Race and competing mortality in advanced head and neck cancer

Zakeri, Kaveh; MacEwan, Iain; Vazirnia, Aria; Cohen, Ezra E.W.; Spiotto, Michael T.; Haraf, Daniel J.; Vokes, Everett E.; Weichselbaum, Ralph R.; Mell, Loren K.

doi:10.1016/j.oraloncology.2013.09.012

Cited by 28 publications

(35 citation statements)

References 25 publications

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“…While net survival is useful for reporting trends in cancer survival, comparing different groups of cancer patients and investigating the impact of various factors on cancer treatment, crude probability of death is important when communicating risks to patients [10] during clinical decision making [9, 26]. Previous studies have suggested that relative survival tends to underestimate social inequalities in cancer survival; our study suggests that the Cronin-Feuer method does underestimate Indigenous to non-Indigenous disparities in cancer death probabilities (except for breast cancer) in the presence of competing risks.…”

Section: Resultsmentioning

confidence: 99%

“…Net survival is the measure most commonly used to compare cancer prognosis in different populations (e.g., between nations, regions, or racial/ethnic groups) [1, 3–9] because net survival removes the effect of non-cancer deaths (which may vary between populations because of different all-cause mortality rates [10]) and measures the hypothetical scenario in which patients are only able to die of their cancer. However, this is a disadvantage of net survival for patients and clinicians who, when considering the treatment options and weighing up the benefits, drawbacks, and toxicities of cancer therapy, want to know about actual prognosis: what is the chance of dying (from cancer or any cause) compared with the chance of surviving [5, 9, 10]?…”

Section: Introductionmentioning

confidence: 99%

“…However, this is a disadvantage of net survival for patients and clinicians who, when considering the treatment options and weighing up the benefits, drawbacks, and toxicities of cancer therapy, want to know about actual prognosis: what is the chance of dying (from cancer or any cause) compared with the chance of surviving [5, 9, 10]? This is particularly important for Indigenous Australians, and other populations who also have higher probability of death from “competing” (i.e., non-cancer) causes [3, 5, 10].…”

Section: Introductionmentioning

confidence: 99%

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Different survival analysis methods for measuring long-term outcomes of Indigenous and non-Indigenous Australian cancer patients in the presence and absence of competing risks

Condon

Baade

et al. 2017

Popul Health Metrics

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BackgroundNet survival is the most common measure of cancer prognosis and has been used to study differentials in cancer survival between ethnic or racial population subgroups. However, net survival ignores competing risks of deaths and so provides incomplete prognostic information for cancer patients, and when comparing survival between populations with different all-cause mortality. Another prognosis measure, “crude probability of death”, which takes competing risk of death into account, overcomes this limitation. Similar to net survival, it can be calculated using either life tables (using Cronin-Feuer method) or cause of death data (using Fine-Gray method). The aim of this study is two-fold: (1) to compare the multivariable results produced by different survival analysis methods; and (2) to compare the Cronin-Feuer with the Fine-Gray methods, in estimating the cancer and non-cancer death probability of both Indigenous and non-Indigenous cancer patients and the Indigenous cancer disparities.MethodsCancer survival was investigated for 9,595 people (18.5% Indigenous) diagnosed with cancer in the Northern Territory of Australia between 1991 and 2009. The Cox proportional hazard model along with Poisson and Fine-Gray regression were used in the multivariable analysis. The crude probabilities of cancer and non-cancer methods were estimated in two ways: first, using cause of death data with the Fine-Gray method, and second, using life tables with the Cronin-Feuer method.ResultsMultivariable regression using the relative survival, cause-specific survival, and competing risk analysis produced similar results. In the presence of competing risks, the Cronin-Feuer method produced similar results to Fine-Gray in the estimation of cancer death probability (higher Indigenous cancer death probabilities for all cancers) and non-cancer death probabilities (higher Indigenous non-cancer death probabilities for all cancers except lung cancer and head and neck cancers). Cronin-Feuer estimated much lower non-cancer death probabilities than Fine-Gray for non-Indigenous patients with head and neck cancers and lung cancers (both smoking-related cancers).ConclusionDespite the limitations of the Cronin-Feuer method, it is a reasonable alternative to the Fine-Gray method for assessing the Indigenous survival differential in the presence of competing risks when valid and reliable subgroup-specific life tables are available and cause of death data are unavailable or unreliable.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-016-0118-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Different survival analysis methods for measuring long-term outcomes of Indigenous and non-Indigenous Australian cancer patients in the presence and absence of competing risks

