Disparities in sinonasal squamous cell carcinoma short‐ and long‐term outcomes: Analysis from the national cancer database

Carey, Ryan M.; Parasher, Arjun K.; Workman, Alan D.; Yan, Carol H.; Glicksman, Jordan T.; Chen, Jinbo; Palmer, James N.; Adappa, Nithin D.; Newman, Jason G.; Brant, Jason A.

doi:10.1002/lary.26804

Cited by 20 publications

(31 citation statements)

References 30 publications

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“…In fact, a recent national surveillance report indicated that of all cancers in the United States, the black versus white difference in survival was worst among head and neck cancer except for melanoma and uterine cancer . Previous studies have been inconclusive about the association between race and sinonasal cancer, especially the black versus white comparison; many have found any suggested association attenuated after adjusting for important tumor and clinical factors; however, we found that the association between race and all‐cause mortality among sinonasal cancer patients in our study remained statistically significant after controlling for important clinical risk factors, including histology, stage of presentation, treatment modality, and comorbidity. One difference between ours and previous studies is that we did not only control for clinical factors, we also accounted for the time‐varying nature of treatment modalities, which provides a more accurate picture of treatment plan since there are usually waiting times and delays between cancer treatment modalities .…”

Section: Discussioncontrasting

confidence: 70%

“…There are prior epidemiological studies on sinonasal cancer, but most are based on the Surveillance, Epidemiology, and End Results (SEER), and therefore do not provide data on comorbidities, unless when linked to the Medicare dataset . A recent study utilized the National Cancer Database (NCDB) which has comorbidity information; however, authors focused on other clinical endpoints such as factors associated with 30‐ and 90‐day mortality and hospital readmission …”

Section: Introductionmentioning

confidence: 99%

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Comorbidity burden and nonclinical factors associated with sinonasal cancer all‐cause mortality

et al. 2019

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Objective: To describe comorbidity burden and nonclinical factors associated with all-cause mortality of sinonasal cancer in the United States.Methods: The National Cancer Database (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) was queried for adult cases of sinonasal cancer (n = 10,518). Outcome of interest was all-cause mortality. Independent variables included comorbidity score and nonclinical factors such as age, gender, race, facility type, distance to facility, insurance, and income. Survival analysis was conducted via multivariable extended Cox regression with Heaviside adjustments.Results: Patients were mostly (79%), male (61%), and mean age of diagnosis was 63.5 years. Approximately one in five patients (18.7%) had a major comorbid condition (Charlson-Deyo score ≥ 1) at diagnosis. After adjusting for clinical factors, increasing comorbidity score was associated with a corresponding increase in hazard of mortality (aHR comorbidity score of 1 = 1.25; 95% CI, 1.16, 1.35), (aHR score of 2+ = 1.61; 95%, CI 1.41, 1.83). Hazard of mortality was also associated with being male (aHR = 1.11; 95% CI, 1.04, 1.17); black (aHR = 1.13, 95% CI, 1.03, 1.24); uninsured (aHR = 1.45; 95% CI, 1.25, 1.68) or on Medicaid (aHR = 1.50; 95% CI, 1.33, 1.69); residence in zip codes with lower median income quartile (aHR < $30,000 = 1.17; 95% CI, 1.06, 1.29); and treatment at community cancer programs (aHR = 1.14, 95% CI 1.01, 1.28).Conclusion: Comorbid disease is associated with all-cause sinonasal cancer mortality, and after accounting for known clinical factors, significant differences in mortality persist based on disparity-driven, nonclinical factors.

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Section: Discussioncontrasting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Comorbidity burden and nonclinical factors associated with sinonasal cancer all‐cause mortality

et al. 2019

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“…Nasal cavity and sinus cancer classification includes subsites encoded by the International Classification of Diseases for Oncology such as nasal cavity (C30.0), maxillary sinus (C31.0), ethmoid sinus (C31.1), frontal sinus (C31.2), sphenoid sinus (C31.3), and accessory sinuses (C31. [8][9]. Only malignant tumors were included.…”

Section: Study Samplementioning

confidence: 99%

“…It has been established that insurance status is a valid proxy for individual SES, and is one of the few patient‐specific characteristics available in research databases . This becomes exceedingly important when considering that late‐stage presentation and delay in diagnosis is often linked with poor health literacy, mistrust of the medical system, and cultural barriers associated with lower SES …”

Section: Introductionmentioning

confidence: 99%

“…7,8 This becomes exceedingly important when considering that late-stage presentation and delay in diagnosis is often linked with poor health literacy, mistrust of the medical system, and cultural barriers associated with lower SES. 2,9 Given the devastating clinical features and high mortality rate of sinonasal cancers, it is even more important to clarify these barriers to care and identify patients who are at higher risk of cancer-associated mortality. Specifically, this study examines the relationship between insurance as a proxy for SES, education, and sinonasal cancer treatment and outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Education and insurance status: Impact on treatment and survival of sinonasal cancer patients

