eNews from the American Head & Neck Society
Issue #98 -  July 2020
In This Issue

Dear Colleagues,

I hope this message finds you safe and well! Six months ago, if you would have asked me how I thought I would be feeling the summer of 2020, I would have told you that I'd be excited for the upcoming International Conference, which has always been a culmination of the strong and impactful work our society has been working on over the past year. I would be eager to learn the new science being presented by our partners across the world, enthusiastic to hear how we are improving the lives of our patients who are affected by head and neck cancer and overcome with anticipation at the idea of welcoming you all to Chicago. I couldn't wait to enjoy the company of people who I consider both my colleagues and my friends.

But then the pandemic happened, and we were all faced with a new reality and asked to quickly adjust to remote working, tele-medicine, new protocols and even asked to be on the front lines to help fight against COVID-19. Some of us contracted this disease and thankfully recovered. Some of us had close friends and relatives who fell victim to the disease and all of us had to rethink, and in many ways retrain, on the best methods to care for our patients. It has been exhausting, stressful and has tested our limits in every possible way.

And the AHNS has truly risen to the occasion. Instead of being excited for our International Conference, I have an even greater feeling at this time, one that is full of pride and gratitude. Our leaders and members have produced amazing work the past few months. The International Conference leadership quickly examined all the facts and pros and cons of conducting an in-person meeting this year and decided to press a "pause" button. They re-arranged the program and faculty and made the appropriate adaptations. Our Patient Care and Education Divisions created a platform on COVID-19 through our web site so that our members from every country can share their research. Our ATC and CDM Services recognized that fellow education still needed to happen and created and implemented weekly Zoom webinars for our ATC fellowships. Our guidelines and position statements service worked tirelessly to approve guidelines and other educational materials to help our fellow physicians with battling COVID-19. And being quarantined did not stop the Administration and Research Divisions and all the Sections from continuing to produce even more impressive work.

We will come together again soon, and we will be stronger and more knowledgeable than before. We will have discovered new research, have a new perspective on our specialty and be able to provide even better care to those we pledged to help the most, our patients. I am very excited for that day!

If you have any suggestions or comments for our society, please do not hesitate to reach out to me through our AHNS headquarters office ( christina@ahns.info ).

It is a great privilege to serve as your president and please stay healthy and safe!

