Determinants of racial differences in survival for sinonasal cancer

Abstract

2c. Laryngoscope, 126:2022-2028, 2016.

Comorbidity burden and nonclinical factors associated with sinonasal cancer all‐cause mortality

“…In fact, a recent national surveillance report indicated that of all cancers in the United States, the black versus white difference in survival was worst among head and neck cancer except for melanoma and uterine cancer . Previous studies have been inconclusive about the association between race and sinonasal cancer, especially the black versus white comparison; many have found any suggested association attenuated after adjusting for important tumor and clinical factors; however, we found that the association between race and all‐cause mortality among sinonasal cancer patients in our study remained statistically significant after controlling for important clinical risk factors, including histology, stage of presentation, treatment modality, and comorbidity. One difference between ours and previous studies is that we did not only control for clinical factors, we also accounted for the time‐varying nature of treatment modalities, which provides a more accurate picture of treatment plan since there are usually waiting times and delays between cancer treatment modalities .…”

“…There is likely an interplay of factors driving this racial disparity finding that requires further investigation. A previous study suggested that the driver of the racial disparity in sinonasal cancer mortality is mostly receiving adequate treatment, and earlier stage of presentation . It is important that systemic factors associated with poor access to standard care are understood to increase early stage presentation and receipt of adequate care …”

“…Sinonasal cancer is a rare cancer, with an incidence rate of 0.6 cases per 100 000, and comprising only 3% of all head and neck cancers diagnosed. Other more common sites of head and neck cancer have incidence that varies from one to five per 100 000 population . The sinonasal anatomy involves complex interplay between structure and empty space, which contributes to late presentation, poor prognosis, higher complexity of treatment, and greater impact of comorbid disease on treatment success and patient survival .…”

“…There are prior epidemiological studies on sinonasal cancer, but most are based on the Surveillance, Epidemiology, and End Results (SEER), and therefore do not provide data on comorbidities, unless when linked to the Medicare dataset . A recent study utilized the National Cancer Database (NCDB) which has comorbidity information; however, authors focused on other clinical endpoints such as factors associated with 30‐ and 90‐day mortality and hospital readmission …”

Disparities in sinonasal squamous cell carcinoma short‐ and long‐term outcomes: Analysis from the national cancer database

“…Due to the overall low incidence of sinonasal cancers, database analyses are crucial for understanding the factors that are associated with disease outcomes. Prior studies utilizing the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program database demonstrated racial differences in survival for sinonasal cancers, specifically in sinonasal SCC . However, there are limited studies describing the role of additional patient and treatment factors on sinonasal SCC survival and short‐term outcomes.…”