Exploring the Role of Artificial Intelligence Chatbots in Preoperative Counseling for Head and Neck Cancer Surgery.

OBJECTIVE: To evaluate the potential use of artificial intelligence (AI) chatbots, such as ChatGPT, in preoperative counseling for patients undergoing head and neck cancer surgery. STUDY DESIGN: Cross-Sectional Survey Study. SETTING: Single institution tertiary care center. METHODS: ChatGPT was used to generate presurgical educational information including indications, risks, and recovery time for five common head and neck surgeries. Chatbot-generated information was compared with information gathered from a simple browser search (first publicly available website excluding scholarly articles). The accuracy of the information, readability, thoroughness, and number of errors were compared by five experienced head and neck surgeons in a blinded fashion. Each surgeon then chose a preference between the two information sources for each surgery. RESULTS: With the exception of total word count, ChatGPT-generated pre-surgical information has similar readability, content of knowledge, accuracy, thoroughness, and numbers of medical errors when compared to publicly available websites. Additionally, ChatGPT was preferred 48% of the time by experienced head and neck surgeons. CONCLUSION: Head and neck surgeons rated ChatGPT-generated and readily available online educational materials similarly. Further refinement in AI technology may soon open more avenues for patient counseling. Future investigations into the medical safety of AI counseling and exploring patients' perspectives would be of strong interest. LEVEL OF EVIDENCE: N/A. Laryngoscope, 134:2757-2761, 2024.

Inequities Associated With Advanced Stage at Presentation of Head and Neck Cancer: A Systematic Review.

Importance: Social determinants of health (SDoH) are defined by a wide range of factors (eg, built environment, economic stability, education level, discrimination, racism, access to health care). Advanced stage at presentation or delayed diagnosis heavily influences health outcomes in patients with head and neck cancer (HNC). While the drivers of advanced-stage presentation come from a multitude of sources, SDoH plays an outsized role. Objective: To systematically review the published literature to identify which SDoH are established as risk factors for delayed diagnosis or advanced stage at presentation among patients with HNC. Evidence Review: In this systematic review, a literature search of PubMed, Web of Science, and Embase was conducted on February 27, 2023, using keywords related to advanced stage at presentation and delayed diagnosis of HNC between 2013 and 2023. Quality assessment was evaluated through the Newcastle-Ottawa Scale. Articles were included if they focused on US-based populations and factors associated with advanced stage at presentation or delayed diagnosis of HNC. Findings: Overall, 50 articles were included for full-text extraction, of which 30 (60%) were database studies. Race was the most commonly reported variable (46 studies [92%]), with Black race (43 studies [93%]) being the most studied racial group showing an increased risk of delay in diagnosis of HNC. Other commonly studied variables that were associated with advanced stage at presentation included sex and gender (41 studies [82%]), insurance status (25 studies [50%]), geographic region (5 studies [10%]), and socioeconomic status (20 studies [40%]). Male sex, lack of insurance, rurality, and low socioeconomic status were all identified as risk factors for advanced stage at presentation. Conclusions and Relevance: This systematic review provides a comprehensive list of factors that were associated with advanced HNC stage at presentation. Future studies should focus on evaluating interventions aimed at addressing the SDoH in communities experiencing disparities to provide a net positive effect on HNC care.

Six-week postoperative opioid use and pain following a randomized controlled trial evaluating multimodal analgesia for head and neck free flap patients.

Introduction: Head and neck malignancy treatment often involves invasive surgeries, necessitating effective postoperative pain control. However, chronic reliance on opioid medications remains a challenge for many patients after surgery. Multimodal analgesia (MMA) within enhanced recovery after surgery protocols has shown success in limiting narcotic pain medications for other cancer types. In a prior study, MMA comprising acetaminophen, ketorolac, gabapentin, and a neurogenic block reduced opioid use in the 7-day postoperative period for major head and neck reconstructive surgery. This study investigates the impact of multimodal analgesia on opioid prescription and pain during the 6-week postoperative period for patients undergoing major head and neck oncologic surgeries, aiming to understand the longer-term effects of narcotic use. Methods: The study retrospectively examined participants in a [hybrid type 1 effectiveness-implementation pragmatic trial to assess multimodal analgesia's long-term effectiveness in head and neck free flap surgery. Arm A received scheduled acetaminophen and as-needed opioids, while Arm B received scheduled gabapentin, ketorolac, a regional nerve block at the donor site, scheduled acetaminophen, and as-needed opioids. Retrospective data collection included opioid prescription use and pain scores up to 6 weeks after surgery, gathered from the Kansas prescription drug monitoring program, K-TRACS. Results: Thirty patients participated, 14 in Arm A and 16 in Arm B. The average morphine milligram equivalents per day of filled prescriptions were not significantly different between Arm A and Arm B (7.23 vs. 7.88, p = .845). Additionally, average pain scores at 6 weeks showed no significant difference between the two groups (1.4 vs. 1.9, p = .612). Conclusion: Patients with head and neck cancer treated with multimodal analgesia during the perioperative period did not exhibit significant differences in opioid use and pain within 6 weeks after discharge. To confirm these findings, a re-examination with strict measures of opioid use and scheduled pain assessments in a prospective manner is warranted. Level of Evidence: 4.

Impact of Adjuvant Radiotherapy Setting on Quality-of-Life in Head and Neck Squamous Cell Carcinoma.

OBJECTIVE: To determine differences in post-treatment QoL across treatment settings in patients receiving adjuvant radiation therapy for head and neck squamous cell carcinoma (HNSCC). METHODS: This was a prospective observational cohort study of patients with HNSCC initially evaluated in a head and neck surgical oncologic and reconstructive clinic at an academic medical center (AMC). Participants were enrolled prior to treatment in a prospective registry collecting demographic, social, and clinical data. Physical and social-emotional QoL (phys-QoL and soc-QoL, respectively) was measured using the University of Washington-QoL questionnaire at pre-treatment and post-treatment visits. RESULTS: A cohort of 177 patients, primarily male and White with an average age of 61.2 ± 11.2 years, met inclusion criteria. Most patients presented with oral cavity tumors (n = 132, 74.6%), had non-HPV-mediated disease (n = 97, 61.8%), and were classified as Stage IVa (n = 72, 42.8%). After controlling for covariates, patients treated at community medical centers (CMCs) reported a 7.15-point lower phys-QoL compared with those treated at AMCs (95% CI: -13.96 to -0.35, p = 0.040) up to 12 months post-treatment. Additionally, patients who were treated at CMCs had a 5.77-point (-11.86-0.31, p = 0.063) lower soc-QoL score compared with those treated at an AMC, which was not statistically significant. CONCLUSION: This study revealed that HNSCC patients treated with radiation at AMCs reported significantly greater phys-QoL in their first-year post-treatment compared to those treated at CMCs, but soc-QoL did not differ significantly. Further observational studies are needed to explore potential factors, including treatment planning and cancer resource engagement, behind disparities between AMCs and CMCs. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:3645-3655, 2024.