Patient Experiences With ctHPVDNA-Guided Surveillance for HPV-Positive Oropharyngeal Cancer
Grace E. Fleming, Hannah Roth, Glenn J. Hanna, Rosh K. V. Sethi, Jacqueline Minken, Dev Mukundan, Jonathan D. Schoenfeld, Melina J. Windon, Eleni M. RettigImportance
Circulating tumor human papillomavirus DNA (ctHPVDNA) is a potential biomarker for surveillance of HPV-positive oropharyngeal cancer. Despite its growing clinical use, patient experiences are not well characterized, and understanding patient perspectives of ctHPVDNA-guided surveillance is essential to guiding its appropriate use while mitigating potential harms.
Objective
To characterize patient experiences with ctHPVDNA-guided surveillance.
Design, Setting, and Participants
A mixed-methods cross-sectional interview study in adults treated for HPV-positive oropharyngeal cancer with 1 or more surveillance ctHPVDNA test 3 or more months before enrollment conducted in June through August 2025 in a single tertiary academic cancer center. Purposive sampling ensured representation of diverse patient experiences.
Exposures
One semistructured interview regarding experiences with ctHPVDNA-guided surveillance. Willingness to pay (WTP) out of pocket was assessed using iterative bidding.
Main Outcomes and Measures
Themes and subthemes were derived from coded interview transcripts using a categorical inductive approach.
Results
Among 20 participants (median age, 58 years [IQR, 55-70 years]; 16 males [80%]), 8 (40%) had true-negative ctHPVDNA test results, 6 had true-positive results (30%), 4 had false-negative results (20%), and 2 had false-positive results (10%). Five major themes emerged: (1) broad enthusiasm and support for ctHPVDNA testing, with a common assumption that more and earlier disease-related information is beneficial, and appreciation for the reassurance of negative test results (discordance between support for testing in general and personal experiences of test accuracy was observed); (2) distress as inherent to the emotional variability of the cancer journey itself, such that anxiety associated with ctHPVDNA testing was considered attributable to cancer survivorship rather than to the test; (3) trust in the oncology team supersedes trust in test itself, whereby clinicians were trusted to appropriately interpret potentially confusing results (this trust was enhanced by clear communication); (4) test as a valuable add-on to standard care, which should enrich, but not replace, standard surveillance; and (5) sensitivity to financial toxicity, with strong support for accessible and equitable testing. The median per-test WTP was $325 (range, $0-$9000).
Conclusions and Relevance
This study found that participants expressed strong support for ctHPVDNA-guided surveillance. Trust in clinicians appeared to mitigate distress related to confusing or inaccurate test results. Clinicians using ctHPVDNA testing should be familiar with and clearly communicate its strengths and limitations to optimize clinical benefit.