Impact of race/ethnicity on laryngeal cancer in patients treated at a Veterans Affairs Medical Center

Sandulache, Vlad C.; Kubik, Mark W.; Skinner, Heath D.; Malsky, Joseph A.; Gelbard, Alexander; Zevallos, José P.

doi:10.1002/lary.24058

Cited by 32 publications

(50 citation statements)

References 15 publications

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“…The VA is an equal access system that provides cancer care to a racially diverse veteran population without the financial restrictions generally associated with the private sector. Previous studies have demonstrated that racial disparities in outcomes are diminished in patients with colon and laryngeal cancer treated within the VA system. We hypothesize that African Americans with oropharyngeal SCC treated in the VA system will similarly have equivalent stage at presentation, treatment, p16 tumor expression, disease‐free survival (DFS), and overall survival (OS) compared with non‐Hispanic whites.…”

Section: Introductionmentioning

confidence: 99%

Impact of race on oropharyngeal squamous cell carcinoma presentation and outcomes among veterans

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Impact of race on oropharyngeal squamous cell carcinoma presentation and outcomes among veterans

et al. 2015

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“…Most patients underwent radiation based treatment, consistent with national trends (Table ) . Chemotherapy was added to radiation in the definitive setting in 152 of 262 patients and in the adjuvant setting in 13 of 55 patients.…”

Section: Resultsmentioning

confidence: 55%

“…Our previous publications detail compliance with NCCN guidelines as it relates to treatment selection . A majority of patients underwent external beam radiotherapy (EBRT) in the primary or adjuvant setting (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…The US Veterans Affairs medical system provides a vertically and horizontally integrated medical system that services a large, diverse patient population across the entire geographical landscape of the United States. As such, it provides a unique opportunity to study, and potentially improve, care delivery patterns for patients with HNSCC, particularly in an understudied patient population . To our knowledge, this is the largest single institution veteran cohort to undergo this type of analysis in the modern era.…”

Section: Discussionmentioning

confidence: 99%

“…We recently published oncologic outcomes for patients with laryngeal and oropharyngeal squamous cell carcinoma (SCC) treated at one of the largest VHA cancer centers in the country . Our results demonstrate that outcomes for veterans with laryngeal and oropharyngeal SCC are comparable to published series from other tertiary centers and prospective clinical trials . Here we sought to evaluate treatment patterns associated with multi‐disciplinary treatment delivery for laryngeal and oropharyngeal cancer.…”

Section: Introductionmentioning

confidence: 99%

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Treatment Patterns in Veterans with Laryngeal and Oropharyngeal Cancer and Impact on Survival

Richardson

Kansara

Chen

et al. 2018

Laryngoscope Investig Oto

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ObjectivesVeterans with laryngeal and oropharyngeal cancer remain an understudied patient population despite a high incidence of disease and decreased survival compared to the general population. Our objective was to evaluate treatment patterns for laryngeal and oropharyngeal cancer in patients treated at one of the Veterans Health Administration's busiest cancer centers in order to generate some basic benchmarks for treatment delivery in the veteran population.MethodsWe reviewed 338 patients treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2000 and 2012.ResultsOropharyngeal site and advanced age were associated with worse overall and disease‐free survival. Treatment periods (mean) were as follows: 1) referral‐diagnosis, 26 days; 2) diagnosis‐surgery, 29 days; and 3) diagnosis‐radiation, 58 days. Adjuvant radiation was initiated within 6 weeks of surgery in 42% of patients and 68% of patients had a total treatment package time ≤100 days. Time from diagnosis to treatment initiation, surgery to adjuvant radiation interval and total treatment package time did not impact survival.ConclusionsThis study establishes basic benchmarks for laryngeal and oropharyngeal cancer treatment delivery in veterans. Additional efforts are warranted to improve consistency and provide treatment in line with NCCN recommendations and literature consensus.Level of Evidence2b

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Inequities Associated With Advanced Stage at Presentation of Head and Neck Cancer

Ioerger,

Mills,

Wagoner

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceSocial determinants of health (SDoH) are defined by a wide range of factors (eg, built environment, economic stability, education level, discrimination, racism, access to health care). Advanced stage at presentation or delayed diagnosis heavily influences health outcomes in patients with head and neck cancer (HNC). While the drivers of advanced-stage presentation come from a multitude of sources, SDoH plays an outsized role.ObjectiveTo systematically review the published literature to identify which SDoH are established as risk factors for delayed diagnosis or advanced stage at presentation among patients with HNC.Evidence ReviewIn this systematic review, a literature search of PubMed, Web of Science, and Embase was conducted on February 27, 2023, using keywords related to advanced stage at presentation and delayed diagnosis of HNC between 2013 and 2023. Quality assessment was evaluated through the Newcastle-Ottawa Scale. Articles were included if they focused on US-based populations and factors associated with advanced stage at presentation or delayed diagnosis of HNC.FindingsOverall, 50 articles were included for full-text extraction, of which 30 (60%) were database studies. Race was the most commonly reported variable (46 studies [92%]), with Black race (43 studies [93%]) being the most studied racial group showing an increased risk of delay in diagnosis of HNC. Other commonly studied variables that were associated with advanced stage at presentation included sex and gender (41 studies [82%]), insurance status (25 studies [50%]), geographic region (5 studies [10%]), and socioeconomic status (20 studies [40%]). Male sex, lack of insurance, rurality, and low socioeconomic status were all identified as risk factors for advanced stage at presentation.Conclusions and RelevanceThis systematic review provides a comprehensive list of factors that were associated with advanced HNC stage at presentation. Future studies should focus on evaluating interventions aimed at addressing the SDoH in communities experiencing disparities to provide a net positive effect on HNC care.

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Impact of race/ethnicity on laryngeal cancer in patients treated at a Veterans Affairs Medical Center

Cited by 32 publications

References 15 publications

Impact of race on oropharyngeal squamous cell carcinoma presentation and outcomes among veterans

Impact of race on oropharyngeal squamous cell carcinoma presentation and outcomes among veterans

Treatment Patterns in Veterans with Laryngeal and Oropharyngeal Cancer and Impact on Survival

Inequities Associated With Advanced Stage at Presentation of Head and Neck Cancer

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