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Fei-Zhang DJ, Park AC, Chelius DC, Smith SS, Samant S, Patel UA, Sheyn AM, Rastatter JC. Influence of Social Vulnerability in Treatment and Prognosis of Squamous Cell Carcinoma of the Tongue. Otolaryngol Head Neck Surg 2024; 170:1338-1348. [PMID: 38353303 DOI: 10.1002/ohn.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/20/2023] [Accepted: 12/23/2023] [Indexed: 04/30/2024]
Abstract
OBJECTIVE To investigate the association of social determinants of health (SDoH) in squamous cell carcinoma of the tongue in the United States and to evaluate the real-world contribution of specific disparities. STUDY DESIGN Retrospective cohort study. SETTING United States. METHODS The Centers for Disease Control and Prevention-Social Vulnerability Index (SVI) and National Cancer Institute-Surveillance, Epidemiology, and End Results Program database were used to study 62,103 adult tongue squamous cell carcinoma patients from 1975 to 2017. Regression analysis assessed trends in months of follow-up and survival across social vulnerability and 4 subcategories of social vulnerability. RESULTS As overall SVI score increases (increased social vulnerability), there is a significant decrease in the average length of follow-up (22.95% decrease from 63.99 to 49.31 months; P < .001) across patients from the lowest and highest social vulnerability groups. As overall SVI score increases, there is a significant decrease in the average months of survival (28.00% decrease from 49.20 to 35.43 months; P < .001). There is also a significantly greater odds ratio (OR = 1.05; P < .001) of advanced cancer staging upon presentation at higher SVI scores. Patients with higher SVI scores have a lower OR (0.93; P < .001) of receiving surgery as their primary treatment when compared to patients with lower SVI scores. Patients with higher SVI scores also have a significantly greater OR (OR = 1.05; P < .001) of receiving chemotherapy as their primary treatment when compared to patients with lower SVI scores. CONCLUSION Increased social vulnerability is shown to have a detrimental impact on the treatment and prognosis of patients with squamous cell carcinoma of the tongue.
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Affiliation(s)
- David J Fei-Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Asher C Park
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniel C Chelius
- Department of Otolaryngology-Head and Neck Surgery, Pediatric Thyroid Tumor Program and Pediatric Head and Neck Tumor Program, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Stephanie S Smith
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandeep Samant
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Urjeet A Patel
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anthony M Sheyn
- Department of Pediatric Otolaryngology, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Pediatric Otolaryngology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jeffrey C Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Walsh AR, Giurintano JP, Maxwell JH, Shah AH, Haupt TL, Wadley AE, Kowkuntla SR, Habib AM, Shah V. Associations Between Race and Survival Outcomes Among Veterans With Head and Neck Cancer in a Racially Diverse Setting. OTO Open 2024; 8:e150. [PMID: 38863487 PMCID: PMC11165679 DOI: 10.1002/oto2.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/14/2024] [Accepted: 05/17/2024] [Indexed: 06/13/2024] Open
Abstract
Objective There is limited data on the impact of clinical-demographic factors on survival outcomes among veterans with head and neck squamous cell carcinoma (HNSCC). This study was undertaken to evaluate the impact of race and other factors on overall survival (OS) in a population of veterans with HNSCC treated with curative intent. Methods Demographic and clinical data were collected on veterans with HNSCC treated with curative intent at our institution between 1999 and 2021. The primary outcome was 3-year OS. Secondary outcomes included treatment delay intervals, including time to treatment initiation (TTI), total package time, and duration of chemoradiation (DCRT). Results Of 260 veterans with HNSCC, black veterans had significantly lower 3-year OS (49.4%) compared to white veterans (65%, P = .019). Black veterans were also more likely to experience delays in treatment initiation (median TTI 46 vs 41 days; P = .047). Black patients were more likely to receive radiation alone (25.8% [black] vs 8.4% [white]; P < .001) and less likely to receive adjuvant therapy if treated surgically (11.1% [black] vs 22.4% [white]; P = .004), despite any statistically significant difference in stage of their tumor at presentation (Stage I: 21.2% [black] vs 19.6% [white]; P = .372); (Stage IV: 44.4% [black] vs 48.6% [white]; P = .487). Other factors associated with worse 3-year OS included older age (P = .023), lower body mass index (P = .026), neurocognitive disorder/dementia (P = .037), mental health disorders (P = .020), hypopharyngeal primary (P = .001), higher stage disease (P = .002), treatment type (P = .001), need for prophylactic gastrostomy tube (P = .048) or tracheotomy (P = .005), recurrent disease (P = .036), persistent disease (P < .001), distant metastases (P = .002), longer TTI (P = .0362), and longer DCRT (P = .004). Discussion Black race appears to be an independent predictor of 3-year OS in veterans with HNSCC. Further studies are warranted to determine the factors responsible for disparities in survival. Implications for Practice This study evaluated the ways in which race affects survival for US veterans with head and neck cancer. The authors found that black veterans had an increased risk of death compared to white patients, and also experienced delays when receiving treatment. Level of Evidence Level IV.