Condon

Baade

et al. 2017

Popul Health Metrics

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“…Previous studies in HNC outcomes research have demonstrated that African American patients face an unequal burden of disease due to differences in socioeconomic status, limited access to care, advanced cancer stage, lower receipt of treatment, and comorbidity [4][5][6][7]. Nevertheless, the existing literature focusing on racial disparities in HNC outcomes have not been able to account for relevant sociodemographic factors such as insurance, which has been suggested to have a significant impact on cancer outcomes and treatment patterns [2,8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, the existing literature focusing on racial disparities in HNC outcomes have not been able to account for relevant sociodemographic factors such as insurance, which has been suggested to have a significant impact on cancer outcomes and treatment patterns [2,8,9]. Additionally, the majority of existing studies do not utilize cancer specific mortality as an endpoint and are unable to account for comorbid disease that has been shown to disproportionally contribute to the mortality of African American patients with HNC [7]. Lastly, previous studies focusing on racial disparities in HNC outcomes have examined smaller cohorts restricted to few sites, thus limiting the number of pertinent covariates that could be adjusted for and generalized conclusions that could be made about disparities in HNC [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Impact of African–American race on presentation, treatment, and survival of head and neck cancer

Mahal

Inverso

Aizer³

et al. 2014

Oral Oncology

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A contemporary analysis of racial disparities in recommended and received treatment for head and neck cancer

Nocon

Ajmani

Bhayani

2019

Cancer

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BACKGROUND: Racial disparities in squamous cell carcinoma of the head and neck (HNSCC) negatively affect non-Hispanic black (NHB) patients. This study was aimed at understanding how treatment is prescribed and received across all HNSCC subsites. METHODS: With the National Cancer Database, patients from 2004 to 2014 with surgically resectable HNSCCs, including tumors of the oral cavity (OC), oropharynx (OP), hypopharynx (HP), and larynx (LX), were studied. The treatment received was either upfront surgery or nonsurgical treatment. Treatment patterns were compared according to race and subsite, and how these differences changed over time was evaluated. RESULTS: NHB patients were less likely than non-Hispanic white (NHW) patients to receive surgery across all subsites (relative risk [RR] for OC, 0.87; RR for OP, 0.75; RR for HP, 0.73; RR for LX, 0.87; all P values <.05). They were also more likely to refuse a recommended surgery (RR for OC, 1.50; RR for OP, 1.23; RR for HP, 1.23; RR for LX, 1.34), and this difference was significant except for HP. NHB patients were more likely to not be offered surgery across all subsites (RR for OC, 1.38; RR for OP, 1.07; RR for HP, 1.05; RR for LX, 1.03; all P values <.05). Rates of surgery increased and rates of not being offered surgery declined for both NHB and NHW patients from 2004 to 2014, but the absolute disparities persisted in 2014. CONCLUSIONS: Across all HNSCC subsites, NHB patients were less likely than NHW patients to be recommended for and receive surgery and were more likely to refuse surgery. These differences have closed over time but persist. Enhanced shared decision making may improve these disparities.

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Race and competing mortality in advanced head and neck cancer

Cited by 28 publications

References 25 publications

Different survival analysis methods for measuring long-term outcomes of Indigenous and non-Indigenous Australian cancer patients in the presence and absence of competing risks

Different survival analysis methods for measuring long-term outcomes of Indigenous and non-Indigenous Australian cancer patients in the presence and absence of competing risks

Impact of African–American race on presentation, treatment, and survival of head and neck cancer

A contemporary analysis of racial disparities in recommended and received treatment for head and neck cancer

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