The aetiological role of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma (OPSCC) is well established, and its incidence has massively increased over the last decade, whilst the incidence of HPV-negative OPSCC is declining. Although we know that HPV-positive OPSCC is associated with improved prognosis, the sexually transmitted nature of HPV infection brings potential stigma to the patient and anxiety to the head and neck cancer health professional inexperienced in discussing sexual behaviour with patients. This interesting preliminary study consisted of structured interviews of 15 health professionals involved in managing HPV-positive OPSCC patients regarding their experiences of explaining the causal role of HPV to their patients. Challenges were reported due to limitations in our knowledge about the virus and discomfort in talking about sexual health matters.

Key messages were reported to form the basis of a successful consultation: 1) normalisation of HPV infection in the majority of sexually active people; 2) HPV infections associated with normal sexual behaviour and not promiscuity;

3) explanation that it’s the same virus associated with cervical cancer and HPV vaccination; 4) no need for change in patient behaviour and that infection was likely to have been acquired a long time ago; 5) good prognosis compared to HPV-negative cancers with de-escalation of treatment in many centres. The authors recommend learning within departments through feedback of experiences of health professionals (from all disciplines), communication skills workshops / courses and keeping up-to-date with the fast-moving story of HPV-associated OPSCC. 

Discussing a diagnosis of human papillomavirus oropharyngeal cancer with patients: an exploratory qualitative study of health professionals.
Dodd RH, Marlow LAV, Waller J.
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Jonathan Hughes

Locum Consultant, Oxford University Hospitals Trust, UK.

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