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Affiliation(s)
- Amanda R. Walsh
- Department of Otolaryngology–Head and Neck SurgeryMedStar Georgetown University HospitalWashingtonDistrict of ColumbiaUSA
| | - Jonathan P. Giurintano
- Department of Otolaryngology–Head and Neck SurgeryMedStar Georgetown University HospitalWashingtonDistrict of ColumbiaUSA
| | - Jessica H. Maxwell
- Department of Otolaryngology–Head and Neck SurgeryDistrict of Columbia Veteran's Affairs Medical CenterWashingtonDistrict of ColumbiaUSA
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Anuja H. Shah
- Department of Otolaryngology‐Head and Neck SurgeryGeorgetown University School of MedicineWashingtonDistrict of ColumbiaUSA
| | - Thomas L. Haupt
- Howard University College of MedicineWashingtonDistrict of ColumbiaUSA
| | - Andrew E. Wadley
- Howard University College of MedicineWashingtonDistrict of ColumbiaUSA
| | - Sandeep R. Kowkuntla
- Department of Otolaryngology‐Head and Neck SurgeryGeorgetown University School of MedicineWashingtonDistrict of ColumbiaUSA
| | - Andy M. Habib
- Department of Otolaryngology‐Head and Neck SurgeryGeorgetown University School of MedicineWashingtonDistrict of ColumbiaUSA
| | - Veranca Shah
- Department of Otolaryngology‐Head and Neck SurgeryGeorgetown University School of MedicineWashingtonDistrict of ColumbiaUSA
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Whitehead RA, Patel EA, Liu JC, Bhayani MK. Racial Disparities in Head and Neck Cancer: It's Not Just About Access. Otolaryngol Head Neck Surg 2024; 170:1032-1044. [PMID: 38258967 DOI: 10.1002/ohn.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Medical literature identifies stark racial disparities in head and neck cancer (HNC) in the United States, primarily between non-Hispanic white (NHW) and non-Hispanic black (NHB) populations. The etiology of this disparity is often attributed to inequitable access to health care and socioeconomic status (SES). However, other contributors have been reported. We performed a systematic review to better understand the multifactorial landscape driving racial disparities in HNC. DATA SOURCES A systematic review was conducted in Covidence following Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidelines. A search of PubMed, SCOPUS, and CINAHL for literature published through November 2022 evaluating racial disparities in HNC identified 2309 publications. REVIEW METHODS Full texts were screened by 2 authors independently, and inconsistencies were resolved by consensus. Three hundred forty publications were ultimately selected and categorized into themes including disparities in access/SES, treatment, lifestyle, and biology. Racial groups examined included NHB and NHW patients but also included Hispanic, Native American, and Asian/Pacific Islander patients to a lesser extent. RESULTS Of the 340 articles, 192 focused on themes of access/SES, including access to high-quality hospitals, insurance coverage, and transportation contributing to disparate HNC outcomes. Additional themes discussed in 148 articles included incongruities in surgical recommendations, tobacco/alcohol use, human papillomavirus-associated malignancies, and race-informed silencing of tumor suppressor genes. CONCLUSION Differential access to care plays a significant role in racial disparities in HNC, disproportionately affecting NHB populations. However, there are other significant themes driving racial disparities. Future studies should focus on providing equitable access to care while also addressing these additional sources of disparities in HNC.
