A contemporary analysis of racial disparities in recommended and received treatment for head and neck cancer

Nocon, Cheryl C.; Ajmani, Gaurav S.; Bhayani, Mihir K.

doi:10.1002/cncr.32342

Cited by 39 publications

(35 citation statements)

References 43 publications

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“…Our results are consistent with the literature that Black patients present with more advanced disease 12 and are less likely to receive treatment. 28,29 Black patients historically have higher rates of not receiving definitive cancer treatment, such as surgery, radiotherapy, or a combination of the two, which our study also shows. 30 Interestingly, we found that Black patients also experienced higher rates of escalation of treatment (surgery and chemoradiotherapy).…”

Section: Discussionsupporting

confidence: 69%

Disparities in Mortality from Larynx Cancer: Implications for Reducing Racial Differences

et al. 2020

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Objective: Race predicts overall mortality (OM) of laryngeal squamous cell carcinoma (LSCC) in the United States (US). We assessed whether racial disparities affect cancer-specific mortality (CSM) using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Adults with LSCC from 2004 to 2015 were selected. Univariable and multivariable Cox proportional hazards and Fine-Gray competing-risks regression analysis adjusted for clinicodemographic factors defined hazard ratios (aHR). Results: We identified 14,506 patients. The median age was 63 years. Most were male (11,725, 80.8%) and white (11,653, 80.3%), followed by Black (2294, 15.8%). Most had early-stage disease (7544, 52.0%) and received radiotherapy only (4107, 28.3%), followed by chemoradiation (3748, 25.8%). With median follow-up of 60 months, overall 3-and 5-year OM were 34.0% and 43.2%; CSM were 16.0% and 18.9%, respectively. Black patients had higher OM than white patients on univariable (

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Section: Discussionsupporting

confidence: 69%

Disparities in Mortality from Larynx Cancer: Implications for Reducing Racial Differences

et al. 2020

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“…Our study is consistent with several others that have noted disparities in the receipt of guideline-concordant cancer care and overall outcomes among Black patients due to a number of patient-and provider-driven factors. [16][17][18][19][20][21][22][23] In addition, our study is consistent with several others that have revealed undertreatment of female patients compared with their male counterparts with respect to other disease sites and modalities of cancer care. 24 We have previously shown that older populations are less likely to receive perioperative RT 11 due to a number of potential factors that others have investigated, including physician-based factors such as hesitancy to recommend more-intensive treatment due to preconceived biases regarding patient frailty, and patient-related factors such as prioritization of immediate convenience and quality of life over long-term outcomes and survival.…”

Section: Discussionsupporting

confidence: 91%

Radiotherapy Remains Underused in the Treatment of Soft-Tissue Sarcomas: Disparities in Practice Patterns in the United States

Reddy¹,

Jain²,

Venigalla³

et al. 2021

Journal of the National Comprehensive Cancer Network

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Background: Practice patterns of radiation therapy (RT) use for soft-tissue sarcoma (STS) remain quite variable, despite clinical practice guidelines recommending the addition of RT to surgery for patients with high-grade STS, particularly for larger tumors. Using the National Cancer Database (NCDB), we assessed patterns of overall RT use, neoadjuvant versus adjuvant treatment, and specific RT modalities in this population. Patients and Methods: Patients aged ≥18 years with stage II/III STS in 2004 through 2015 were identified from the NCDB. Patterns of care were assessed using multivariable logistic regression analysis. Results: Of 27,426 total patients, 11,654 (42%) were treated with surgery alone versus 15,772 (58%) with RT in addition to surgery, with no overall increase in RT use over the study period. Notable clinical predictors of receipt of RT included tumor size (>5 cm), grade III, and tumors arising in the extremities. Conversely, female sex, older age (≥70 years), Black race, noncommercial insurance coverage, farther distance to treatment, and poor performance status were negative predictors of RT use. Of those receiving RT, 27% were treated with neoadjuvant RT and 73% with adjuvant RT. The proportion of those receiving neoadjuvant RT increased over time. Relevant factors associated with neoadjuvant RT included treatment at academic centers, larger tumor size, and extremity tumors. Of those who received RT with a modality specified as either intensity-modulated RT (IMRT) or 3D conformal RT (3DCRT), 61% were treated with IMRT and 39% with 3DCRT. The proportion of patients treated with IMRT increased over time. Relevant factors associated with IMRT use included treatment at academic centers, commercial insurance coverage, and larger and nonextremity tumors. Conclusions: Although use of neoadjuvant RT and IMRT has increased over time, a significant number of patients with STS are not receiving adjuvant or neoadjuvant RT. Our findings also note potential sociodemographic disparities and highlight the concern that not all patients with STS are being equally considered for RT.

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“…For example, a recent study showed that black patients were at a 10% greater risk of mortality within 90 days after treatment of HNSCC 20 . Black patients were also 13% less likely to undergo the standard surgery for oral cavity squamous cell carcinoma and more likely to refuse a recommended surgery across all HNSCC subsites 5,21 . These results suggest important differences in care and the patient‐physician relationship between black and white patients.…”

Section: Discussionmentioning

confidence: 99%

Explaining Racial Disparities in Surgically Treated Head and Neck Cancer

Jassal

Cramer

2020

The Laryngoscope

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Objectives/Hypothesis To assess the causative factors that contribute to racial disparities in head and neck squamous cell carcinoma (HNSCC) and establish the role of hospital factors in racial disparities. Study Design Retrospective database analysis. Methods Patients with surgically treated HNSCC were identified using the National Cancer Database (2004–2014). Logistic and proportional‐hazard regression models were used to characterize the factors that contribute to racial disparities. Differences in quality of care received were compared among black and white patients using previously validated metrics. Results We identified 69,186 eligible patients. Black patients had a 48% higher mortality than white patients (HR 1.48; 95% confidence interval [CI], 1.41–1.54). Black patients had a lower mean quality score (67.6%; 95% CI, 66.8%–69.4%) compared with white patients (71.2%: 95% CI, 71.0%–71.4%) for five quality metrics. After adjusting for differences in patient, oncologic, and hospital factors we were able to explain 60% of the excess mortality for black patients. Oncologic factors at presentation accounted for 57.7% of observed mortality differences, whereas hospital characteristics and quality of care accounted for 11.5%. After adjusting for these factors, black patients still had a 19% higher mortality (HR 1.19; 95% CI, 1.14–1.24). Conclusions Oncologic factors at presentation are a major contributor to racial disparities in outcomes for HNSCC. Hospital factors, such as quality, volume, and safety‐net status, constitute a minor factor in the mortality difference. Resolving existing disparities will require detecting head and neck cancer at an earlier stage and improving the quality of care for black patients. Level of Evidence 3. Laryngoscope, 131:1053–1059, 2021

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A contemporary analysis of racial disparities in recommended and received treatment for head and neck cancer

Cited by 39 publications

References 43 publications

Disparities in Mortality from Larynx Cancer: Implications for Reducing Racial Differences

Disparities in Mortality from Larynx Cancer: Implications for Reducing Racial Differences

Radiotherapy Remains Underused in the Treatment of Soft-Tissue Sarcomas: Disparities in Practice Patterns in the United States

Explaining Racial Disparities in Surgically Treated Head and Neck Cancer

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