Disadvantaged Subgroups Within the Global Head and Neck Cancer Population: How Can We Optimize Care?

Abstract

Within the global head and neck cancer population, there are subgroups of patients with poorer cancer outcomes independent from tumor characteristics. In this article, we review three such groups. The first group comprises patients with nasopharyngeal cancer in low- and middle-income countries where access to high-volume, well-resourced radiotherapy centers is limited. We discuss a recent study that is aiming to improve outcomes through the instigation of a comprehensive radiotherapy quality assurance program. The second group comprises patients with low socioeconomic status in a high-income country who experience substantial financial toxicity, defined as financial hardship for patients due to health care costs. We review causes and consequences of financial toxicity and discuss how it can be mitigated. The third group comprises older patients who may poorly tolerate and not benefit from intensive standard-of-care treatment. We discuss the role of geriatric assessment, particularly in relation to the use of chemotherapy. Through better recognition and understanding of disadvantaged groups within the global head and neck cancer population, we will be better placed to instigate the necessary changes to improve outcomes and quality of life for patients with head and neck cancer.

Fully-automated, CT-only GTV contouring for palliative head and neck radiotherapy

“…Moreover, between 50 and 90% are not even able to receive beneficial radiotherapy due to lack of access 2 – 4 . In particular, high-quality radiotherapy has been shown to be essential for local control or durable palliation for HN cancers, yet LMICs consistently struggle to provide it to a majority of patients 5 , 6 .…”