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Affiliation(s)
- Russell A Whitehead
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Evan A Patel
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jeffrey C Liu
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Mihir K Bhayani
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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4
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Lin J, Orestes MI, Shriver CD, Zhu K. Differences in Survival between Black and White Patients with Head and Neck Squamous Cell Carcinoma: Comparison of Data from the DOD Central Cancer Registry and SEER. Cancer Epidemiol Biomarkers Prev 2024; 33:426-434. [PMID: 38099827 DOI: 10.1158/1055-9965.epi-23-0862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/06/2023] [Accepted: 12/13/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Barriers to health care access may contribute to the poorer survival of Black patients with head and neck squamous cell carcinoma (HNSCC) than their White counterparts in the U.S. general population. The Department of Defense's (DOD) Military Health System (MHS) provides universal health care access to all beneficiaries with various racial backgrounds. METHODS We compared overall survival of patients with HNSCC by race in the MHS and the general population, respectively, to assess whether there were differences in racial disparity between the two populations. The MHS patients were identified from the DOD's Central Cancer Registry (CCR) and the patients from the U.S. general population were identified from the NCI's Surveillance, Epidemiology and End Results (SEER) program. For each cohort, a retrospective study was conducted comparing survival by race. RESULTS Black and White patients in the CCR cohort had similar survival in multivariable Cox regression models with a HR of 1.04 and 95% confidence interval (95% CI) of 0.81 to 1.33 after adjustment for the potential confounders. In contrast, Black patients in the SEER cohort exhibited significantly worse survival than White patients with an adjusted HR of 1.47 (95% CI = 1.43-1.51). These results remained similar in the subgroup analyses for oropharyngeal and non-oropharyngeal sites, respectively. CONCLUSIONS There was no racial difference in survival among patients with HNSCC in the MHS system, while Black patients had significantly poorer survival than White patients in the general population. IMPACT Equal access to health care could reduce racial disparity in overall survival among patients with HNSCC.
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Affiliation(s)
- Jie Lin
- John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Michael I Orestes
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Craig D Shriver
- John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kangmin Zhu
- John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
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5
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Dias KB, Hildebrand LC, Carvalho ALHD, Ferri CA, Nör JE, Cerski CTS, Visioli F, Oliveira MG, Rados PV. Clinical outcomes and prognostic factors of head and neck squamous cell carcinoma: a ten-year follow-up study. Braz Oral Res 2023; 37:e128. [PMID: 38126472 DOI: 10.1590/1807-3107bor-2023.vol37.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 07/07/2023] [Indexed: 12/23/2023] Open
Abstract
Traditional guidelines for determining the prognosis of patients with head and neck squamous cell carcinoma (HNSCC) are used to make therapeutic decisions. However, only 50% of the patients had lived for more than five years. The present study aimed to analyze the correlation of traditional prognostic factors such as tumor size, histological grading, regional metastases, and treatment with the survival of patients with HNSCC. A total of 78 patients diagnosed with HNSCC were followed up for 10 years after diagnosis and treatment. The health status of the patients was tracked at four time points, and according to the evolution of the patients and their final clinical status, we performed a prognostic analysis based on the clinical outcomes observed during the follow-up period. The final study cohort comprised 50 patients. Most patients had tumors < 4 cm in size (64%) and no regional metastases (64%); no patients had distant metastases at the time of diagnosis. Most individuals had tumors with good (48%) and moderate (46%) degrees of malignancy. At the end of the follow-up period, only 14% of the patients were discharged, 42% died of the tumor, and 44% remained under observation owing to the presence of a potentially malignant disorder, relapse, or metastases. This analysis showed that traditional prognostic factors were not accurate in detecting subclinical changes or predicting the clinical evolution of patients.
