Duke is a high-volume referral center for the treatment of head and neck cancers, which include tumors in the mouth, throat, tonsils, larynx, sinuses, neck lymph nodes, salivary glands, and thyroid gland. Duke’s head and neck cancer specialists are internationally recognized research and clinical experts who make these diseases their primary focus.
Learn more about head and neck cancer treatment at Duke
An Integrated Approach to Head and Neck Cancer Treatment
The team includes specialists in head and neck oncologic surgery, plastic and reconstructive surgery, radiation oncology, medical oncology, oral medicine, radiology, speech therapy, and pathology.
Their integrated approach to head and neck cancer treatment includes state-of-the-art surgical approaches such as transoral robotic surgery to treat tonsil, tongue, oral, and larynx cancers. These approaches incorporate the resection of the tumor while preserving speech, swallowing, and breathing functions.[DBM2] High-precision image-guided radiotherapy allows for the delivery of full doses of radiation to tumors while sparing the function of adjacent, uninvolved normal tissues.
Speech pathology, audiology, oral medicine specialists, and patient support services also play an active role in helping patients maintain quality of life throughout their treatment and recovery.
Learn more about head and neck cancer treatment at Duke
Duke head and neck cancer researchers are developing new approaches for early diagnosis that may one day eliminate the need for biopsy in collaboration with the Duke University School of Engineering. They are also conducting research to study the effect of cancer on the tumor microenvironment.
Duke radiation oncologists are investigating the use of biologically based imaging during treatment, such as 18FDG- PET/CT to identify patients with HPV-related oropharyngeal cancer who may be treated with lower doses of radiation and chemotherapy. They are also studying novel combinations of medication and stereotactic radiation therapy in patients with recurrent head and neck squamous cell cancer that cannot be surgically removed.
In August 2023, a team of volunteers led by Trinitia Cannon, MD (third from left), Leda Scearce, CCC-SLP, MM, MS, and Dina Abouelella, MPH, which also included Tammara Watts, MD, PhD (center) and Katharine Ciarrocca, DMD, MSEd, partnered with North Raleigh International Baptist Church and Duke Raleigh Hospital to offer head and neck cancer screenings. Dozens of families from the Cedar Creek Apartment Complex community came out for the free screenings, education, and games, and Duke Raleigh Hospital donated backpacks full of school supplies.
TheDuke University School of Medicine Department of Head and Neck Surgery & Communication Sciences (HNS&CS) recently launched Project CHECKERS (Community Head and NEck Cancer Knowledge, Engagement, Research and Screening) a Duke Cancer Institute-funded pilot project to bring head and neck cancer resources and education to the broader Durham community.
Led by DCI head and neck surgeon Trinitia Cannon, MD, an associate professor in the Department, the project will be the Department’s first community-based participatory research project and the first such head and neck cancer screening and cancer prevention education project in North Carolina.
Evolving Community Research
The Project CHECKERS team will use a mixed methodology, which includes traditional surveys and screenings as well as interviews and focus groups.
One of their community partners will be the Cedar Creek Apartment Complex community in North Raleigh. Many of these families are refugees — from at least seven different countries in Africa, Asia, and the Middle East — who speak Farsi, French, Swahili, Arabic, and other languages. They are building new lives in North Carolina, in a culture and language that is new to many of them. As is the case with many similar communities, their healthcare needs often go unmet.
The investigators believe that, compared to traditional methods, mixed-method research is an improved way to establish a community partnership, highlight gaps in the community’s knowledge and risk perception, and pave the way for successful future health interventions.
According to co-PI Nosayaba (Nosa) Osazuwa-Peters, BDS, MPH, PhD, an associate professor in the Department of Head and Neck Surgery & Communication Sciences, Project CHECKERS takes an important step in improving community engagement.
“Traditional research is very systematic, very top-down. The researchers have knowledge and decide what they believe the community needs. But these outside scientific experts do not know the values, the culture, the knowledge, or the risks inherent in that community,” he explained.
For example, traditional surveys restrict participants to answering either yes or no; for many people, that binary does not tell a complete story.
“Project CHECKERS will help us understand the lived experiences of people in these communities,” added Osazuwa-Peters. “We’ll learn about context, and we’ll learn to ask questions that allow community members to express themselves. We’ll get responses we would never get based on yes or no.”
Building a Partnership
Project CHECKERS kicked off this fall with focus groups and interviews with community members facilitated by Laura Fish, PhD, MPH, assistant professor in Family Medicine and Community Health, Duke University School of Medicine, and program director for the Behavioral Health and Survey Research Core (a DCI shared resource). An advisory board will provide feedback from both clinical and community perspectives.
Lessons learned from these conversations will help the team develop a knowledge and risk factor survey that will be administered during two head and neck cancer screening events with the community in 2024.
The CHECKERS team will also recruit providers outside the department to participate in these events to address other health concerns in the community such as primary care, mental health, and women’s health.
The long-term goal of Project CHECKERS is to show the benefits of tailoring head and neck cancer screening programs to the communities being served, and how that personalization can improve prevention, early detection, and overall survival in high-risk individuals who have limited access to care.
