Elderly Black Non-Hispanic Patients With Head and Neck Squamous Cell Cancer Have the Worst Survival Outcomes

Abstract

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.

Impact of racial disparities and insurance status in patients with bone sarcomas in the USA

“…As such, these patients are likely presenting with advanced stage of disease, with patients with Medicaid insurance known to have delays in care. [33][34][35][36] In addition to racial disparities in the use of surgery, previous studies have shown the impact of race on the outcome of patients with head and neck cancer, 37 lung cancer, 38 as well as brain cancer. 39 Previous studies had shown that Black patients had worse survival compared to White patients, however if the patients underwent the same treatment protocols, these survival differences were mitigated.…”

“…39 Previous studies had shown that Black patients had worse survival compared to White patients, however if the patients underwent the same treatment protocols, these survival differences were mitigated. [37][38][39] However, this may not be the case for all types of cancer. 40,41 In our current study, we did not find an association between overall survival and race in patients with a bone sarcoma.…”

Disparities in Access to Radiotherapy Among Hispanic/Latinx Populations in the United States

“…For instance, patients who present at later stages may require more intense treatment regimens or may have less treatment options available to them compared with if they presented earlier. Six of the identified articles addressed this disparity, with 4 identifying a disparity 32–35 and 2 finding no relationship with the Hispanic population 36,37 . One of the identified studies, by Moore et al, 34 identified that regardless of rural versus urban location, patients with breast cancer that identified as Hispanic were more likely to present with late-stage disease at diagnosis compared with non-hispanic white (NHW) patients (Hispanic-Urban: adjusted odds ratio [aOR] 1.25, Hispanic-Rural: aOR 1.75).…”

Clinical and Therapeutic Considerations for Older Adults with Head and Neck Cancer

“…A SEER-Medicare database study, published in 2021, found that socioeconomic status is a key prognosticator in older adults, and that Black, non-Hispanic older adults have worse HNSCC prognosis compared to older adults of other races and ethnicities. 28 The authors postulate that this may be secondary to a lack of access and barriers to healthcare and prevention measures (eg smoking cessation resources). Another SEER-Medicaid study, assessing outcomes based on insurance status, found that uninsured patients and Medicaid patients are more likely to present with metastatic disease (adjusted odds ratio 1.60; p <0.001) and to have higher rates of head and neck cancer-related mortality, and are less likely to receive definitive therapy.…”