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Affiliation(s)
- Kelly Bienk Dias
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry , Pathology Department , Porto Alegre , RS , Brazil
| | - Laura Campos Hildebrand
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry , Pathology Department , Porto Alegre , RS , Brazil
| | - Ana Luísa Homem de Carvalho
- Pathology Department , School of Dentistry , Pontifícia Universidade Católica do Grande do Sul , Porto Alegre , Rio Grande do Sul , Brazil
| | - Camila Alves Ferri
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry , Pathology Department , Porto Alegre , RS , Brazil
| | - Jacques Eduardo Nör
- University of Michigan , School of Dentistry , Cariology Department, Restorative Sciences, and Endodontics , Ann Arbor , MI , USA
| | - Carlos Thadeu Schmidt Cerski
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clinícas de Porto Alegre , Porto Alegre , RS , Brazil
| | - Fernanda Visioli
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry , Pathology Department , Porto Alegre , RS , Brazil
| | - Márcia Gaiger Oliveira
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry , Pathology Department , Porto Alegre , RS , Brazil
| | - Pantelis Varvaki Rados
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry , Pathology Department , Porto Alegre , RS , Brazil
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Ramadan S, Lee JJ, Wang R, Jackson RS, Pipkorn P, Rich J, Harbison RA, Zolkind P, Kang SY, Puram SV, Mazul AL. Neighborhood socioeconomic status and race are associated with incidence disparities in oral cavity cancers. Oral Oncol 2023; 147:106607. [PMID: 37897859 DOI: 10.1016/j.oraloncology.2023.106607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES To determine the association between neighborhood socioeconomic status (nSES), race and incidence rate trends of oral cavity cancer (OCC). MATERIALS AND METHODS We used data from the SEER (Surveillance, Epidemiology, and End Results) 18 Census Tract-level SES and Rurality Database (2006-2018) database of the National Cancer Institute to create cohorts of OCC patients between 2006 and 2018. Annual incidence rates were calculated and trends in rates were estimated using joinpoints regression. RESULTS The incidence of OCC is the highest among low nSES White Americans (2.86 per 100 000 persons) and the lowest among high nSES Black Americans (1.17 per 100 000 persons). Incidence has significantly increased among Asian Americans (annual percent change [APC]: low nSES-2.4, high nSES-2.6) and White Americans (APC: low nSES-1.4, high nSES-1.6). Significant increases in the incidence of oral tongue cancer in these groups primarily drive this increase. Other increases were noted in alveolar ridge cancer among White Americans and hard palate cancer among Asian Americans. OCC incidence decreased significantly in Hispanic Americans of high nSES (APC: -2.5) and Black Americans of low nSES (APC: -2.7). Floor of mouth cancer incidence decreased among most groups. CONCLUSION Despite the overall decreasing incidence of OCC, these trends are inconsistent among all OCC subsites. Differences are seen by race, nSES, and subsite, indicating intersectional barriers that extend beyond nSES and race and ethnicity alone. Further research on risk factors and developing interventions targeting vulnerable groups is needed.
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Affiliation(s)
- Salma Ramadan
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jake J Lee
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ray Wang
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ryan S Jackson
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Patrik Pipkorn
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jason Rich
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - R Alex Harbison
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Paul Zolkind
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Stephen Y Kang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Sidharth V Puram
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA; Department of Genetics, Washington University School of Medicine, Saint Louis, MO, USA.
| | - Angela L Mazul
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA; Department of Otolaryngology, University of Pittsburgh, and UPMC Hillman Cancer Center, Pittsburgh, PA, 15260, USA
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Polachini GM, de Castro TB, Smarra LFS, Henrique T, de Paula CHD, Severino P, López RVM, Carvalho AL, de Mattos Zeri AC, Silva IDCG, Tajara EH. Plasma metabolomics of oral squamous cell carcinomas based on NMR and MS approaches provides biomarker identification and survival prediction. Sci Rep 2023; 13:8588. [PMID: 37237049 DOI: 10.1038/s41598-023-34808-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Metabolomics has proven to be an important omics approach to understand the molecular pathways underlying the tumour phenotype and to identify new clinically useful markers. The literature on cancer has illustrated the potential of this approach as a diagnostic and prognostic tool. The present study aimed to analyse the plasma metabolic profile of patients with oral squamous cell carcinoma (OSCC) and controls and to compare patients with metastatic and primary tumours at different stages and subsites using nuclear magnetic resonance and mass spectrometry. To our knowledge, this is the only report that compared patients at different stages and subsites and replicates collected in diverse institutions at different times using these methodologies. Our results showed a plasma metabolic OSCC profile suggestive of abnormal ketogenesis, lipogenesis and energy metabolism, which is already present in early phases but is more evident in advanced stages of the disease. Reduced levels of several metabolites were also associated with an unfavorable prognosis. The observed metabolomic alterations may contribute to inflammation, immune response inhibition and tumour growth, and may be explained by four nonexclusive views-differential synthesis, uptake, release, and degradation of metabolites. The interpretation that assimilates these views is the cross talk between neoplastic and normal cells in the tumour microenvironment or in more distant anatomical sites, connected by biofluids, signalling molecules and vesicles. Additional population samples to evaluate the details of these molecular processes may lead to the discovery of new biomarkers and novel strategies for OSCC prevention and treatment.
