Racial parities in outcomes after radiotherapy for head and neck cancer

Abstract

Background Although blacks experience worse outcomes after treatment for squamous cell carcinoma of the head and neck (HNSCC), these conclusions were based on populations where blacks comprised a minority of patients. Here, we determined the impact of race on outcomes in HNSCC patients treated with radiotherapy at an institution where blacks comprise the majority of patients. Methods We performed a retrospective cohort study by reviewing 366 black and 236 white patients with non-metastatic HNSCC treated with radiotherapy between 1990 and 2012. The primary study outcome measurements were locoregional control, freedom from distant metastasis, progression-free survival, and overall survival. Results Median follow-up was 18.3 months for all patients. The 2-year locoregional control was 71.9% for blacks compared to 64.2% for whites (HR 0.72; P = .03). There was no difference between blacks and whites regarding 2-year freedom from distant metastasis, progression-free survival, and overall survival. For Stage III–IVB patients, blacks had similar outcomes as white patients. On multivariate analysis, race was not statistically significant for locoregional control, freedom from distant metastasis, progression free survival or overall survival. Despite these similar outcomes, black patients had worse socioeconomic factors as well as increased comorbidities but similar treatment compliance. Conclusions With more adverse prognostic factors, black patients experienced similar oncologic outcomes as white patients after radiotherapy for HNSCC. Our data suggests that centers treating large percentages of minority patients with radiotherapy for HNSCCs may overcome existing healthcare disparities through improved treatment compliance.

Weekly versus every-three-weeks platinum-based chemoradiation regimens for head and neck cancer

“…Additionally, the comparative efficacy and toxicity of platinum chemotherapy versus epidermal growth factor receptor (EGFR) inhibitors, namely cetuximab, as radiosensitizers remains an area of great interest currently being studied in the RTOG 1016 and TROG 12.01 trials. Lastly, the low level of HPV-positivity in this study, which is consistent with prior results from our institution [30], limits the generalizability of our results to populations with higher proportions of HPV-positivity.…”

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

“…Hypotheses as to why African American patients do not receive appropriate treatment include late stage of diagnosis, lack of access to care, lack of continual care, poor communication between patient and provider, and patient misconceptions about healthcare [22,28,29]. Furthermore, recent literature examining patients undergoing radiotherapy treatment suggests that disparities in HNC survival can be overcome through increased treatment compliance [30]. These hypotheses should be examined in further detail in future studies.…”

Effect of actionable somatic mutations on racial/ethnic disparities in head and neck cancer prognosis

“…[24][25][26] The data from The Cancer Genome Atlas study showed that HPV-associated tumors are dominated by PIK3CA mutations (56%), novel alterations involving loss of TRAF3 and amplification of the cell cycle gene E2F1. [9][10][11][12]27 Therefore, this is the first study to pilot test whether there were racial/ethnic differences in mutation profiles that may contribute to disparities in HNSCC prognosis. However, most of these studies were performed mainly in non-Hispanic whites; racial/ethnic differences in HNSCC mutation profiles and prognosis have not been evaluated.…”

“…4 Despite advances in treatments, the 5-year survival rates for HNSCC have not improved for the past 20 years. [7][8][9][10][11] Racial and socioeconomic factors continue to play critical roles in late-stage diagnosis, healthcare access, and poorer clinical outcomes. 6 HNSCC has divergent clinical outcomes among different racial/ethnic groups.…”