The impact of the addition of chemotherapy to radiotherapy for cancer of the oropharynx in 2003/4: a population-based study from the Province of Ontario Canada.
Hall SF, O’Sullivan B, Irish J, Meyer R, Gregg R, Groome PA. Head Neck. 2014 May 21. doi: 10.1002/hed.23777.
Background: Concurrent chemoradiotherapy became the standard of care for locoregionally advanced head and neck cancers based on clinical trials but it’s effectiveness at the community level is not reported. Methods: a population-based comparative effectiveness study of all 571 patients with oropharynx cancer in Ontario Canada (2003/4) that describes the patients and the treatments and compares concurrent chemoradiotherapy (CCT/RT) to radiotherapy (RT) alone. Results: When comparing the outcomes (CCT/RT vs RT) for all patients or patients eligible for either treatment,The 3 and 5 year Overall Survival was 58.8% and 51.5%. When comparing the outcomes for all patients, for patients eligible for either treatment,for patients of centers with the ‘higher-use’ of CCT/RT to patients of the ‘lower-use’ centers and comparing all centers, we found no overall or disease-specific advantage to CCT/RT over RT alone. There was also no difference in recurrence free survival, pattern of recurrences or distant control. Conclusions: In Ontario (in 2003/ and 2004), in daily clinical practice, the addition of concurrent chemotherapy to radiotherapy had little impact on survival in patients with oropharyngeal carcinoma..

Practice Patterns in the management of patients with differentiated thyroid cancer in Ontario Canada 2000-2008.
Hall SF, Irish J, Groome PA, Urbach DR. Journal of Otolaryngology/Head and Neck surgery. 2014 Jul 24;43:29. doi: 10.1186
: The extent of treatment for differentiated thyroid cancer remains controversial. The objective of this study was to describe the variations in practice prior to diagnosis and for the first year after diagnosis, including the investigations, the extent of surgery and the use of RAI 131, for all patients with thyroid cancer (TC) treated Jan 1 2000 to Dec 2008 across Ontario Canada. Method:   Population-based study of all patients who had a therapeutic surgical procedure for TC based on the data holdings of the Institute of Clinical Investigative Sciences (ICES) linking the Ontario Cancer Registry to the Ontario Health Insurance Plan and to the Canadian Institutes of Health Information.   The analysis includes comparisons between health care utilization/geographic regions and between treating specialties. The study population was 12957 patients. Results: There was a 112% increase in case detection over 9 years. Overall the initial (index) surgery was less-than-total thyroidectomy (LTT) in 37.6% and 63.4% of the patients who had total thyroidectomy (TT) as an index surgery went on to adjuvant RAI, however there was wide variation in all aspects of patient care across the province, between Local Health Networks and between surgical specialties. Conclusion: In Ontario, there was wide variation for most aspects of the management of TC and, as the incidence of TC is increasing at least 7 % per year in females, these data provide a foundation for future discussions, the provision of health care services and research.

Should the CPG process include an estimate of adherence? Lessons learns from CCO CPG 5-6a – Concomitant Chemotherapy with radiotherapy in squamous cell head and neck cancer.
Hall SF, Irish J, Gregg RW, Groome PA, Rohland S.
Accepted by Current Oncology Oct 2014


Access, Excess and Overdiagnosis: the case for thyroid cancer.
Hall SF, Irish J, Groome PA, Griffiths R.  Cancer Medicine 2014; 3(1): 154–161
The incidence of thyroid cancer in women is increasing at an epidemic rate. Numerous studies have proposed that the cause is increasing detection due to availability and use of medical diagnostic ultrasound. Our objective was to compare rates of diagnosis across different health-care regions to rates of diagnostic tests and to features of both health and access of the regional populations. Read full publication here.


Follow-up policies at Canadian Head and Neck cancer treatment centers: a survey.
Hall SF.  Can J Otolaryngology Head and Neck Surgery. 39: 659-63.

The results of a survey of all English speaking cancer centers demonstrating wide variation in the policies and beliefs about routine follow-up. Research is required to determine effective policies for patients and the health care system.


Increasing detection or increasing incidence in thyroid cancer.
Hall SF, Walker H,  Siemens R, Schneeberg A. World J of Surgery. 33: 2567-71.

The rising rates in incidence in thyroid cancer in women is due to increasing detection by medical imaging

Radiotherapy or Surgery for cancer of the hypopharynx: establishing the baseline.
Hall SF, Groome PA,  O’Sullivan B,  Irish J. Cancer 115: 5711-22.

A population-based study in Ontario from 1990 to 2000 demonstrating wide variation in treatment by center and no difference in outcome between primary radiotherapy with surgical salvage vs surgery with postoperative radiotherapy.

Towards further understanding of Prognostic factors in head and neck cancer patients:  the example of cancer of the hypopharynx.
Laryngoscope 119: 696-02.

The impact of prognostic factors varies with treatment and the outcome of interest. N category and T category were the predominant factors with Performance Status.

Diagnostic Delay in Head and Neck cancer: a synopsis of the literature.
Goy J,  Hall SF, Feldman-Stewart D, Groome PA. Laryngoscope 119: 889-98.

No consistent positive associations in the literature between delay and stage at diagnosis.


TNM-based stage groupings in head and neck cancer: application in cancer of the hypopharynx.
Hall SF, Groome PA, Irish J, O’Sullivan B. Head and Neck 31: 1-8.

The UICC/TNM stage group classification although successful in creating statistically distinct groups did not perform as well as other proposed stage grouping systems continuing a theme previously reported.

The Natural history of patients with squamous cell carcinoma of the hypopharynx.
Hall SF,  Groome PA, Irish J, O’Sullivan B. Laryngoscope  118: 1362-71.

The typical patient is 65, male, unemployed and poor. They are heavy drinkers with significant comorbidity compromising functional status. The tumors are advanced (over 50% Stage 4). After curative treatment 20% had residual disease, recurrences tended to appear in the first year and 50% of first recurrences included metastases. Overall 47% of patients were disease free at 3 years but eventually 64% of patients died of their cancer.   This information can be used by clinicians and researchers to understand the natural history of the patient group in order to critically assess both the selection bias and effectiveness of treatments.


The increasing incidence of differentiated thyroid carcinoma and detection of subclinical disease.
Kent W, Hall SF etal. CMAJ 1357-62
The increasing incidence is due to the detection of subclinical tumors especially in women that could only be found on medical imaging.


Inter-rater reliability and measurements of  comorbid illness.
Hall SF, Groome PA, Streiner DS, Rochon P. J Clinical Epidemiology 59: 926-22.

Reliability varied between and within 4 indexes  as measured by the Intraclass Correlation Coefficient.  Reliability should be reported in studies using numerous abstractors.

A User’s Guide to selecting a comorbidity index for clinical research.
Hall SF.  J Clinical Epidemiology.  59: 849-55.

Using cancer registry data for survival studies: the example of the Ontario cancer Registry.
Hall SF, Schulze K, Groome PA, Mackillop W, Holowaty E. J Clinical Epidemiology 58: 67-76.
This project compared the accuracy of the Ontario cancer Registry to a personal prospective database for 898 patients with head and neck cancer. Researchers can be confident in the confirmation rate, detection rate, vital status and date of death in the OCR. Cause of death had a 31% error rate.