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Affiliation(s)
- Giovana Mussi Polachini
- Department of Molecular Biology, School of Medicine of São José Do Rio Preto - FAMERP, Av. Brigadeiro Faria Lima, 5416, Vila São Pedro, São José do Rio Preto, SP, CEP 15090-000, Brazil
| | - Tialfi Bergamin de Castro
- Department of Molecular Biology, School of Medicine of São José Do Rio Preto - FAMERP, Av. Brigadeiro Faria Lima, 5416, Vila São Pedro, São José do Rio Preto, SP, CEP 15090-000, Brazil
| | - Luis Fabiano Soares Smarra
- Department of Molecular Biology, School of Medicine of São José Do Rio Preto - FAMERP, Av. Brigadeiro Faria Lima, 5416, Vila São Pedro, São José do Rio Preto, SP, CEP 15090-000, Brazil
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, SP, Brazil
| | - Tiago Henrique
- Department of Molecular Biology, School of Medicine of São José Do Rio Preto - FAMERP, Av. Brigadeiro Faria Lima, 5416, Vila São Pedro, São José do Rio Preto, SP, CEP 15090-000, Brazil
| | - Carlos Henrique Diniz de Paula
- Department of Molecular Biology, School of Medicine of São José Do Rio Preto - FAMERP, Av. Brigadeiro Faria Lima, 5416, Vila São Pedro, São José do Rio Preto, SP, CEP 15090-000, Brazil
| | - Patricia Severino
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - André Lopes Carvalho
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil
| | | | | | - Eloiza H Tajara
- Department of Molecular Biology, School of Medicine of São José Do Rio Preto - FAMERP, Av. Brigadeiro Faria Lima, 5416, Vila São Pedro, São José do Rio Preto, SP, CEP 15090-000, Brazil.
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, SP, Brazil.
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Gobin C, Inkabi S, Lattimore CC, Gu T, Menefee JN, Rodriguez M, Kates H, Fields C, Bian T, Silver N, Xing C, Yates C, Renne R, Xie M, Fredenburg KM. Investigating miR-9 as a mediator in laryngeal cancer health disparities. Front Oncol 2023; 13:1096882. [PMID: 37081981 PMCID: PMC10112398 DOI: 10.3389/fonc.2023.1096882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
Background For several decades, Black patients have carried a higher burden of laryngeal cancer among all races. Even when accounting for sociodemographics, a disparity remains. Differentially expressed microRNAs have been linked to racially disparate clinical outcomes in breast and prostate cancers, yet an association in laryngeal cancer has not been addressed. In this study, we present our computational analysis of differentially expressed miRNAs in Black compared with White laryngeal cancer and further validate microRNA-9-5p (miR-9-5p) as a potential mediator of cancer phenotype and chemoresistance. Methods Bioinformatic analysis of 111 (92 Whites, 19 Black) laryngeal squamous cell carcinoma (LSCC) specimens from the TCGA revealed miRNAs were significantly differentially expressed in Black compared with White LSCC. We focused on miR-9-5 p which had a significant 4-fold lower expression in Black compared with White LSCC (p<0.05). After transient transfection with either miR-9 mimic or inhibitor in cell lines derived from Black (UM-SCC-12) or White LSCC patients (UM-SCC-10A), cellular migration and cell proliferation was assessed. Alterations in cisplatin sensitivity was evaluated in transient transfected cells via IC50 analysis. qPCR was performed on transfected cells to evaluate miR-9 targets and chemoresistance predictors, ABCC1 and MAP1B. Results Northern blot analysis revealed mature miR-9-5p was inherently lower in cell line UM-SCC-12 compared with UM-SCC-10A. UM -SCC-12 had baseline increase in cellular migration (p < 0.01), proliferation (p < 0.0001) and chemosensitivity (p < 0.01) compared to UM-SCC-10A. Increasing miR-9 in UM-SCC-12 cells resulted in decreased cellular migration (p < 0.05), decreased proliferation (p < 0.0001) and increased sensitivity to cisplatin (p < 0.001). Reducing miR-9 in UM-SCC-10A cells resulted in increased cellular migration (p < 0.05), increased proliferation (p < 0.05) and decreased sensitivity to cisplatin (p < 0.01). A significant inverse relationship in ABCC1 and MAP1B gene expression was observed when miR-9 levels were transiently elevated or reduced in either UM-SCC-12 or UM-SCC-10A cell lines, respectively, suggesting modulation by miR-9. Conclusion Collectively, these studies introduce differential miRNA expression in LSCC cancer health disparities and propose a role for low miR-9-5p as a mediator in LSCC tumorigenesis and chemoresistance.