Noted Osazuwa-Peters, “The mixed-methods framework helps us understand not just whether an intervention works, but how, why, and for whom.”
Community Partners
Another plus to mixed-methods research is its appeal to community partners who might otherwise be hesitant to work with researchers.
“The design places a high value on the stories behind the numbers,” explained Cannon, “so these projects are especially attractive to community partners such as faith-based organizations, whose priority is improving practice and outcomes, more so than research and advancing knowledge.”
Project CHECKERS will provide a valuable bridge between Duke and the North Raleigh International Baptist Church (NRIBC), which ministers to a large immigrant community. NRIBC’s Pastor, Patrick Warutere, invited Duke to participate in the church’s inaugural Health and Dignity for All Fair in Raleigh in 2022. Cannon and CHECKERS co-PI Leda Scearce,CCC-SLP, MM, MS, a Duke speech pathologist and director of Community Engagement for the Department of HNS&CS, recruited nurses, medical students, and resident volunteers to provide HNC screenings for the event.
“We immediately felt a kinship with NRIBC’s Pastor Patrick Warutere and his leadership team,” shared Searce. “By the end of the day, we knew we wanted to continue to work together and set up a meeting the following week.”
Duke HNS&CS and the NRIBC team worked closely to develop the research plan and ensure that the goals and expectations of each group were aligned and transparent.
“That relationship with NRIBC has enabled us to incorporate the community’s perspectives into the development of Project CHECKERS,” said Scearce. “Our aim was to amplify the assets and expertise of the community members themselves.”
Cannon anticipates that Project CHECKERS will become a framework for future projects.
“We are looking forward to similar initiatives in hearing health for older adults, right-hemisphere stroke awareness, and more.”
Breast surgical oncologist and Mary and Deryl Hart Distinguished Professor of Surgery Eun-Sil Shelley Hwang, MD, MHS, with Oluwadamilola "Lola" Fayanju, MD, MA, MPHS, FACS, in early 2020.
Dr. Hwang was Chief of Breast Surgery at Duke at that time and Dr. Fayanju was an assistant professor of Surgery, Division of Surgical Oncology. Dr. Fayanju is currently Chief of the Breast Surgery Division at Penn Medicine.
A study initiated at Duke University School of Medicine lays bare significant racial and gender disparities in America’s surgical leadership.
Of the 2,165 faculty members included across 154 departments, men overwhelmingly claimed the top spots in surgical leadership, making up 85.9% of department chairs, 68.4% of vice chairs, and a staggering 87% of division chiefs.
What’s more a mere 8.9% of these leadership roles were filled by those from underrepresented racial or ethnic groups.
While women made a modest showing as vice chairs at 31.6%, they remained underrepresented elsewhere. Many of these women and those from underrepresented racial or ethnic groups were clustered in roles linked to diversity and faculty development, which might not pave the way to top department positions.
The study in JAMA Surgery — led by Oluwadamilola “Lola” M. Fayanju, MD — stands out because the research team of surgeons, trainees, and biostatisticians looked in detail at different leadership roles and the implications these disparities have for the pipeline to department chair.
CONTINUE READING at the Duke University School of Medicine Newsroom
THE GRADUATE Monica Bodd, MD, MTS, at her MD Graduation with Associate Dean for Student Affairs Aimee Chung, MD, her advisory dean (left); her primary Duke Surgery mentor DCI head & neck surgical oncologist Dan Rocke, MD (top right) and clinic staff; and with her proud parents on match day (bottom right).
Monica Bodd thinks a lot about the patient experience and how to make it better — both through research and clinical practice.
While earning her MD and her Masters of Theological Studies degrees at Duke, she learned from some of the best, including Thomas LeBlanc, MD, MA, MHS, Dan Rocke, MD, JD, and Walter Lee, MD, MHS, from Duke Cancer Institute, and from the Duke Divinity School, Warren Kinghorn MD, ThD, Sarah Barton OT, ThD,Susan Eastman, MDiv, PhD, and Kate Bowler, PhD.
Patient experience research in oncology is an investigation of common issues faced by people with cancer, including symptom burden, quality of life, and psychological distress, as well as how patients understand their prognosis and make decisions about their treatment through the various stages of their disease.
“The way I explain it to my friends or to my family, it’s about asking patients how they live and work through their diagnoses on a day-to-day basis, centering their perspective over the perspective of a medical record or a diagnosis or a doctor's words,” said Bodd. “There are validated and quantitative aspects to it, but it’s more about what we wouldn't necessarily capture with our big data and metrics… I believe it’s the redeeming hope for a lot of medicine.”
As Bodd was leaving Duke to begin her residency in Otolaryngology-Head & Neck Surgery at Stanford Medicine this past spring, she spoke with DCI about some of the unique projects she got to work on and co-lead as a medical student and theology student — and the wisdom and practices she’s carrying forward in her medical career from both disciplines.
