity for perineural spread and local recurrence. Adjuvant radiation therapy has been shown to improve clinical outcomes in completely resected adenoid cystic carcinoma. In fact, omission of postoperative radiation therapy has been identified as an independent predictor of local recurrence.

Suggested Reading

Chen AM, Branchi PJ, Garcia J, et al. Local-regional recurrence after surgery without postoperative irradiation for carcinomas of the major salivary glands: implications for adjuvant therapy. Int J Radiat Oncol Biol Phys. 2007;67:982-7.

Chen AM, Bucci MK, Weinberg V, et al. Adenoid cystic carcinoma of the head and neck treated by surgery with or without postoperative radiation therapy: prognostic features of recurrence. Int J Radiat Oncol Biol Phys. 2006;66:152-9.

2: D

Patients age 85 or older are the least likely to access medical oncology services in the initial phase of care, in the continuing phase of care, or in the last 12 months of life. This finding suggests that older patients are at the greatest risk of receiving inadequate care as a result of the expected shortage of medical oncologists.

Suggested Reading

Warren JL, Mariotto AB, Meekins A, et al. Current and future utilization of services from medical oncologists. J Clin Oncol. 2008;26:3242-7.

 

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