Psychosocial Predictors of Health Behaviors and Outcomes in Patients with Human Papillomavirus (HPV) Positive Head and Neck Cancer

PROJECT SUMMARY/ABSTRACT Human Papillomavirus (HPV) related head and neck cancer (HNC) has increased in incidence by nearly 225% since the 1980s and is expected to rise over the next forty years. Patients with HPV positive HNC typically have lower rates of substance use and a more favorable prognosis than HPV negative HNC. Nevertheless,

patients with HPV positive HNC often experience significant side effects from extensive treatment regiments and psychosocial distress secondary to facial disfigurement, symptom burden, and concerns about prognosis. It remains unclear how this distress may contribute to health behaviors that have a direct bearing on relapse,

morbidity, and mortality in individuals with HNC. Despite the lower rates of behavioral risk factors associated with HPV negative HNC (e.g., tobacco and alcohol use), patients with HPV positive HNC who engage in these risk factors (≥ 50% of patients) are at an increased risk for recurrence or secondary malignancy. Among cancer

survivors generally, including HPV negative HNC, psychosocial distress (i.e., anxiety, depression, and fear of cancer recurrence) has been associated with higher rates of tobacco and alcohol use. However, this relationship has been understudied in the context of HPV positive HNC. This study involves a secondary

analysis of the Head and Neck 5000 study, a large longitudinal clinical cohort of HNC patients in the United Kingdom. Through the parent study, patients with HNC were recruited shortly after diagnosis and prior to cancer treatment, provided blood samples at baseline for HPV status, and completed self-report surveys at

baseline (diagnosis), 4-months, 12-months, and 5-years post-diagnosis. The current study aims to 1) evaluate the trajectories of psychosocial variables (i.e., psychological distress, fear of cancer recurrence, and physical symptom burden) in patients with HPV positive HNC from diagnosis to one year following diagnosis, 2)

examine the relationship between psychosocial variables and change in tobacco and alcohol use in patients with HPV positive HNC during the first year after diagnosis, and 3) assess the role of health behavior change on 5-year health outcomes (recurrence-free survival). This study will be the first to examine psychosocial

variables in association to health behavior change and long-term health outcomes in a large longitudinal clinical cohort of patients with HPV positive HNC. Results will inform the need for resources in clinical care and contribute to psychosocial and behavioral intervention development for patients with HPV positive HNC. This

Fellowship will provide the applicant with the training needed to launch an independent and productive research program examining the psychosocial and behavioral processes affecting the quality of life of patients with cancer. The proposed research and training plan will fill gaps in her discipline-specific knowledge in health

psychology, head and neck oncology, and HPV-infection. As well as enhance her skills in longitudinal quantitative analysis and prepare her for a career as an independent investigator in academia.