Cherie-Ann Nathan, MD
President, AHNS

The Patient Care Division and its four Services have continued their work on behalf of our head and neck cancer patients and our Society. The COVID-19 pandemic has significantly affected all aspects of our professional and personal lives. To help address these challenges, The Patient Care Division and its Services have worked diligently and creatively to educate and problem solve as we strive to maintain the high standards of patient care encompassed in our mission. Through efforts such as the COVID-19 Bulletin Board, production of educational material for patients and physicians as well as formulation of recovery guidelines, the Division strives to make a positive difference in these challenging times. Our appreciation goes out to the members of each Service and their outstanding leaders, who have made substantial contributions over the past several months.
The Value and Quality of Care Service (VQOCS), under the leadership of Dr. Terry Tsue, has built a leadership infrastructure including an executive committee and steering committee to expedite inter-meeting progress. Based on the Service's decided target audience of general otolaryngologists that perform head & neck surgery, the Service has created a VQOCS Quality Metric Database. Pilot data was collected from 8 steering committee institutions for the initial 26 metrics = (11 pre-treatment, 8 treatment, 3 post-treatment, 4 value) + 8 characteristic questions. These results will be presented to AHNS leadership as well as to the VQOCS July meeting to recruit to expand database institutional membership. Next steps include developing a database governance committee, create national benchmarks and coordinate with other national societies involved in the multidisciplinary care of the Head and Neck patient. These metrics would also then serve as a catalyst for multi-institutional PI and Research Projects. A need to closely collaborate with the Sections and other Committees who are developing quality metrics within their efforts is also anticipated.
The Practice Guidelines and Position Statements Service, under the leadership of Dr. Russell Smith, is glad to share that multiple collaborative projects are ongoing with multiple disease Sections. Each of the Sections has identified concepts for development with some projects nearing completion. In the near future, efforts related to surgical margins for early stage oral cavity cancer and HPV vaccination will be finalized.
The C ancer Prevention Service (CPS), under the leadership of Dr. Michael Moore, is excited to relay that the Food and Drug Administration recently approved the use of the Gardasil 9 vaccine, by Merck, for prevention of certain HPV-related oropharyngeal cancersBy recognizing prevention of oropharyngeal cancer as an indication for HPV vaccination, this opens the door for more robust public awareness campaigns and will hopefully allow for better vaccine uptake in both girls and boys.
In addition to this important news, the Cancer Prevention Service has been active over the past few months in efforts to raise public awareness related to head and neck malignancies. April 13-19 of this year served as the Annual Oral and Head and Neck Cancer Awareness Week, hosted by the Head and Neck Cancer Alliance. Like most things in our society, this initiative was impacted by the on-going COVID-19 pandemic, causing all in-person screenings to be postponed indefinitely. In response to this, the service has embarked on an initiative to develop a Head and Neck Cancer Screening App for smartphones in conjunction with the Head and Neck Cancer Alliance. Led by Dr. Alex Malone and CPS Co-Chair, Dr. Ann GIllenwater, the app will contain an oral lesion library, demonstrating many benign, premalignant and malignant mucosal lesions that can be a reference for the public as they perform a self-exam as guided by the app. The goal for roll-out of the App is the fall or winter of 2020. An additional collaborative project is underway to develop a cutaneous malignancies lesion library in conjunction with the Cutaneous Section of the AHNS for the Society's website, and a survey is being developed to assess current practice patterns in the management of oral leukoplakia by otolaryngologists, head and neck surgeons and oral surgeons.
And although the Oral head & Neck Cancer Awareness Week had to be cancelled this year, important screening and prevention work continued, and the Service was pleased to give out four Community Service Awards for 2020:
  • Tina Sowers, lead - Ohio State University: The Head and Neck Service Line at the Arthur G. James Cancer Hospital and Solove Research Institute - two community events: the 12th Annual Head and Neck Screening Day and the 4th Annual Head and Neck Survivorship Conference on April 18th
  • Sharon Davis, lead - Mercy- Springfield Head and Neck Team: Multi-disciplinary team provide free Oral screenings and education about head and neck cancer prevention and early detection, and healthy lifestyle choices, including nutrition, smoking cessation and access to healthcare to a target population of adult men and women who live in an underserved community
  • Lindsay Olinde, lead - UC Davis Department of Otolaryngology: Head and Neck/Oral Cancer Screening in the Sacramento Community: Minority Neighborhood Clinics and Community Sporting Events during Head and Neck Cancer Awareness Week
  • Kate Clancy, lead - Cleveland Clinic: Interdisciplinary Head and Neck Cancer Screening in an Urban Underserved Neighborhood in Cleveland, Ohio
The CPS would encourage any Society members, interested in being involved in these or other projects related to head and neck cancer prevention, to please reach out to us. We look forward to working with you.

* * *

The Survivorship/Supportive Care/Rehabilitation Service, under the leadership of Dr. Carole Fakhry, has been busy on multiple fronts. Much of their activity focused on planning the first in-person Survivorship Symposium in collaboration with Head and Neck Cancer Alliance. In light of the pandemic, the in-person symposium has been deferred until the next AHNS international meeting, while a portion of the planned content for this year will be presented in a virtual format. This will be comprised of four webinars, one-hour in length, Wednesdays, at 4PM EST beginning the week of July 22nd. Each will consist of a 30-minute pre-recorded session and 30 minutes of question and answer with survivors and health experts. Click the flyer below for information and registration details

The service as a whole has been productive creating materials dedicated to survivors, both pre-COVID and during COVID. Dr. Evan Graboyes has led a longstanding effort of the division to create topical reviews. These are brief informational pieces, directed to the lay person, with commonly asked questions regarding aspects of survivorship. There are currently 21 topical reviews available online, both as a web page and a downloadable document, and several more are in process. These topical reviews can be found on the AHNS Patients pages . With the appreciation that survivor care would be altered due to COVID, in collaboration with the Patient Care Division, the overwhelming majority of service members contributed to a compendium regarding care of survivors during the pandemic posted to our COVID-19 Bulletin Board . Lastly, Dr. Nishant Agrawal drafted and is completing a Survivorship Consensus Statement with the goal of getting approval for submission for publication this year.

