Racial and Ethnic Disparities in Salivary Gland Cancer Survival

Abstract

Importance Several recent studies have documented disparities in head and neck cancer outcomes for Black patients in the United States. However, few studies have been conducted to evaluate for differences in long-term survival from salivary gland cancer (SGCA) for racial/ethnic minorities compared to Whites. Objective To determine if patient race or ethnicity impact SGCA survival. Design, Setting, and Participants Retrospective survival analysis of all patients with SGCA from 1988–2010 in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, a population-level database of cancer registries covering approximately 28 percent of the US population. Intervention None Main Outcomes and Measures The primary outcome measured was disease-specific survival. Patients with SGCA were grouped according to race and ethnicity. The end points assessed in each group included age at diagnosis, gender, tumor grade, tumor size at diagnosis, extension at diagnosis, lymph node involvement at diagnosis, and treatment modalities. The racial/ethnic groups were further analyzed by histologic subtype of the SGCAs. Results Of 11,007 patients with SGCA, 1,073 (9.7%) and 1,068 (9.7%) were Black and Hispanic, respectively. The mean age at diagnosis for Whites was 63 years old compared to 53 and 52 years old for Blacks and Hispanics, respectively (p < 0.0001). Twenty-year disease-specific survival rates for all SGCA histologies combined for Whites, Blacks, and Hispanics were 78%, 79%, and 81%, respectively. The log-rank test of the unadjusted survival curves showed no significant difference in survival between Black and White patients and an apparent survival advantage for Hispanic compared to White patients. However, using multivariable Cox regression models to control for patient, tumor, and treatment characteristics, we demonstrated that Black patients actually have significantly poorer disease-specific survival for SGCA compared to White patients, while Hispanic patients have no significant difference in disease-specific survival compared to White patients. Further analyses of the individual SGCA histological subtypes identified poorer disease-specific survival for Black compared to White patients with mucoepidermoid and squamous cell carcinomas as the source of the overall poorer disease-specific survival for Black compared to White patients with SGCA. Less surgical treatment for Black compared to White patients was a significant source of the survival disparity for squamous cell SGCA, but not for mucoepidermoid SGCA. Conclusions and Relevance This is the largest study to date to explore racial and ethnic disparities in SGCA survival. Our results show that for patients diagnosed with SGCA, Black race is a risk factor for poorer disease-specific survival for those with mucoepidermoid or squamous cell carcinoma, while Hispanic ethnicity has no effect on disease-specific survival for any SGCA histology. Differences in treatment regimens between Black and White patients play a significant rol...

Clinical characteristics and outcomes of major salivary gland malignancies in children

“…Several studies have reported disparities in various adult head and neck cancer outcomes for black patients . A prior study using the SEER database did find that black adults with salivary gland malignancies had poorer survival rates than whites . The disparity in survival was due primarily to poorer disease‐specific survival for blacks with mucoepidermoid and squamous cell carcinomas.…”

Socioeconomic disparities and comorbidities, not race, affect salivary gland malignancy survival outcomes

“…Race and median household income was not associated with survival in the multivariate analysis; however, the proportion of high school education or less in the patient's neighborhood was. Russell et al did not report socioeconomic factors, but demonstrated that after controlling for age, gender, and tumor characteristics, disease‐specific survival for African Americans was significantly worse than for Caucasians. Needless to say, the patterns of how race and socioeconomic factors interact and how these may combine to influence health outcomes are enormously complex and relevant, but beyond the scope of this article .…”

Sinonasal Carcinoma

“…Moreover, death due to the diagnosed sinonasal cancer (SEER site recode: 22010) was considered as the event of interest, and death due to other causes was treated as a censoring event. 10 Patient characteristics were summarized using percentages for categorical variables, means and medians, standard deviations, and interquartile ranges for central tendency and spread on numerical variables. Unadjusted differences between racial/ethnic groups were compared using chi-square and Kruskal-Wallis tests where appropriate.…”

“…Given the reported survival disparities according to race and ethnicity for other head and neck cancer subsites, as well as cancers in other sites of the body, we conducted this study with the primary objective of determining whether or not race and ethnicity affect sinonasal cancer survival. [6][7][8][9][10][11][12][13] Methods…”