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Affiliation(s)
- Christina Gobin
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, United States
| | - Samuel Inkabi
- College of Graduate Health Studies, A.T. Still University, Kirksville, MO, United States
| | - Chayil C. Lattimore
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, United States
| | - Tongjun Gu
- Interdisciplinary Center for Biotechnology Research Bioinformatics Core Facility, University of Florida, Gainesville, FL, United States
| | - James N. Menefee
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, United States
| | - Mayrangela Rodriguez
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, United States
| | - Heather Kates
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, United States
| | - Christopher Fields
- Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX, United States
| | - Tengfei Bian
- Department of Medicinal Chemistry, University of Florida, Gainesville, FL, United States
| | - Natalie Silver
- Head and Neck Institute/Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Chengguo Xing
- Department of Medicinal Chemistry, University of Florida, Gainesville, FL, United States
| | - Clayton Yates
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rolf Renne
- Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, FL, United States
| | - Mingyi Xie
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL, United States
| | - Kristianna M. Fredenburg
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, United States
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Disparities in Survival Outcomes among Racial/Ethnic Minorities with Head and Neck Squamous Cell Cancer in the United States. Cancers (Basel) 2023; 15:cancers15061781. [PMID: 36980667 PMCID: PMC10046381 DOI: 10.3390/cancers15061781] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Racial/ethnic (R/E) minorities with head and neck squamous cell carcinoma (HNSCC) have worse survival outcomes compared to White patients. While disparities in patient outcomes for R/E minorities have been well documented, the specific drivers of the inferior outcomes remain poorly understood. Patients and Methods: This was a population-based retrospective cohort study that analyzed HNSCC patients using the National Cancer Database (NCDB) from 2000–2016. Patient outcomes were stratified by R/E groups including White, Black, Hispanic, Native American/Other, and Asian. The main outcome in this study was overall survival (OS). Univariate time-to-event survival analyses were performed using the Kaplan–Meier product limit estimates and the log-rank test to evaluate the differences between strata. Results: There were 304,138 patients with HNSCC identified in this study, of which 262,762 (86.3%) were White, 32,528 (10.6%) were Black, 6191 were Asian (2.0%), and 2657 were Native American/Other (0.9%). Black R/E minorities were more likely to be uninsured (9% vs. 5%, p < 0.0001), have Medicaid insurance (22% vs. 8%, p < 0.0001), be in a lower income quartile (<30,000, 42% vs. 13%, p < 0.0001), have metastatic disease (5% vs. 2%, p < 0.001), and have a total treatment time 6 days longer than White patients (median 107 vs. 101 days, p < 0.001). The 5-year OS for White, Black, Native American/Other, and Asian patients was 50.8%, 38.6%, 51.1%, and 55.8%, respectively. Among the oropharynx HNSCC patients, the 5-year OS rates in p16+ White, Black, and Asian patients were 65.7%, 39.4%%, and 55%, respectively. After a multivariate analysis, Black race was still associated with an inferior OS (HR:1.09, 95% CI: 1.03–1.15, p = 0.002). Conclusions: This large cohort study of HNSCC patients demonstrates that Black race is independently associated with worse OS, in part due to socioeconomic, clinical, and treatment-related factors.
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10
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Liu JC, Egleston BL, Blackman E, Ragin C. Racial survival disparities in head and neck cancer clinical trials. J Natl Cancer Inst 2023; 115:288-294. [PMID: 36477855 PMCID: PMC9996207 DOI: 10.1093/jnci/djac219] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/13/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Survival disparities between Black and White head and neck cancer patients are well documented, with access to care and socioeconomic status as major contributors. We set out to assess the role of self-reported race in head and neck cancer by evaluating treatment outcomes of patients enrolled in clinical trials, where access to care and socioeconomic status confounders are minimized. METHODS Clinical trial data from the Radiation Therapy Oncology Group studies were obtained. Studies were included if they were therapeutic trials that employed survival as an endpoint. Studies that did not report survival as an endpoint were excluded; 7 Radiation Therapy Oncology Group Studies were included for study. For each Black patient enrolled in a clinical trial, a study arm-matched White patient was used as a control. RESULTS A total of 468 Black participants were identified and matched with 468 White study arm-specific controls. White participants had better outcomes than Black participants in 60% of matched pairs (P < .001). Black participants were consistently more likely to have worse outcomes. When outcomes were measured by progression-free survival or disease-free survival, the failure rate was statistically significantly higher in Black participants (hazard ratio [HR] = 1.50, P < .001). Failure was largely due to locoregional failure, and Black participants were at higher risk (subdistribution HR =1.51, P = .002). The development of distant metastasis within the paired cohorts was not statistically significantly different. CONCLUSION In this study of clinical trial participants using self-reported race, Black participants consistently had worse outcomes in comparison to study arm-specific White controls. Further study is needed to confirm these findings and to explore causes underlying this disparity.