A SERIOUS ISSUE DCI epidemiologist Nosayaba Osazuwa-Peters, PhD, MPH, BDS, an associate professor, Department of Head and Neck Surgery & Communication Sciences, and an assistant professor, Department of Population Health Sciences, studies suicide risk in head and neck cancer patients.
In 2013, shortly after Nosayaba Osazuwa-Peters, PhD, MPH, BDS, had begun work on his doctorate degree in cancer epidemiology at St. Louis University, he gave a talk to a support group for patients with head and neck cancer. He drew on his experience as a dental surgeon in his home country of Nigeria to speak about managing the side effects of head and neck cancer treatment, such as dry mouth and tissue damage from radiation.
Afterward, a patient approached him, thanked him for the talk, and said, “Doc, do you know how it feels when everything you eat tastes like cardboard?"
Osazuwa-Peters had not heard it put that way before.
Another patient at the talk said to him, “Every night I go to bed, and I just pray I don't wake up in the morning.”
As he continued to talk to these patients, it struck him that “this is the reality of a patient with head and neck cancer.”
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Studies in mice suggest the therapy could be a new approach to fighting lethal disease
In animal studies led by researchers atDuke Cancer Institute, a drug approved to treat leukemia successfully disrupted the ability of HER2-positive breast cancer tumors from colonizing the brain.
The finding, appearing online Aug. 30 in the journal Cell Reports, provides evidence for human trials and suggests a potential new approach to derail one of the main ways that breast cancer turns deadly.
“We have made huge strides in treating HER2-positive breast cancers, but when tumors escape the therapies, they often metastasize to the brain,” said senior authorAnn Marie Pendergast, PhD, professor and vice chair of theDepartment of Pharmacology and Cancer Biologyat Duke University School of Medicine.
“When brain metastasis occurs, treatments are unsuccessful either because the tumors have developed resistance, or the therapies cannot penetrate the blood-brain barrier,” Pendergast said. “This remains a devastating diagnosis for patients.”
Pendergast and colleagues looked at how HER2 promotes breast cancer growth, particularly after becoming resistant to targeted treatments that have been highly successful in prolonging lives. The HER2 protein is a driving force in 30% of breast cancers, with approximately 45% of these leading to brain metastases.
The researchers focused on a pair of enzymes called ABL1 and ABL2 kinases that regulate the expression of HER2. The researchers found that these kinases play a critical role in creating the conditions that allow HER2 to accumulate on the surface of breast cancer cells, fueling breast cancer tumor metastasis.
Experimenting in mice, Pendergast and her team were able to disrupt the ABL kinases using a leukemia drug called asciminib. A kinase inhibitor, the drug is not impeded by the blood-brain barrier in tumor-bearing mice and interferes with the ABL kinases’ signaling mechanism.
By blocking the ABL signaling network, the therapy keeps the HER2 protein from accumulating in the breast cancer cells and shuts down their process for fueling the proliferation and spread of cancer cells.
“These findings support the use of ABL kinase inhibitors for the treatment of HER2-positive brain metastasis,” Pendergast said.
In addition to Pendergast, study authors include Courtney M. McKernan, Aaditya Khatri, Molly Hannigan, Jessica Child, Qiang Chen, Benjamin Mayro, David Snyder, and Christopher V. Nicchitta.
The study received funding support from the Department of Defense (W81XWH-18-1-0403, W81XWH-22-10033), the National Institutes of Health (F31CA224952, F31CA243293, F99CA264162, 1R38HL143612, Q10GM101533, Q10GM118630), the National Cancer Institute (P30CA014236), and the Duke Cancer Institute and Translating Duke Health Initiative.
In Dec. 2017, Robert Russell brought donuts to the nurses on all three wards of the ninth floor of Duke Hospital — his tradition for the past three years. He says it’s the least he can do for those who saw him through the “scariest” couple weeks of his life, which began with an HPV-associated tonsil cancer diagnosis.
In December 2017 Robert Russell brought donuts to the nurses on all three wards of the ninth floor of Duke Medical Center — something he’s been doing regularly for the past three years. He started the tradition because he says it’s the least he can do for those who saw him through the “scariest” couple weeks of his life.
In July 2014, at age 52, Russell was diagnosed by Duke surgical oncologist Ramon Esclamado, MD, with advanced-stage human papilloma virus (HPV) associated squamous cell carcinoma of the oropharynx.
The oropharynx is themiddlepart of the throat, which includes the soft palate, the base of the tongue, the tonsils, and the side and back wall of the throat.
The first symptoms oforopharynx cancer are typically a lump in the neck, a sore throat and/or ear pain although oropharynx cancer can also be asymptomatic. Physicians say self-awareness and regular visits to the dentist, who does a thorough oral exam, are key to early detection.
Russell had a sore throat and had been coughing up blood for six or seven months by the time he was diagnosed. When his symptoms didn’t go away, following visits to two different primary care physicians, he had asked his wife to look down his throat.
“I think she passed out,” he recounted. “My tonsil was hanging inward and my throat was in bad shape. I went to my ENT doctor the very next day and he said he thought it was cancer, but not bad cancer, and referred me to Duke.”