D. Gregory Farwell, MD FACS 
Daniel G. Deschler, MD
Co-Chairs, AHNS Patient Care Division
from the AHNS Membership and Credentials Service

One of the highlights of our annual conference occurs during the Business Meeting when new Fellows of our Society are inducted and recognized. In lieu of recognizing our 2019 Inductees in person, this year we are pleased to present them here, and look forward to again congratulating them along with the 2020 Inductees in Chicago next summer.
AHNS New Member Inductees for 2019

Active Fellows Candidate Fellows
Al Haitham Al Shetawi Andrew Agnew
William Albergotti Ayham Al Afif
Brittany Barber Zaid Al-Qurayshi
Jo-Lawrence Bigcas Ian Behr
Isaac Bohannon Felipe Cardemil
Justin Bond Patrick Carpenter
Robert Brody Wenhua (Diane) Chen
Natasha Cohen Erin Cohen
Deepa Danan Catherine Colaianni
Andrew Day Andrew Coniglio
Jonathan Fowlkes Dustin Conrad
Matthew Hearn Kevin Contrera
Jared Inman Camil Correia
Erik Interval Marcus Couey
Namou Kim Catriona Douglas
Diana Kirke Liliana Ein
Scott Kohlert Eric Eisen
Daniel Kwon Allen Feng
Suhael Momin Andrey Finegersh
Nicholas Purdy Amarbir Gill
Michael Roskies Richard Harbison
Lenka Stankova Brian Hondorp
Rodney Taylor Joshua Kain
Kathryn Vorwald Shkala Karzai
Veronique Wan Fook Cheung Minhui (Laura) Kim
Shayanne Lajud
Associate Fellows Mirko Manojlovik Kolarski
Rachelle Gish-Johnson Lindsey Moses
Michael Kase Hassan Nasser
Michael Otremba Christopher Nickel
Mohamman Shaear Tyson Nielson
Evan Walgama Julia Noel
Alex Wong Anuraag Parikh
Hamdan Pasha
Corresponding Fellows Zachary Pflum
Erick Gonzales Cassandra Puccinelli
Jonathan Serpell Ricardo Ramirez
Scott Roof
Janine Rotsides
Yamil Selman
Daniel Sharbel
Justin Shinn
Lindsey Stull
Shiraz Syed
Paul Tabet
Vilija Vaitaitis
Varun Vendra
Jeffery Wells
Paul Zolkind

Jeremy Richmon, MD
Chair, AHNS Membership & Credentials Service

* * *

From the AHNS International Advisory Service

The International Advisory Service has contributed to the academic program for the AHNS 10th International Conference on Head and Neck Cancer "Survivorship through Quality and Innovation". Also we have participated In the Delphi method of consensus for HNC care during the COVID-19 pandemic (Mehanna H, Hardman JC, Shenson JA, et al. Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus [published online ahead of print, 2020 Jun 11]. Lancet Oncol. 2020; S1470-2045(20)30334-X. doi:10.1016/S1470-2045(20)30334-X)

René Leemans, MD and Johaness Fagan, MD
AHNS International Advisory Service Chairs

* * *

From the AHNS Website and Social Media Service.
AHNS Website and Social Media Service has been working collaboratively with the AHNS Patient & Public Education Service to analyze, review and the AHNS' website content. We have completed the foundational work and now are in the process of implementing projects for sub-taskforce of members of AHNS Service and Sections Education Leaders to start.
Also, the AHNS Podcast, Young Members Corner, led by the AHNS Young Members Service, is coming to AHNS members in the near future. The podcast will focus on educational topics of general interest to AHNS members and particular attention to AHNS young members.

Snehal Patel, MD and Mark Shrime, MD
AHNS Website and Social Media Service Chairs
* * *

From the AHNS Young Members Service .
The AHNS Executive Council has approved the development of an AHNS podcast, Young Members Corners. Project leader Andres Bur will work with AHNS IT to record and share these podcasts. Plans to record our first interviews have been delayed given the postponement of the International Meeting. We will use this time to continue to create content. 
The goal of the AHNS Podcast, Young Members Corner, is to focus on educational topics of general interest to AHNS members and particular attention to AHNS young members. Please let us know if you have any discussion topics of interest.

