Elderly Black Non-Hispanic Patients With Head and Neck Squamous Cell Cancer Have the Worst Survival Outcomes
Background: In this population study, we compared head and neck cancer (HNC) prognosis and risk factors in 2 underserved minority groups (Hispanic and Black non-Hispanic patients) with those in other racial/ethnicity groups. Methods: In this SEER-Medicare database study in patients with HNC diagnosed in 2006 through 2015, we evaluated cancer-specific survival (CSS) between different racial/ethnic cohorts as the main outcome. Patient demographics, tumor factors, socioeconomic status, and treatments were analyzed in relation to the primary outcomes between racial/ethnic groups. Results: Black non-Hispanic patients had significantly worse CSS than all other racial/ethnic groups, including Hispanic patients, in unadjusted univariate analysis (Black non-Hispanic patients: hazard ratio, 1.48; 95% CI, 1.33–1.65; Hispanic patients: hazard ratio, 1.12; 95% CI, 0.99–1.28). To investigate the association of several variables with CSS, data were stratified for multivariate analysis using forward Cox regression. This identified socioeconomic status, cancer stage, and receipt of treatment as predictive factors for the survival differences. Black non-Hispanic patients were most likely to present at a later stage (odds ratio, 1.62; 95% CI, 1.38–1.90) and to receive less treatment (odds ratio, 0.67; 95% CI, 0.55–0.81). Unmarried status, high poverty areas, increased emergency department visits, and receipt of healthcare at non-NCI/nonteaching hospitals also significantly impacted stage and treatment. Conclusions: Black non-Hispanic patients have a worse HNC prognosis than patients in all other racial/ethnic groups, including Hispanic patients. Modifiable risk factors include access to nonemergent care and prevention measures, such as tobacco cessation; presence of social support; communication barriers; and access to tertiary centers for appropriate treatment of their cancers.
Submitted March 27, 2020; accepted for publication June 22, 2020. Published online September 28, 2020.
Author contributions: Study concept: McDermott, Karam. Data acquisition: Borrayo, Karam. Data analysis and interpretation: McDermott, Eguchi, Karam. Project supervision: Borrayo. Manuscript preparation: McDermott. Critical revision: All authors.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: Research reported in this publication was supported by the Population Health Shared Resource, University of Colorado Cancer Center (NCI award P30CA046934). Dr. Karam is supported by the National Institute of Dental and Craniofacial Research of the NIH (R01 DE028529-01 and R01 DE028282-01), and receives clinical trial funding from the Cancer League of Colorado and from AstraZeneca for work unrelated to this research.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. None of the funders had any role in the conduct of the study; in the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.
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