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Affiliation(s)
- Jeffrey C Liu
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine of Temple University, Philadelphia, PA, USA.,Division of Head and Neck Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Brian L Egleston
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elizabeth Blackman
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
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11
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Yan EZ, Wahle BM, Massa ST, Zolkind P, Paniello RC, Pipkorn P, Jackson RS, Rich JT, Puram SV, Mazul AL. Race and socioeconomic status interact with HPV to influence survival disparities in oropharyngeal squamous cell carcinoma. Cancer Med 2023; 12:9976-9987. [PMID: 36847063 PMCID: PMC10166958 DOI: 10.1002/cam4.5726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/27/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is associated with a favorable prognosis, yet patients of color and low socioeconomic status (SES) continue to experience inferior outcomes. We aim to understand how the emergence of HPV has impacted race and SES survival disparities in OPSCC. METHODS A retrospective cohort of 18,362 OPSCC cases from 2010 to 2017 was assembled using the SEER (Surveillance, Epidemiology, and End Results) database. Cox proportional regression and Fine and Gray regression models were used to calculate hazard ratios (HRs) adjusting for race, SES, age, subsite, stage, and treatment. RESULTS Black patients had lower overall survival than patients of other races in HPV-positive and HPV-negative OPSCC (HR 1.31, 95% CI 1.13-1.53 and HR 1.23, 95% CI 1.09-1.39, respectively). Higher SES was associated with improved survival in all patients. Race had a diminished association with survival among high SES patients. Low SES Black patients had considerably worse survival than low SES patients of other races. CONCLUSION Race and SES interact variably across cohorts. High SES was protective of the negative effects of race, although there remains a disparity in outcomes among Black and non-Black patients, even in high SES populations. The persistence of survival disparities suggests that the HPV epidemic has not improved outcomes equally across all demographic groups.
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Affiliation(s)
- Emily Z Yan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Benjamin M Wahle
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Paul Zolkind
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason T Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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12
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Boudeau S, Ramakodi MP, Zhou Y, Liu JC, Ragin C, Kulathinal RJ. Extensive set of African ancestry-informative markers (AIMs) to study ancestry and population health. Front Genet 2023; 14:1061781. [PMID: 36911410 PMCID: PMC9997643 DOI: 10.3389/fgene.2023.1061781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction: Human populations are often highly structured due to differences in genetic ancestry among groups, posing difficulties in associating genes with diseases. Ancestry-informative markers (AIMs) aid in the detection of population stratification and provide an alternative approach to map population-specific alleles to disease. Here, we identify and characterize a novel set of African AIMs that separate populations of African ancestry from other global populations including those of European ancestry. Methods: Using data from the 1000 Genomes Project, highly informative SNP markers from five African subpopulations were selected based on estimates of informativeness (In) and compared against the European population to generate a final set of 46,737 African ancestry-informative markers (AIMs). The AIMs identified were validated using an independent set and functionally annotated using tools like SIFT, PolyPhen. They were also investigated for representation of commonly used SNP arrays. Results: This set of African AIMs effectively separates populations of African ancestry from other global populations and further identifies substructure between populations of African ancestry. When a subset of these AIMs was studied in an independent dataset, they differentiated people who self-identify as African American or Black from those who identify their ancestry as primarily European. Most of the AIMs were found to be in their intergenic and intronic regions with only 0.6% in the coding regions of the genome. Most of the commonly used SNP array investigated contained less than 10% of the AIMs. Discussion: While several functional annotations of both coding and non-coding African AIMs are supported by the literature and linked these high-frequency African alleles to diseases in African populations, more effort is needed to map genes to diseases in these genetically diverse subpopulations. The relative dearth of these African AIMs on current genotyping platforms (the array with the highest fraction, llumina's Omni 5, harbors less than a quarter of AIMs), further demonstrates a greater need to better represent historically understudied populations.
