Non-Hispanic Black Patients With Head and Neck Cancer May Have Significantly Worse Survival vs Other Minority Groups

Black patients with head and neck cancer had significantly worse survival outcomes compared with other racial minority subgroups that were not fully explained by stage of presentation, highlighting possible unexplored multilevel factors that could be associated with social determinates of health and disparities within this disease type, according to results from a retrospective cohort study published in JAMA Otolaryngology–Head & Neck Surgery.

Investigators reported that Hispanic patients had a subdistribution hazard ration (sdHR) of head and neck cancer–specific mortality that was 11% lower vs Black patients (sdHR, 0.85; 95% CI, 0.78-0.93). Additionally, Asian and Pacific islander patients had 15% lower risk (sdHR, 0.85; 95% CI, 0.78-0.93), and American Indian and Alaska Native individuals trended towards having a lower risk (sdHR, 0.85; 95% CI, 0.71-1.01) vs Black patients. Further, race, sex, insurance, marital status, and socioeconomic status were all consistently associated with all-cause and head and neck cancer–specific mortality, as well as stage of presentation.

“The results of this cohort study suggest that significant disparities exist in head and neck cancer survival and stage of presentation among patients belonging to racial and ethnic minority groups,” the investigators wrote.

Deidentified data were taken from the Surveillance, Epidemiology, and End Results (SEER) database from 2007 to 2016. Patients included in the study’s population were aged 18 years or older at time of malignant primary head and neck cancer diagnosis and belonged to a racial and ethnic minority group.

Main outcomes of the research were head and neck cancer–specific mortality, all-cause mortality, and stage of presentation. Study covariates included both nonclinical and clinical factors.

A total of 21,966 patients with head and neck cancer were included in the study cohort. Mean age at diagnosis for the overall cohort was 56.02 years and 72.4% of patients were male. The majority of patients within the overall cohort had private insurance (64.9%).

The cohort consisted of non-Hispanic Black (n = 9229), Hispanic (n = 6893), Asian/Pacific Islander (n = 5342), and American Indian/Alaska Native (n = 502) patients. Age and sex characteristics were relatively consistent in each subgroup compared with the overall cohort characteristics. Socioeconomic status varied, with the plurality of non-Hispanic Black patients categorized as very low (37.7%), Hispanic as low (31.9%), Asian/Pacific Islander as high (52.8%), and American Indian/Alaska Native as medium (44.8%).

Unadjusted 5-year overall survival (OS) analysis indicated that survival was lowest for the non-Hispanic Black cohort (46%; 95% CI, 45%-47%), which was significantly lower than that of the Hispanic (62%; 95% CI, 60%-63%), Asian/Pacific Islander (67%; 95% CI, 66%-69%), and American Indian/Alaska Native (58%; 95% CI, 53%-63%) groups.

Further, a higher OS was observed among women with head and neck cancer (64%; 95% CI, 62%-65%) compared with men (53%; 95% CI, 53%-54%). In terms of insurance status, those with private insurance had the highest OS (63%; 95% CI, 62%-64%), compared with the much lower OS observed among those with Medicaid (42%; 95% CI, 41%-44%) and uninsured patients (49%; 95% CI, 46%-52%).

The highest OS rate was seen in the high socioeconomic status group (65%; 95% CI, 64%-67%), compared with other groups, including those in the very low socioeconomic status group (50%; 95% CI, 48%-51%). Those with localized stage of presentation (78%; 95% CI, 77%-79%) and lower for regional (51%; 95% CI, 50%-53%) had the highest OS rates, whereas tumors that presented at distant stages (31%; 95% CI, 29%-33%) had the lowest rate.

A total of 11,369 patients had stage of presentation data available. Data indicated that all patient sociodemographic variables had significant main associations with the odds of stage of presentation. Of note, Hispanic patients and Asian/Pacific Islander patients had 23% (adjusted odds ratio [aOR], 0.77; 95% CI, 0.7-0.85) and 27% (aOR, 0.73; 95% CI, 0.65-0.82) lower odds of presenting at a later stage than non-Hispanic Black patients, respectively.

Moreover, men had 41% higher odds (aOR, 1.41; 95% CI, 1.30-1.52) than women of presenting at a later stage. Very low socioeconomic status had 21% increased odds of presenting at a later stage compared with high socioeconomic status (aOR, 1.21; 95% CI, 1.08-1.35). Finally, those who were Medicaid-insured and uninsured 60% higher odds (aOR, 1.60; 95% CI, 1.48-1.74) and 70% higher odds (aOR, 1.70; 95% CI, 1.48-1.95) of presenting at a distant stage, respectively, compared with privately insured patients.

“These findings could inform interventions aimed at ameliorating health disparities among patients with head and neck cancer belonging to racial and ethnic groups,” the investigators concluded.

Reference

Taylor DB, Osazuwa-Peters OL, Okafor SI, et al. Differential outcomes among survivors of head and neck cancer belonging to racial and ethnic minority groups. JAMA Otolaryngol Head Neck Surg. Published online December 23, 2021. doi:10.1001/jamaoto.2021.3425