Grant: Operating Grant

Cancers of the mouth and throat have traditionally been caused by and associated with individuals who abuse tobacco and alcohol. It has however become apparent over the past 10 years that a new subpopulation of patients is emerging at an epidemic rate. The new patient group was born after the 1940's, were part of the sexual revolution and their cancers are caused by sexually transmitted HPV virus. Over the same 10 years clinical trials have shown that combining chemotherapy with radiation treatment improved survival compared to the traditional treatment of radiotherapy (with or without associated surgery) for patients with cancers of the mouth and throat but carries a huge increase in the incidence of acute and late side effects. More recently it has been shown that the prognosis for those with HPV associated cancer is better than those without the virus association, but we do not know if the improvement in survival is due to a more treatment sensitive tumor or to the newer treatment. Patients need to know this information to balance the potential of side effects and complications to the potential for survival, and oncologists need to know this information to efficiently and effectively use resources as the incidence of this cancer increases. A clinical trial will not be done on this question due to the belief that more intensive treatment is always better but the question can be answered using carefully designed population-based research. The Cancer Care and Epidemiology group at the Queen's Cancer Research Institute has the expertise and experience to complete the study.