Racial disparities in tumor features and outcomes of patients with squamous cell carcinoma of the tonsil

Albert, Ashley; Giri, Shankar; Kanakamedala, M.R.; Mangana, S.H.; Bhanat, Eldrin; Shenoy, Veena; Thomas, Toms Vengaloor; Joseph, Sanjay; González, Mercedes; Shalaby, Akram; Vijayakumar, Srinivasan

doi:10.1002/lary.27395

Cited by 15 publications

(16 citation statements)

References 38 publications

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“…3,7,8,[10][11][12][13][18][19][20][21][22][23][24][25][26][27][28][29][30] There were 13 publications that used a multivariable analysis, with HRs for OS in black patients ranging from 1.17 to 4.81 (Table 1). 13,18 Of the 13 studies that used a multivariable model, 8 showed significantly worse OS for black patients in the adjusted analysis. In a survival model evaluating independent predictors of 5-year survival in OPSCC, for example, black race was associated with a HR of 2.57 (95% CI 1.78-3.72) after adjusting for age, sex, stage, grade, tumor subsite, HPV status, and treatment modality.…”

Section: Narrative Review Of Racial Disparities In Oropharyngeal Camentioning

confidence: 99%

Systematic review and meta‐analysis of racial survival disparities among oropharyngeal cancer cases by HPV status

et al. 2020

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Background There is a well documented racial disparity in overall survival for oropharyngeal squamous cell carcinoma (OPSCC); however, it is unknown to what extent this disparity varies by HPV‐status. Methods A literature search was conducted through December 2019 using Ovid Medline, Cochrane Library, Embase, Scopus, and http://Clinicaltrials.gov. PRISMA guidelines were followed. A meta‐analysis was conducted using random effects models to obtain pooled hazard ratios (HRs). Results Of 649 studies initially identified, 20 studies met criteria for the narrative review. There were four studies evaluating survival by race in HPV‐positive OPSCC and five studies in HPV‐negative OPSCC suitable for pooling. The pooled HR associated with black race was 1.10 (95% CI 0.96‐1.23) among patients with HPV‐positive (n = 23 608) and 1.50 (95% CI 1.12‐1.88) among patients with HPV‐negative (n = 12 112). There was notable heterogeneity (I2 = 83%) and publication bias among the HPV‐negative OPSCC studies. Conclusions The racial disparity in OPSCC survival persists for HPV‐negative disease and is nonsignificant for HPV‐positive disease. Unmeasured differences in socioeconomic status and access to care may contribute to this disparity.

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Section: Narrative Review Of Racial Disparities In Oropharyngeal Camentioning

confidence: 99%

Systematic review and meta‐analysis of racial survival disparities among oropharyngeal cancer cases by HPV status

et al. 2020

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“…We identified late cancer stage at diagnosis and receipt of any treatment as areas of major health gaps accounting for disparities between Black NH individuals and those of other races/ethnicities. Although other studies have shown that Black NH patients have worse survival outcomes in HNC, [8][9][10][11][12][13][14][15] our data underscore that this holds true compared with Hispanic patients, a similarly underserved population. Hispanic patients were more likely to present with an earlier cancer stage and to receive treatment.…”

Section: Discussionmentioning

confidence: 43%

“…7 Multiple studies examining racial/ethnic disparities have found worse outcomes in Black NH patients than in White NH patients, although there has not been a comparison with Hispanic patients. [8][9][10][11][12][13][14][15] These studies have attributed the differences in outcomes to differences in socioeconomic status, cancer stage at presentation, insurance coverage, and treatment patterns.…”

Section: Introductionmentioning

confidence: 99%

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

McDermott¹,

Eguchi²,

Morgan

et al. 2021

Journal of the National Comprehensive Cancer Network

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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.

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“…Another study reported that general cancer care among low-income patients, despite access to care, included a lack of knowledge of resources, denial or fear, competing obligations, and embarrassment, potentially leading to diminished outcomes [9,18]. On the contrary, several other studies suggest that when hypopharyngeal cancer patients who mostly present at the advanced stage are given uniform patient care, racial disparities in disease prognosis and outcomes are not evident [1][2][3][4]8,10,16].…”

Section: Possible Reasons For Racial Disparitiesmentioning

confidence: 99%

“…Hypopharyngeal cancer is a rare malignancy presenting mostly in the advanced stages partly due to its anatomic location and delayed symptomatic presentation. Extensive research into racial disparities in head and neck cancers exists, but racial disparities in hypopharyngeal cancer have not been concretely identified due to the rarity of this disease [1][2].…”

Section: Introductionmentioning

confidence: 99%

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?

Thomas¹,

Krishna²,

Ahmed³

et al. 2020

Cureus

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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.

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Racial disparities in tumor features and outcomes of patients with squamous cell carcinoma of the tonsil

Abstract: 3. Laryngoscope, 2018.

Cited by 15 publications

References 38 publications

Systematic review and meta‐analysis of racial survival disparities among oropharyngeal cancer cases by HPV status

Systematic review and meta‐analysis of racial survival disparities among oropharyngeal cancer cases by HPV status

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

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?

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