Dr. Mell Discusses Flaws in Risk Stratification for Head and Neck Cancer

Loren K. Mell, MD
Published: Monday, Feb 26, 2018



Loren K. Mell, MD, assistant professor, Department of Radiation Medicine and Applied Sciences, University of California, San Diego School of Medicine, discusses flaws in the current model of risk stratification for patients with head and neck cancer.

The dominant paradigm used to risk-stratify patients with head and neck cancer is fundamentally flawed, says Mell. The current models tend to focus on 1 endpoint, or class of endpoints, called event-free survival—most commonly overall survival. This is an unambiguous endpoint, making it simple to quantify. Mell says that although it is a desirable endpoint to know, it does not account for patients who have an appreciable risk of dying from something other than cancer.

Mell claims that these current models fail because they treat death from cancer equally to a death not from cancer. This results in a patient with very advanced cancer being put in the same category as a patient with cancer who is at a high-risk for death due to separate health problems. These patients need different treatment regimens, and nothing will be solved if these events are not separated, Mell says. Risk stratification schemes should not focus solely on the tumors, because at best, they are only explaining part of the problem.


Loren K. Mell, MD, assistant professor, Department of Radiation Medicine and Applied Sciences, University of California, San Diego School of Medicine, discusses flaws in the current model of risk stratification for patients with head and neck cancer.

The dominant paradigm used to risk-stratify patients with head and neck cancer is fundamentally flawed, says Mell. The current models tend to focus on 1 endpoint, or class of endpoints, called event-free survival—most commonly overall survival. This is an unambiguous endpoint, making it simple to quantify. Mell says that although it is a desirable endpoint to know, it does not account for patients who have an appreciable risk of dying from something other than cancer.

Mell claims that these current models fail because they treat death from cancer equally to a death not from cancer. This results in a patient with very advanced cancer being put in the same category as a patient with cancer who is at a high-risk for death due to separate health problems. These patients need different treatment regimens, and nothing will be solved if these events are not separated, Mell says. Risk stratification schemes should not focus solely on the tumors, because at best, they are only explaining part of the problem.

View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Community Practice Connections™: Translating Research to Inform Changing Paradigms: Assessment of Emerging Immuno-Oncology Strategies and Combinations Across Lung, Head and Neck, and Bladder CancersApr 28, 20182.0
Clinical Interchange™: Translating Research to Inform Changing Paradigms: Assessment of Emerging Immuno-Oncology Strategies and Combinations across Lung, Head and Neck, and Bladder CancersOct 31, 20182.0
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