The Case of the HPV-Positive Perk
Warren is a 50-year-old man recently diagnosed with human papillomavirus (HPV)-positive oropharyngeal cancer. He and his wife meet with a radiation oncologist and develop a plan of care. Lisa, the radiation oncology nurse, meets with the couple to provide education and answer questions. Darren tells her that two of his “hard living” uncles died from head and neck cancer and the treatment was horrible. He says, “I’ve only had two sexual partners and never smoked—is this cancer really worth treating?”
What Would You Do?
Of the various sexually transmitted infections, HPV is the most prevalent (https://www.cdc.gov/std/hpv/stdfact-hpv.htm) with approximately 79 million Americans affected by the infection by their late teens and early twenties. However, the highest incidence (https://seer.cancer.gov/statfacts/html/oralcav.html) of HPV-related oropharyngeal cancer occurs in men aged 55–64.
An estimated 75% of the U.S. population has been exposed (http://www.theoncologynurse.com/ton-issue-archive/2019/october-2019-vol-12-no-5/17855-head-and-neck-cancer-and-sexuality-in-the-era-of-hpv-common-questions-and-answers) to one of the HPV virus’s 100 strains. Although most HPV infections clear the body within two years, some strains are more persistent and may one day lead to cancer. The majority of HPV-related oropharyngeal squamous cell carcinomas are HPV-16 positive. HPV-positive patients are less likely to be smokers but do report having multiple sexual partners.
HPV-positive oropharyngeal cancer has a significantly better prognosis (http://www.theoncologynurse.com/ton-issue-archive/2019/october-2019-vol-12-no-5/17855-head-and-neck-cancer-and-sexuality-in-the-era-of-hpv-common-questions-and-answers) than HPV negative, and in 2018, the American Joint Committee on Cancer (AJCC) changed its staging system to better reflect its improved prognosis.
Clinical trials are underway to determine whether HPV-positive cancer can be treated (https://doi.org/10.3747/co.26.4819) less aggressively than with the current standard of concurrent platinum-based chemotherapy and high-dose radiation therapy.
Lisa explains that HPV-positive oropharyngeal cancer occurs more frequently in nonsmokers and although a higher number of sexual partners increases (http://www.theoncologynurse.com/ton-issue-archive/2019/october-2019-vol-12-no-5/17855-head-and-neck-cancer-and-sexuality-in-the-era-of-hpv-common-questions-and-answers) the risk of contracting HPV, patients with fewer sexual partners still have some risk. She educates the couple on staging criteria and studies indicating a higher survival rate in HPV-positive oropharyngeal cancer. Lisa explains common treatment side effects like dry mouth, difficulty swallowing, and fatigue and discusses symptom management and self-care strategies. Darren and his wife report feeling better about moving forward with treatment.