Racial disparities in the choice of definitive treatment for squamous cell carcinoma of the oral cavity

Lewis, Carol M.; Ajmani, Gaurav S.; Kyrillos, Alexandra; Chamberlain, Paul; Wang, Chi Hsiung; Nocon, Cheryl C.; Peek, Monica E.; Bhayani, Mihir K.

doi:10.1002/hed.25341

Cited by 23 publications

(21 citation statements)

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“…Racial disparities are well documented across multiple types of cancers, including head and neck squamous cell carcinoma (HNSCC) 1–4 . Black patients with HNSCC face worse prognoses, are less likely to receive the standard of care therapy, and have worse overall survival 4–11 . Some of the differences may be explained by comorbid conditions, differences in stage at presentation, socioeconomic status, and hospital factors 3,4,12 .…”

Section: Introductionmentioning

confidence: 99%

Explaining Racial Disparities in Surgically Treated Head and Neck Cancer

Jassal

Cramer

2020

The Laryngoscope

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Objectives/Hypothesis To assess the causative factors that contribute to racial disparities in head and neck squamous cell carcinoma (HNSCC) and establish the role of hospital factors in racial disparities. Study Design Retrospective database analysis. Methods Patients with surgically treated HNSCC were identified using the National Cancer Database (2004–2014). Logistic and proportional‐hazard regression models were used to characterize the factors that contribute to racial disparities. Differences in quality of care received were compared among black and white patients using previously validated metrics. Results We identified 69,186 eligible patients. Black patients had a 48% higher mortality than white patients (HR 1.48; 95% confidence interval [CI], 1.41–1.54). Black patients had a lower mean quality score (67.6%; 95% CI, 66.8%–69.4%) compared with white patients (71.2%: 95% CI, 71.0%–71.4%) for five quality metrics. After adjusting for differences in patient, oncologic, and hospital factors we were able to explain 60% of the excess mortality for black patients. Oncologic factors at presentation accounted for 57.7% of observed mortality differences, whereas hospital characteristics and quality of care accounted for 11.5%. After adjusting for these factors, black patients still had a 19% higher mortality (HR 1.19; 95% CI, 1.14–1.24). Conclusions Oncologic factors at presentation are a major contributor to racial disparities in outcomes for HNSCC. Hospital factors, such as quality, volume, and safety‐net status, constitute a minor factor in the mortality difference. Resolving existing disparities will require detecting head and neck cancer at an earlier stage and improving the quality of care for black patients. Level of Evidence 3. Laryngoscope, 131:1053–1059, 2021

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Section: Introductionmentioning

confidence: 99%

Explaining Racial Disparities in Surgically Treated Head and Neck Cancer

Jassal

Cramer

2020

The Laryngoscope

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“…Harmful outcomes from racial disparities have been extensively researched in the US, with one 2019 OMFS study investigating the patient's choice of treatment for oral squamous cell carcinoma between different ethnicities. 5 The study found that, despite statistically significantly better outcomes with surgery rather than chemoradiotherapy, the Black patients were significantly less likely than the white patients to receive surgery. 5 Further to this, a blinded retrospective analysis to determine the independent effect of ethnicity on analgesic prescriptions in A&E found that Black patients received less analgesia than white patients.…”

Section: Bias Within Dentistrymentioning

confidence: 94%

“…5 The study found that, despite statistically significantly better outcomes with surgery rather than chemoradiotherapy, the Black patients were significantly less likely than the white patients to receive surgery. 5 Further to this, a blinded retrospective analysis to determine the independent effect of ethnicity on analgesic prescriptions in A&E found that Black patients received less analgesia than white patients. 58 Although they had the same fractures and reported similar pain levels, 66% more Black patients than white received no analgesia.…”

Section: Bias Within Dentistrymentioning

confidence: 94%

“…Racial bias in dental treatment planning is evident worldwide. 4,5,57,58 A 2019 crosssectional survey conducted at King's College London concluded that a patient's race affected the dentist's decision-making. 4 The survey discovered that, for the same clinical vignette of irreversible pulpitis symptoms, photographs and radiographs, 86% of the dental participants would recommend a root canal treatment for the white patient but only 61% for the Black patient.…”

Section: Bias Within Dentistrymentioning

confidence: 99%

“…It is therefore hard to imagine how a profession committed to treating patients equally can improve with respect to the Black population, but studies show that unconscious bias in dentistry still exists and can have severe repercussions. 3,4,5,6 Increasingly, dental curricula have included communication skills along with equality and diversity training; however, there will always remain a need for reflection and improvement throughout a dentist's career. 7 As a Black dental student, pictured in Figure 1 at Queen Mary University of London, I felt compelled to discuss and document the issues that I and others have faced.…”

Section: Introductionmentioning

confidence: 99%

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Black Lives Matter: the impact and lessons for the UK dental profession

Kadiyo

Mellish

2021

Br Dent J

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A contemporary analysis of racial disparities in recommended and received treatment for head and neck cancer

Nocon

Ajmani

Bhayani

2019

Cancer

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BACKGROUND: Racial disparities in squamous cell carcinoma of the head and neck (HNSCC) negatively affect non-Hispanic black (NHB) patients. This study was aimed at understanding how treatment is prescribed and received across all HNSCC subsites. METHODS: With the National Cancer Database, patients from 2004 to 2014 with surgically resectable HNSCCs, including tumors of the oral cavity (OC), oropharynx (OP), hypopharynx (HP), and larynx (LX), were studied. The treatment received was either upfront surgery or nonsurgical treatment. Treatment patterns were compared according to race and subsite, and how these differences changed over time was evaluated. RESULTS: NHB patients were less likely than non-Hispanic white (NHW) patients to receive surgery across all subsites (relative risk [RR] for OC, 0.87; RR for OP, 0.75; RR for HP, 0.73; RR for LX, 0.87; all P values <.05). They were also more likely to refuse a recommended surgery (RR for OC, 1.50; RR for OP, 1.23; RR for HP, 1.23; RR for LX, 1.34), and this difference was significant except for HP. NHB patients were more likely to not be offered surgery across all subsites (RR for OC, 1.38; RR for OP, 1.07; RR for HP, 1.05; RR for LX, 1.03; all P values <.05). Rates of surgery increased and rates of not being offered surgery declined for both NHB and NHW patients from 2004 to 2014, but the absolute disparities persisted in 2014. CONCLUSIONS: Across all HNSCC subsites, NHB patients were less likely than NHW patients to be recommended for and receive surgery and were more likely to refuse surgery. These differences have closed over time but persist. Enhanced shared decision making may improve these disparities.

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Racial disparities in the choice of definitive treatment for squamous cell carcinoma of the oral cavity

Abstract: The non-Hispanic black patients are less likely to receive or be recommended surgery for oral cavity SCC and are more likely to refuse surgery. Further study is needed to identify strategies to close this disparity.

Cited by 23 publications

References 35 publications

Explaining Racial Disparities in Surgically Treated Head and Neck Cancer

Explaining Racial Disparities in Surgically Treated Head and Neck Cancer

Black Lives Matter: the impact and lessons for the UK dental profession

A contemporary analysis of racial disparities in recommended and received treatment for head and neck cancer

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