Socioeconomic and Other Demographic Disparities Predicting Survival among Head and Neck Cancer Patients

Abstract

BackgroundThe Institute of Medicine (IOM) report, “Unequal Treatment,” which defines disparities as racially based, indicates that disparities in cancer diagnosis and treatment are less clear. While a number of studies have acknowledged cancer disparities, they have limitations of retrospective nature, small sample sizes, inability to control for covariates, and measurement errors.ObjectiveThe purpose of this study was to examine disparities as predictors of survival among newly diagnosed head and neck cancer patients recruited from 3 hospitals in Michigan, USA, while controlling for a number of covariates (health behaviors, medical comorbidities, and treatment modality).MethodsLongitudinal data were collected from newly diagnosed head and neck cancer patients (N = 634). The independent variables were median household income, education, race, age, sex, and marital status. The outcome variables were overall, cancer-specific, and disease-free survival censored at 5 years. Kaplan-Meier curves and univariate and multivariate Cox proportional hazards models were performed to examine demographic disparities in relation to survival.ResultsFive-year overall, cancer-specific, and disease-free survival were 65.4% (407/622), 76.4% (487/622), and 67.0% (427/622), respectively. Lower income (HR, 1.5; 95% CI, 1.1–2.0 for overall survival; HR, 1.4; 95% CI, 1.0–1.9 for cancer-specific survival), high school education or less (HR, 1.4; 95% CI, 1.1–1.9 for overall survival; HR, 1.4; 95% CI, 1.1–1.9 for cancer-specific survival), and older age in decades (HR, 1.4; 95% CI, 1.2–1.7 for overall survival; HR, 1.2; 95% CI, 1.1–1.4 for cancer-specific survival) decreased both overall and disease-free survival rates. A high school education or less (HR, 1.4; 95% CI, 1.0–2.1) and advanced age (HR, 1.3; 95% CI, 1.1–1.6) were significant independent predictors of poor cancer-specific survival.ConclusionLow income, low education, and advanced age predicted poor survival while controlling for a number of covariates (health behaviors, medical comorbidities, and treatment modality). Recommendations from the Institute of Medicine’s Report to reduce disparities need to be implemented in treating head and neck cancer patients.

Overall Survival in Stage III and IV High-Risk Head and Neck Squamous Cell Carcinoma Patients who received Adjuvant Chemotherapy and Radiation without Cisplatin

“…Advanced age has generally been associated with worse OS in multiple studies (Chen, Harris, Hara, Sirjani & Divi, 2016, Choi et al, 2016 although in our study advanced age correlated with a superior OS. The higher OS was observed in an individual as well as a stratified approach based on the age-groups.…”

Undertreatment of women with locoregionally advanced head and neck cancer

“…11,12 Racial disparities have also been described in patients with HNC. Higher socioeconomic status and health insurance status have been associated with improved survival.…”

The role of tumor grade, demographics and psychological factors in Cancer survivorship

“…Exact methods of diagnosis, improved treatment and supportive care of cancer have increased survival rate (8). In the meantime, demographic factors such as age, gender, and income have an effect on the survival rate (9)(10)(11). More survival rate of cancer is associated with lower age, higher socioeconomic status, increased income and female gender (9,12).…”

“…In the meantime, demographic factors such as age, gender, and income have an effect on the survival rate (9)(10)(11). More survival rate of cancer is associated with lower age, higher socioeconomic status, increased income and female gender (9,12). In addition, according the tumor stage, grade 1 cancer shows a minimum of malignant tumors and is associated with long-term survival and grade 4 tumors are fully malignant that are associated with lower survival in the patients (13).…”

“…Danhauer et al (2013) showed posttraumatic growth is linked with demographic factors such as age, marital status, education, race and religion (22). According to numerous evidence, demographic factors such as age, sex, socioeconomic status affect survival and posttraumatic growth, self-management and cancer survival (9,11,24). In previous research, the role of object relations in the survival and development of post-traumatic growth accompanied with these factors not addressed and it seems essential.…”