The relationship between survival and socio-economic status for head and neck cancer in Canada

Abstract

BackgroundHuman papilloma virus (HPV) is emerging as the primary cause for some head and neck cancers. The objective of this study was to investigate the association between head and neck cancer (HNC) survival and socioeconomic status (SES) in Canada, and to investigate changes in the relationship between HNC survival and SES from 1992 to 2005.MethodsCases were drawn from the Canadian Cancer Registry (1992–2005), and were categorized into three subsites: oropharynx, oral cavity, and “other” (hypopharynx, larynx, and nasopharynx). Demographic and socioeconomic information were extracted from the Canadian Census of Population data for the study period, which included three census years: 1991, 1996 and 2001. We linked cases to income quintiles (InQs) according to patients’ postal codes.ResultsOverall survival, without controlling for smoking, for oropharyngeal cancer increased dramatically from 1992–2005 in Canada. This increase in survival for oropharynx cancer was eliminated by the introduction of controls for smoking. Survival for all head and neck cancer subsites was strongly correlated with SES, as measured by income quintile, with lower InQ’s having lower survival than higher. Lastly, the magnitude of the difference in survival between the highest and lowest income quintiles increased significantly over the time period studied for oropharynx cancer, but did not statistically significantly change for oral cavity cancer or other head and neck cancers.ConclusionsThese data confirm a significant impact of socioeconomic deprivation on overall survival for head and neck cancers in Canada, and may provide indirect evidence that HPV-positive head and neck cancers are more common in higher socioeconomic groups.

Smoking at Diagnosis Is an Independent Prognostic Factor for Cancer-Specific Survival in Head and Neck Cancer: Findings from a Large, Population-Based Study

“…The higher rate of cancer-related death in older patients is consistent with findings from other population-based studies of head and neck cancer (61,62), as is the positive association between area-level deprivation and mortality (63)(64)(65). Moreover, the fact that our smoking results were adjusted for deprivation makes socioeconomic confounding an unlikely explanation for our findings in relation to smoking.…”

The incidence and mortality of lip and oral cavity cancer and its relationship to the 2012 Human Development Index of Asia

“…All the aforementioned are among the important reasons for the low 5-year survival of patients as well as the higher mortality rates in developing countries (Funk et al, 2002;Global Burden of Disease Cancer, 2015;Patel et al, 2012;Sargeran et al, 2008). McDonald et al reported in their study that there was lower survival of head and neck cancers, including oral cavity cancer, in people of low socioeconomic statuses (McDonald et al, 2014).…”

Impact of social deprivation on the outcome of major head and neck cancer surgery in England: A national analysis

“…9 If cancer incidence rates were to be considered having adjusted for deprivation group, 15 300 fewer cancers would have been diagnosed in a period between 2006 and 2010. 9 The changing epidemiology of HNC, particularly in the Western world, 10,11 is a balance between a significant fall in the rates of tobacco and excess alcohol consumption, particularly in high-income countries, 12,13 and a rapid concurrent increase in the incidence of oropharyngeal squamous cell carcinoma. 9 The changing epidemiology of HNC, particularly in the Western world, 10,11 is a balance between a significant fall in the rates of tobacco and excess alcohol consumption, particularly in high-income countries, 12,13 and a rapid concurrent increase in the incidence of oropharyngeal squamous cell carcinoma.…”

“…9 In a similar period (2007-2011), there was a yearly excess of 19 200 deaths. This rise of oropharyngeal cancer is associated with human papilloma virus (HPV) infection, 10 which is a biologically and phenotypically distinct type of HNC. This rise of oropharyngeal cancer is associated with human papilloma virus (HPV) infection, 10 which is a biologically and phenotypically distinct type of HNC.…”

“…16 When accounting for areas of socioeconomic deprivation, both men and women demonstrated a linear relationship between increasing deprivation and tobacco consumption. 10 This can be significant, encompassing parameters such as Union Internationale Contre le Cancer (UICC) tumor stage, 19 length of hospital stay, 20 number of postoperative complications, 20,21 and overall survival (OS). 18 In patients undergoing major surgery, factors related to or derivative of socioeconomic status have been suggested as influential, not only to cancer presentation but also to outcomes of surgery.…”