Andres Bur MD, AHNS Young Members P roject Lead, AHNS podcast
Vikas Mehta, MD and Vivian Wu, MD
AHNS Young Members Service Chairs

* * *
from the Ethics and Professionalism Service
The service published an article in Head & Neck: "Ethical Framework for Head & Neck Cancer Care Impacted by COVID-19."  The essay, written by Andy Shuman and co-authored by Bruce Campbell, was efficiently reviewed by several members of the service and by AHNS leadership prior to submission. The article reviewed the risks of SARS-CoV-2 transmission as known at the time and made several points:
  • Head and neck providers are at considerable risk for exposure to the virus given the anatomy of the upper aerodigestive tract.
  • There is a duty to balance care for patients with the protection of self and colleagues.
  • Diagnoses for which there are documented equivalent results between radiation therapy and surgery should be considered for radiation therapy. Even in cases where surgery has traditionally the preferred option, treatment choices might be altered by emerging risk/benefit ratios.
  • In times of scarcity, there is a potential for tension between "clinical ethics" and "public health ethics," given potential shortages of PPE, testing capacity, personnel, and ICU beds.
  • Patients and survivors are vulnerable, and deserve support, counseling, and reassurance for cancer control and symptom management as much as ever.
  • Treatment and care must be consistent and equitable for all populations. Pandemics worsen care and outcomes for victims of explicit and implicit biases who live with cultural, racial, geographic, and economic discrimination. Health care providers must deliberately partner with underrepresented groups to assure that the risks of care disparities are addressed in the face of crisis.
  • Clinical trial risks, benefits, and tradeoffs should be assessed, knowing that every intervention and instrumentation of the upper aerodigestive tract poses a risk to patients, subjects, and providers alike.
In order to provide the membership and meeting attendees the opportunity to see head and neck cancer treatment from a different perspective, the service had worked with William Lydiatt, MD to hold a reception during the 2020 International Meeting at the International Museum of Surgical Science featuring the work of artist Mark Gilbert. With the cancellation of the 2020 meeting this event did not take place, but we will continue to find ways to explore the intersection of surgical care and the humanities.
The Service was also pleased to see that the AHNS leadership endorsed the "American College of Surgeons Response to Recent Violence and Protests."

Bruce Campbell, MD
Chair AHNS Ethics & Professionalism Service

Sentinel Lymph Node Biopsy versus Elective Neck Dissection for Early-Stage Oral Cavity Cancer: Activation of the NRG-HN006 Trial
For patients with early-stage oral cavity squamous cell carcinoma (OCSCC), there is a 20-30% risk for occult metastatic cervical disease despite clinical and radiographic imaging. The debate surrounding management of the node-negative neck has spanned multiple decades initially centered around elective neck dissection (END) versus "watchful waiting" with subsequent therapeutic neck dissection. Recently, sentinel lymph node biopsy (SLN Bx) has emerged as a viable option for active management of the node-negative neck in these patients.
NRG Oncology has just activated a National Cancer Institute (NCI)-approved international, multi-institutional prospective trial comparing SLN Bx versus END for early-stage oral cavity cancer. The study is NRG-HN006 "Randomized Phase II/III Trial of Sentinel Lymph Node Biopsy Versus Elective Neck Dissection for Early-Stage Oral Cavity Cancer." (Clinicaltrials.gov: NCT04333537)
The trial divides patients to two surgical arms, SLN Bx and END, following a PET/CT scan with a central reading as an integral biomarker supported by the NCI. The trial builds upon the recent results of the ACRIN 6685 trial, which demonstrated the relatively high negative predictive value of PET/CT for neck disease in patients with T2-4N0 head and neck cancers. Patients with a positive central read of their PET/CT for neck disease will still have their neck pathology results recorded to understand the functional performance of PET/CT in accurately assessing neck nodal status.
Patients with a negative central read of their PET/CT for neck disease will be randomized to the two surgical arms with stratification based on T-stage and performance status (Zubrod). The Phase II portion of the trial will test the hypothesis that SLN biopsy will have superior patient-reported neck and shoulder function and quality of life (QOL), as measured by the Neck Dissection Impairment Index (NDII), compared to END at 6 months post-surgery. Comparing the difference in the two arms from baseline and 6 months will serve to determine the "Go/No-Go" decision to proceed to Phase III. Phase III has co-primary endpoints and will test the hypothesis that SLN Bx will achieve non-inferior disease-free survival (DFS) compared to END, and that SLN Bx will have superior patient-reported neck and shoulder function and QOL, as measured by the NDII.
NRG-HN006 has an ambitious patient accrual target of 224 patients for Phase II who will be included as part of the 618 patients total for Phase III. The trial represents an opportunity to address the performance of SLN Bx and END in a definitive manner relative to QOL and patient survival. The collection of high-quality prospective data in this study will also permit the assessment of issues that continue to be raised with regard to extent of treatment for early-stage OCSCC, including extent of END, distribution of occult metastatic disease, and practice variations in adjuvant radiation therapy.
Site activation is currently in process and additional details, including the complete protocol, can be obtained here:CTSU website. Surgeon credentialing will require completion of an education course and case review. Please feel free to contact the study PI at sylai@mdanderson.org if you have additional questions and/or issues.

