Head and Neck Cancer Stage at Presentation and Survival Outcomes Among Native Hawaiian and Other Pacific Islander Patients Compared With Asian and White Patients

Abstract

often group Native Hawaiian and Other Pacific Islander individuals together with Asian individuals despite being consistently identified as having worse health outcomes and higher rates of comorbidities and mortality. Native Hawaiian and Other Pacific Islander individuals also have high incidence rates of oral cavity and pharyngeal cancer compared with the general population; however, disparities in clinical presentation and survival outcomes of head and neck cancer squamous cell carcinoma (HNSCC) among this population have not been investigated nor compared with those of other races. OBJECTIVE To determine the association of race with cancer stage at diagnosis and survival outcomes among Native Hawaiian and Other Pacific Islander patients with HNSCC compared with Asian and non-Hispanic White patients. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective population-based cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) 18 database. Asian, Native Hawaiian or Other Pacific Islander, and non-Hispanic White adult patients diagnosed in 1988 through 2015 with HNSCC of the oral cavity, oropharynx, nasopharynx, larynx, and hypopharynx were included; any patient whose record was missing data on disease or demographic information was excluded. MAIN OUTCOMES AND MEASURES Cancer stage at presentation was compared among Asian, Native Hawaiian and Other Pacific Islander, and non-Hispanic White patients using a multivariable logistic regression model. Survival outcomes were compared among these racial groups using Cox regression models. Data analyses were performed from July 1, 2021, to March 20, 2022. RESULTS The total study population comprised 76 473 patients: 4894 Asian (mean [SD] age at presentation, 60.7 [14.6] years), 469 Native Hawaiian and Other Pacific Islander (57.8 [12.3] years), and 71 110 non-Hispanic White (62.2 [12.1] years) individuals. Native Hawaiian and Other Pacific Islander patients were more likely to present with advanced-stage HNSCC (odds ratio [OR], 1.38; 95% CI, 1.12 -1.72) compared with non-Hispanic White patients. Asian patients presented with similar stage disease (OR, 1.04; 95% CI, 0.97-1.11) compared with non-Hispanic White patients. Native Hawaiian and Other Pacific Islander patients had worse disease-specific survival (HR, 1.18; 95% CI, 1.02-1.36) compared with non-Hispanic White patients after adjusting for clinical and demographic factors. In contrast, Asian patients had improved disease-specific survival (HR, 0.93; 95% CI, 0.88-0.98) compared with non-Hispanic White patients.CONCLUSIONS AND RELEVANCE This retrospective population-based cohort study suggests that Native Hawaiian and Other Pacific Islander race was associated with more advanced HNSCC, and worse disease-specific survival compared with non-Hispanic White race, while Asian race was associated with improved survival. This study highlights the importance of disaggregating Asian from Pacific Islander data when assessing health disparities, and the need for culturally sensitive interventions t...

Racial disparities in surgical treatment of oropharyngeal cancer: A Surveillance, Epidemiology, and End Results review

“…45 Second, we combined Asian, Native American, Native Hawaiian, and Pacific Islander populations to help with data analysis given the small numbers of these populations in the SEER database, but we agree with the current literature 11,59 that caution must be taken aggregating these groups because, within this group, differences exist even in HNSCC outcomes. 11,59 Third, due to large numbers of missing HPV statuses for earlier years, we were unable to stratify the data by HPV status as this would lead to a missing data bias in our manuscript and potentially provide a misleading trends analysis of change over time. HPV status is essential to examine in future studies, as black patients have worse overall survival and diseasefree survival within HPV-related oropharyngeal cancer.…”

“…The lower rates of surgery in the NHB population may be related to many reasons unavailable within SEER; for example, this association is likely influenced by insurance status 39,40 and comorbidities 45 . Second, we combined Asian, Native American, Native Hawaiian, and Pacific Islander populations to help with data analysis given the small numbers of these populations in the SEER database, but we agree with the current literature 11,59 that caution must be taken aggregating these groups because, within this group, differences exist even in HNSCC outcomes 11,59 . Third, due to large numbers of missing HPV statuses for earlier years, we were unable to stratify the data by HPV status as this would lead to a missing data bias in our manuscript and potentially provide a misleading trends analysis of change over time.…”

“…Similarly, Megwala et al reported worse overall survival and disease‐specific survival for the black race after adjusting for age, sex, marital status, tumor site, and year of diagnosis 10 . Moreover, Moon et al reported that Native Hawaiian and Other Pacific Islander patients were more likely to present with more advanced stage HNSCC as well as worse disease‐specific survival compared to their non‐Hispanic white (NHW) counterparts 11,12 …”

“…10 Moreover, Moon et al reported that Native Hawaiian and Other Pacific Islander patients were more likely to present with more advanced stage HNSCC as well as worse disease-specific survival compared to their non-Hispanic white (NHW) counterparts. 11,12 A need to understand surgical disparities is especially poignant for oropharyngeal squamous cell carcinoma, a disease for which innumerable de-escalation protocols centered on transoral surgical techniques and novel adjuvant therapy protocols have been proposed and conducted over the last decade. [13][14][15][16][17] There is also evidence now of a rising diversity in the HPV(+)OPSCC cancer patient population, 18 an age range extending above 65, 19 and a wide range of smoking histories.…”

Change in Title

“…The Original Investigation titled “Head and Neck Cancer Among Native Hawaiian and Other Pacific Islander Patients—Disparities in Cancer Stage at Presentation and Survival Outcomes Compared With Other Races,” published online on May 26, 2022, was retitled as “Head and Neck Cancer Stage at Presentation and Survival Outcomes Among Native Hawaiian and Other Pacific Islander Patients Compared With Asian and White Patients” to comply with style guidelines. This article was corrected online.…”