Gender and race interact to influence survival disparities in head and neck cancer

Mazul, Angela L.; Naik, Akash N.; Zhan, Kevin Y.; Stepan, Katelyn; Old, Matthew; Kang, Stephen Y.; Nakken, Erik R; Puram, Sidharth V.

doi:10.1016/j.oraloncology.2020.105093

Cited by 40 publications

(42 citation statements)

References 47 publications

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“… 52 Although there is not enough evidence to declare a relationship between gender/sex and delayed PORT, Mazul et al found that although female patients with HNSCC had greater overall survival than males, Black female patients had significantly worse survival rates than White and Hispanic male patients. 53 This interaction would be interesting to study in rates of delayed PORT.…”

Section: Resultsmentioning

confidence: 99%

An equity‐based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma

Noyes

Burks

Larson

et al. 2021

Laryngoscope Investig Oto

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Objectives: The majority of patients with head and neck squamous cell carcinoma (HNSCC) do not commence postoperative radiation treatment (PORT) within the recommended 6 weeks. We explore how delayed PORT affects survival outcomes, what factors are associated with delayed PORT initiation, and what interventions exist to reduce delays in PORT initiation. Methods: We conducted a PubMed search to identify articles discussing timely PORT for HNSCC. We performed a narrative review to assess survival outcomes of delayed PORT as well as social determinants of health (SDOH) and clinical factors associated with delayed PORT, using the PROGRESS-Plus health equity framework to guide our analysis. We reviewed interventions designed to reduce delays in PORT. Results: Delayed PORT is associated with reduced overall survival. Delays in PORT disproportionately burden patients of racial/ethnic minority backgrounds, Medicaid or no insurance, low socioeconomic status, limited access to care, more comorbidities, presentation at advanced stages, and those who experience postoperative complications. Delays in PORT initiation tend to occur during transitions in head and neck cancer care. Delays in PORT may be reduced by interventions that identify patients who are most likely to experience delayed PORT, support patients according to their specific needs and barriers to care, and streamline care and referral processes. Conclusions: Both SDOH and clinical factors are associated with delays in timely PORT. Structural change is needed to reduce health disparities and promote equitable access to care for all. When planning care, providers must consider not only biological factors but also SDOH to maximize care outcomes.

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Section: Resultsmentioning

confidence: 99%

An equity‐based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma

Noyes

Burks

Larson

et al. 2021

Laryngoscope Investig Oto

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“…Although it is well known that females have improved survival in comparison with their male counterparts [ 18 ], gender disparities were especially neglected so far when analyzing treatment trends. The above-mentioned Thuringian data showed that treatment decisions were different between male and female patients even for the same tumor type and stage [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…The above-mentioned Thuringian data showed that treatment decisions were different between male and female patients even for the same tumor type and stage [ 5 ]. Understanding these gender disparities is essential to providing appropriate care to HNC patients [ 18 ]. Therefore, prospective trials are needed to better analyze the decision making for or against a certain treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

Trends in Treatment of Head and Neck Cancer in Germany: A Diagnosis-Related-Groups-Based Nationwide Analysis, 2005–2018

Hermanns

Ziadat

Guntinas‐Lichius

2021

Cancers

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Advances in head and neck cancer (HNC) treatment might have changed treatment strategies. This study determined, with focus on gender disparity, whether treatment rates have changed for inpatients in Germany between 2005 and 2018. Nation-wide population-based diagnosis-related groups (DRG) data of virtually all HNC cases (1,226,856 procedures; 78% men) were evaluated. Poisson regression analyses were used to study changes of annual treatment rates per German population. For surgery, the highest increase was seen for women with cancer of the oral cavity (relative risk (RR) 1.14, 95% confidence interval (CI) 1.11–1.18, p < 0.0001) and the highest decrease for men with laryngeal cancer (RR 0.90, CI 0.87–0.93). In women with oropharyngeal cancer, the highest increase of radiotherapy rates was seen (RR 1.18, CI 1.10–1.27, p < 0.0001). A decrease was seen in men for hypopharyngeal cancer (RR 0.93, CI 0.87–0.98, p = 0.0093). The highest increase for chemotherapy/immunotherapy was seen for women with oropharyngeal cancer (RR 1.16, CI 1.08–1.24, p < 0.0001), and a decrease in men with hypopharyngeal cancer (RR 0.93, CI 0.88–0.97, p = 0.0014). Treatment patterns had changed for nearly all subsites and therapy types. There were relevant gender disparities, which cannot be explained by the DRG data.

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“…In our study cohort, male patients constituted 88.5% of the elderly cohort, which is consistent with existing reports and indicates that elderly patients with OPSCC have a strong male predominance. 11 Although an association of race with head and neck cancer prognosis has been reported, 12 , 13 it is not appropriate to isolate race as an independent prognostic factor. There are significant differences among ethnic groups regarding economic status and the level of treatment that directly affect survival.…”

Section: Discussionmentioning

confidence: 99%

Retrospective study of the clinicopathological characteristics and prognosis of elderly patients with oropharyngeal squamous cell carcinoma

Li¹,

Jiang²,

Huang³

et al. 2021

J Int Med Res

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Objective Oropharyngeal squamous cell carcinoma (OPSCC) is a malignant tumor that occurs at the tongue base, soft palate, palatine tonsil, and pharyngeal wall. Few studies of OPSCC have been performed in elderly patients. Methods Patients with human papilloma virus (HPV)-related OPSCC were extracted from the Head and Neck with HPV Status Database of the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. We identified 355 patients with HPV-positive status, and we retrospectively evaluated elderly (≥65 years) and younger (30–64 years) patient groups to compare the differences. Results Of the 355 patients who were diagnosed with HPV-related OPSCC, 113 constituted the elderly group. Comparing the elderly group with the younger group, the 3-year HPV-positive overall survival (OS) rates were 62.4% and 70.2%, respectively, and the 5-year OS rates were 50.4% and 59.2%, respectively. Cox regression analysis demonstrated that tumor (T) stage and chemotherapy were prognostic factors for OS. Conclusion Elderly patients with OPSCC had different clinicopathological characteristics. T stage and chemotherapy should be priorities when evaluating the OS of elderly patients with OPSCC.

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Gender and race interact to influence survival disparities in head and neck cancer

Cited by 40 publications

References 47 publications

An equity‐based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma

An equity‐based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma

Trends in Treatment of Head and Neck Cancer in Germany: A Diagnosis-Related-Groups-Based Nationwide Analysis, 2005–2018

Retrospective study of the clinicopathological characteristics and prognosis of elderly patients with oropharyngeal squamous cell carcinoma

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