Sociodemographic correlates of head and neck cancer survival among patients with metastatic disease

Abstract

Background To describe sociodemographic factors associated with head and neck cancer (HNC) survival among patients with distant metastatic disease. Methods We retrospectively analyzed national data for 2889 adult patients with metastatic HNC (2007‐2015). We used Fine and Gray competing risks proportional hazard models, stratified by oropharyngeal cancer status, controlled for sociodemographic factors (age, sex, race/ethnicity, marital status, and insurance status), and accounted for multiple testing. Results Median survival time was 11 months (15 months for patients married/partnered; 13 months for patients with non‐Medicaid insurance; P < .01). Among patients with oropharyngeal cancer, being married/partnered was associated with lower mortality hazard (sdHRdivorced/separated = 1.37, 97.5% confidence interval [CI] = 1.07, 1.75; and sdHRnever married = 1.43, 97.5% CI = 1.14, 1.80), as was having non‐Medicaid insurance (sdHRuninsured = 1.44, 97.5% CI = 1.02, 2.04). Conclusions Health insurance and marital status are sociodemographic factors associated with survival among HNC patients with distant metastatic disease, especially in oropharyngeal cases.

Targets for improving disparate head and neck cancer outcomes in the low‐income population

“…The head and neck cancer outcomes in low‐income populations lag behind those of the more affluent—and the degree is dramatic. The degree of disparity is in the range of 20%–90% worse overall survival across most subtypes 5–13 . Yet the necessary solutions advocated in this review have already been proven to work—as drastically better outcomes have already been achieved in more affluent populations.…”

“…The degree of disparity is in the range of 20%–90% worse overall survival across most subtypes. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 Yet the necessary solutions advocated in this review have already been proven to work—as drastically better outcomes have already been achieved in more affluent populations. Eliminating smoking, which is two to three times more prevalent in low‐income populations, should be at the forefront of preventive measures.…”

“…Even when limiting the analysis to young patients with fewer comorbidities, Medicaid patients have 60% worse survival for all head and neck sites 10 . For patients with metastatic disease, Medicaid patients have nearly 50% worse overall survival in SEER and 30% worse overall survival in the National Cancer Database 11,12 . Even in HPV‐positive oropharynx cancer, patients with low income had worse 3‐year overall survival 13 …”

“… 10 For patients with metastatic disease, Medicaid patients have nearly 50% worse overall survival in SEER and 30% worse overall survival in the National Cancer Database. 11 , 12 Even in HPV‐positive oropharynx cancer, patients with low income had worse 3‐year overall survival. 13 …”

Healthcare Disparities in Laryngology: A Scoping Review

“…Insurance status may also not be applicable in single‐payer healthcare systems, and uniquely defined American insurance status, such as Medicaid, is not applicable elsewhere. Moreover, Medicaid in particular has previously been demonstrated to be associated with inferior outcomes in a wide range of otolaryngologic and other conditions 28–31 . Disparities related to occupation were not considered for inclusion due to the difficulty in distinguishing between occupation‐related environmental exposures and occupation as a proxy for socioeconomic status.…”