2019

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Objectives/Hypothesis To understand the impact of education and insurance as social determinants of health on sinonasal cancer treatment and outcomes. Study Design Retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database. Methods Demographics, tumor characteristics, location, stage at diagnosis, treatment, and survival data for 1,365 patients diagnosed with sinonasal cancers were extracted from the SEER database. All statistical analyses were performed using SAS 9.5. The Fine and Grey method was used to assess covariate impacts. Results Medicaid patients were more likely to live in counties with lower educational levels (8.32% vs. 6.46% below ninth grade education, P < .0001) and lower median household incomes ($56,316 vs. $60,284, P = .0004). Medicaid patients presented with later (T3‐T4) stage disease compared to other insurances (P = .0007) and larger tumor size (P = .011). Medicaid patients were less likely to have surgery recommended (P = .0017) or receive surgery as part of their treatment (P = .0033). Analysis of histology‐specific 5‐year survival rates were lower for Medicaid patients with squamous cell carcinoma (SCCA) (P = .016). Conclusions This is the first and largest study to examine how education and insurance status may impact treatment and outcomes in sinonasal cancers. It is the first using this method of examining other covariates and informing associated risk. Patients with Medicaid and less education present with larger sinonasal cancers. They are less likely to have surgery recommended or receive surgery. For SCCA, the most common histology, Medicaid patients have significantly worse survival. Further emphasis on education and improving health literacy is needed in the at‐risk Medicaid populations. Level of Evidence NA Laryngoscope, 130:649–658, 2020

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Association of Type of Treatment Facility With Overall Survival After a Diagnosis of Head and Neck Cancer

et al. 2020

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IMPORTANCE Patients with head and neck cancer receive care at academic comprehensive cancer programs (ACCPs), integrated network cancer programs (INCPs), comprehensive community cancer programs (CCCPs), and community cancer programs (CCPs). The type of treatment facility may be associated with overall survival.OBJECTIVE To examine whether type of treatment facility is associated with overall survival after a diagnosis of head and neck cancer. DESIGN, SETTING, AND PARTICIPANTSThis population-based retrospective cohort study included patients from the National Cancer Database, a prospectively maintained, hospital-based cancer registry of patients treated at more than 1500 US hospitals. Participants were diagnosed with malignant tumors of the EXPOSURES Treatment at facilities classified as ACCPs, INCPs, CCCPs, or CCPs. MAIN OUTCOMES AND MEASURES Overall survival after diagnosis and treatment of head and neck cancer was the primary outcome. The secondary outcome was the odds of receiving treatment at ACCPs and INCPs vs CCCPs and CCPs. Multivariable Cox proportional hazards regression and univariable and multivariable logistic regression models were used for analysis. RESULTS A total of 525 740 patients (368 821 men [70.2%]; mean [SD] age, 63.3 [14.0] years) were diagnosed with malignant tumors of the head and neck during the study period. Among them, 36 595 patients (7.0%) were treated at CCPs; 174 658 (33.2%), at CCCPs; 232 867 (44.3%), at ACCPs; and 57 857 (11.0%), at INCPs. The median survival for patients with aerodigestive cancers was 69.2 (95% CI, 68.6-69.8) months; salivary gland cancers, 107.2 (95% CI, 103.9-110.2) months; and skin cancers, 113.2 (95% CI, 111.4-114.6) months. Improved overall survival was associated with treatment at ACCPs (hazard ratio [HR], 0.89; 95% CI, 0.88-0.91), INCPs (HR, 0.94; 95% CI, 0.92-0.96), and CCCPs (HR, 0.94; 95% CI, 0.92-0.95) compared with CCPs. Compared with patients with private insurance, those with government insurance (odds ratio [OR], 1.35; 95% CI, 1.29-1.41), no insurance (OR, 1.12; 95% CI, 1.09-1.16), or Medicaid (OR, 1.17; 95% CI, 1.14-1.20) were more likely to receive treatment at ACCPs and INCPs, whereas patients with Medicare were less likely to receive treatment at ACCPs and INCPs (OR, 0.95; 95% CI, 0.94-0.97). Compared with white patients, black (OR, 1.55; 95% CI, 1.52-1.59) and Asian (OR, 1.56; 95% CI, 1.49-1.63) patients were more likely to receive care at ACCPs and INCPs. Compared with patients from lower-income areas, patients from high-incomeareas were more likely to receive treatment at ACCPs and INCPs (OR, 1.25; 95% CI, 1.22-1.28). (continued)

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Disparities in sinonasal squamous cell carcinoma short‐ and long‐term outcomes: Analysis from the national cancer database

Abstract: 2c. Laryngoscope, 128:560-567, 2018.

Cited by 20 publications

References 30 publications

Comorbidity burden and nonclinical factors associated with sinonasal cancer all‐cause mortality

Comorbidity burden and nonclinical factors associated with sinonasal cancer all‐cause mortality

Education and insurance status: Impact on treatment and survival of sinonasal cancer patients

Association of Type of Treatment Facility With Overall Survival After a Diagnosis of Head and Neck Cancer

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