Assessing the Need for an Educational Intervention for Primary Care Practitioners on HPV-Related Oropharyngeal Cancer

Background and Objectives: Human papillomavirus (HPV) is causing an epidemic of oropharyngeal squamous cell carcinoma (OPSCC). Patients presenting with HPV-related OPSCC tend to be younger than patients with non-HPV-related OPSCC and lack the traditional OPSCC-related risk factors of smoking and alcohol use. The objective of the present study is to assess whether knowledge of this demographic shift in the patient population affected by OPSCC has been disseminated to primary care practitioners. Methods: A quantitative cross-sectional needs assessment was performed using an original questionnaire. The questionnaire assessed general knowledge regarding OPSCC and its recognition in at-risk patients and was distributed to family physicians, family medicine residents and advanced practice registered nurses in Ontario, Canada. Results: Of 11,000 primary care practitioners contacted, fifty-four responded (0.5% response rate), the majority of whom were CCFPs (n= 29; 59.18%) or FCFPs (n= 9; 18.37%). The survey included two case scenarios of patients presenting with possible OPSCC and eleven true/false questions. In Case 1, the majority of respondents (98%; n= 50) indicated that they would not refer the patient immediately. Of those who did not refer after first and second line management (n= 33), the majority (n= 20; 60.6%) would wait 1-4 weeks before referring. In Case 2, a sexual history was elicited always (64.7%; n= 33), sometimes (31.37%; n= 16) and never (3.92%; n= 2), while smoking and alcohol history was almost always elicited (90.2%; n= 46 and 62.8%; n= 32, respectively). Two out of eleven true/false questions regarding prevalence and prognosis were answered incor-rectly by a majority of respondents: 69.4% (n= 34) falsely believed that tonsillar cancer is not the most prevalent type of oropharyngeal cancer in Canada; 59.2% (n= 29) falsely believed that there is a poorer overall survival rate associated with HPV-related ton-sillar cancer as compared to non-HPV-related tonsillar cancer. Most participants (95.9%; n= 47) ex-pressed an interest in learning more about OPSCC. Conclusions: The results of the questionnaire sug-gest that a knowledge gap exists among primary care practicioners regarding the demographic shift in OPSCC. Closing this knowledge gap may lead to earlier referral to head and neck specialists and lead to improved patient outcomes.