Stephen Lai, MD PhD

From the Endocrine Section:

Click HERE to read our current Endocrine Section newsletter.

Greg Randolph MD FACS FACE 
AHNS Endocrine Section Chair 
From the Salivary Gland Section

This represents an interval report on the Salivary Gland Board Section activities. Despite the impediments of COVID-19, the AHNS Salivary Section has continued its grass roots efforts to improve the surgical and medical care of the salivary glands. The executive group held an interactive conference call on Wednesday, June 3rd, 2020. This provided an opportunity to review many of the activities involving the section.
Recent highlights are listed below:
I. Clinical Consensus Statements - The AHNS Salivary Section initiated two ad hoc teams comprised of salivary section members to develop clinical consensus statements by comprehensive literature review and assessment. The two teams met over the past 6 months to develop drafts of the CCS that will be submitted for presentation at a future AHNS meeting and for publication. The topics include:
(1) Facial Nerve Monitoring During Parotidectomy (Team Leaders- M. Boyd Gillespie; Danny Enepekides; Robert Witt; Team Members- Joseph F. Goodman; Ameya Asarkar; Mirabelle Sajisevi)
  • Surveyed AHNS membership on current use of facial nerve monitoring during parotidectomy (ongoing).
  • Performed extensive literature review concerning use of facial nerve monitoring during parotidectomy
  • Compiled draft of paper based on the above results (ongoing).
(2) Management of the Parotid for High-Risk Cutaneous Squamous Cell Carcinoma (Team Leader- Alexandra Kejner; Team Members- Caitlin McMullen; Rusha Patel; Brianna N. Harris; William R. Carroll)
  • Collaboration of AHNS Salivary and Cutaneous Malignancy Sections
  • Performed extensive literature review concerning parotidectomy during management of advanced cutaneous squamous cell carcinoma (complete)
  • Compiled draft of paper based on the above results (complete).
II. American Academy of Otolaryngology-Head & Neck Surgery (AAOHNS) - AHNS Surgery Prioritization Effort (Drs. Jim Denneny; Cherie Ann Nathan-Leaders)
  • These recommendations for prioritization schedule for salivary gland surgery during COVID were reviewed.
  • Implementation will depend on needs of local area and PPE-related resources
III. Preparation for 10th International Meeting in 2021. The section was able to compile the salivary video presentations as follows:
  • Robotic Parapharyngeal Space Tumor Resection (Dr. Chris Rassekh)
  • Management of Parotid Duct Stricture Including Vein Grafting (Dr. Trevor Hackman)
  • Submandibular Gland Transfer (Drs. Charles Coffey; William Ryan)
IV. AHNS Website Updates
  • AHNS Salivary Section Content Draft (submitted to Mr. JJ Jackman)
  • Initial emphasis and priority will be towards content for patient care and education.
  • Parotidectomy Patient Handout (Drs. Tanya Fancy; Kiran Kakarala; Trevor Hackman)- draft in process
  • Dr. Jeffson Chung to coordinate and solicit for content and work with AHNS on website flow.
  • Salivary Cancer Content for Patients (Dr. Danny Enepekides, leader)
  • Benign Salivary Tumor Content for Patients (Drs. Will Ryan; Charley Coffey, leaders)
  • Benign Salivary Disorders (Dr. Boyd Gillespie, leader)
V. Future Research Priorities
  • Multi-center retrospective analysis of results of neck dissection at the time of resection of parotid malignancy (Dr. David Cognetti, leader)
Boyd Gillespie MD, and Danny Enepekides, MD
AHNS Salivary Gland Section Chairs