A 25-year Experience at an Academic Medical Center in the United States: Are There Racial Disparities in the Prognosis of Patients Diagnosed With Hypopharyngeal Carcinoma?

Abstract

This study attempted to identify disparities in outcomes between African American (AA) and Caucasian American (CA) patients treated for hypopharyngeal carcinoma at a tertiary care institution over the past 25 years. Methods An institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPPA)-compliant retrospective analysis was performed on patients with squamous cell carcinoma of the hypopharynx treated at our institution between January 1994 and December 2018. Data regarding demographics, stage, treatment, and follow-up were collected. Outcomes, including median survival and overall survival, were calculated using the Kaplan-Meier method. All analyses were performed using the Social Packages for the Social Sciences (SPSS) v. 24 (IBM Corp., Armonk, NY). Results We identified 144 hypopharyngeal carcinoma patients who were treated during this period. Our patient cohort consisted of 61.8% AA and 35.4% CA (P=0.538). Overall, 96% of them presented at an advanced stage (Stages III & IV) of the disease, and only 4% presented in the early stages (Stages I & II). There was no significant difference between AA and CA patients who presented with advanced disease (96.6% vs. 94.1%). In our patient cohort, 15.3% of patients did not receive any therapy; however, 51.4%, 22.9%, and 10.4% of them underwent definitive chemoradiotherapy, definitive surgery, or palliative chemotherapy, respectively. There were no significant differences in patient racial proportions within each treatment group. The median follow-up of the entire cohort was 13 months. There was no significant difference between the median survival of AA and that of CA patients (16 months vs. 15 months; p=0.917). Moreover, there was no significant difference in the overall survival between AA and CA patients at three years (27.2% vs. 36.3%; p=0.917) and five years (20.4 % vs. 16.7 %; p=0.917). Conclusions A retrospective review of patients with hypopharyngeal cancer treated at our institution over the previous 25 years did not identify significant racial disparities regarding the stage at presentation or prognosis. This study suggests that when patients have equal access to care, they appear to have a similar prognosis despite racial differences. Further studies are needed to validate this hypothesis.

Updated racial disparities in incidence, clinicopathological features and prognosis of hypopharyngeal squamous carcinoma in the United States

“…It warrants further studies to explore underlying causes for the decreased trend of HPSCC incidence and racial disparity. On the other hand, this and other studies indicated the majority of HPSCC was diagnosed at the advanced stages [30,31], implying that the decreased incidence of HPSCC is not caused by the increased early screening and detection. There is a great need to develop more effective ways of early detection for HPSCC.…”

“…There was no significant difference in overall survival in other races compared to NHW [41]. A negative racial disparity in overall survival was also reported between black and white, or between other and White [4], or between African American and Caucasian American [31]. S2 Table summarizes of these previous studies on racial disparities in the prognosis of patients with HPSCC.…”

Racial Disparities in Head and Neck Cancer: It's Not Just About Access

“…Studies that identified income, education, insurance coverage, cancer screenings, distance to treating hospital, and transportation were grouped as “access and SES.” NHB patients in these studies experienced dramatically lower overall survival (OS) rates of HNC compared to NHW patients in part due to inferior access to care and SES 6,8,14‐35 . Native Hawaiian (NH) and Other Pacific Islander patients were associated with more advanced HNC stage at initial diagnosis and worse disease‐free survival when compared to NHW patients, also thought to be associated with decreased access to care, while contrastingly Asian race was associated with improved OS from HNC 36 .…”

Persistent Poverty Disparities in Incidence and Outcomes Among Oral and Pharynx Cancer Patients

“…However, compared to the other OPC sites, a higher cumulative incidence of hypopharynx cancer-speci c death was seen among residents from both persistent poverty and non-persistent poverty areas. Hypopharyngeal cancer survival rates have not improved over the years, mainly due to detection at late stages and asymptomatic progression (35,36). Therefore, our study provides evidence that additional research is warranted to improve survival for this cancer.…”