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Affiliation(s)
- Samantha Boudeau
- Department of Biology, Temple University, Philadelphia, PA, United States.,Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States.,African Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Meganathan P Ramakodi
- Department of Biology, Temple University, Philadelphia, PA, United States.,Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States.,African Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Yan Zhou
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Jeffrey C Liu
- Department of Otolaryngology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.,Department of Surgical Oncology, Fox chase Cancer center, Philadelphia, PA, United States
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States.,African Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Rob J Kulathinal
- Department of Biology, Temple University, Philadelphia, PA, United States.,African Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA, United States
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13
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Liang Z, Wu M, Wang P, Quan H, Zhao J. Updated racial disparities in incidence, clinicopathological features and prognosis of hypopharyngeal squamous carcinoma in the United States. PLoS One 2023; 18:e0282603. [PMID: 36928727 PMCID: PMC10019746 DOI: 10.1371/journal.pone.0282603] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE This study was to determine the racial disparities in incidence, clinicopathological features and prognosis of hypopharyngeal squamous cell carcinoma (HPSCC) in the US. METHODS The National Program of Cancer Registries and Surveillance, Epidemiology, and End Results (SEER) database was used to determine racial disparity in age adjusted incidence rate (AAIR) of HPSCC and its temporal trend during 2004-2019. Using the separate SEER 17 database, we further evaluated racial disparity in clinicopathological features, and in prognosis using Kaplan-Meier curves and Cox proportional hazard models. RESULTS HPSCC accounted for 95.8% of all hypopharyngeal cancers and occurred much more frequently in males. Its incidence decreased in both male and females, in male non-Hispanic white (NHW), non-Hispanic black (NHB) and Hispanic as well as female NHW and NHB during the study period. NHB had the highest, whereas non-Hispanic Asian or Pacific Islanders (API) had comparable and the lowest incidence in both males and females. Among 6,172 HPSCC patients obtained from SEER 17 database, 80.6% were males and 83.9% were at the advanced stages III/IV. Five-year cancer specific and overall survival rates were 41.2% and 28.9%, respectively. NHB patients were more likely to be younger, unmarried, from the Southern region, larger sized tumor, and at the stage IV, but less likely to receive surgery. They also had higher proportions of dying from HPSCC and all causes. Multivariate analyses revealed that NHB with HPSCC at the locally advanced stage had both significantly worse cancer specific and overall survival compared with NHW, but not at early stage (I/II) or distant metastatic stage. Hispanic patients had significantly better prognosis than NHW at locally advanced and metastatic stages. NHW and API had comparable prognoses. CONCLUSIONS HPSCC displays continuously decreased incidence and racial disparity. The majority of the disease is diagnosed at the advanced stage. NHB have the highest burden of HPSCC and a worse prognosis. More studies are needed to curtail racial disparity and improve early detection.
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Affiliation(s)
- Zhong Liang
- Head and Neck Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
- Department of Surgery, People’s Hospital of Haixi, Haixi Prefecture, Qinghai, China
| | - Meijuan Wu
- Department of Pathology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), The Key Laboratory of Zhejiang Province for Aptamers and Theranostics, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
- * E-mail:
| | - Peng Wang
- Head and Neck Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Huatao Quan
- Head and Neck Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Jianqiang Zhao
- Head and Neck Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
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14
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Klingelhöffer C, Obst A, Meier JK, Reichert TE, Ettl T, Mueller S. Socioeconomic influence on treatment and outcome of patients with oral cancer in Germany. Oral Maxillofac Surg 2022; 26:365-371. [PMID: 34436719 PMCID: PMC9385794 DOI: 10.1007/s10006-021-00997-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/15/2021] [Indexed: 05/03/2023]
Abstract
PURPOSE To illustrate the influence of different socioeconomic factors on the treatment and outcome of patients in Germany with oral cancer. METHODS In this retrospective single-center study, 400 patients of our department of oral and maxillofacial surgery with primary cases of oral cancer were included. Preoperative diagnostics, occupational groups, and marital and health insurance status were evaluated. Overall and disease-specific survival were analyzed. Occupations were distinguished in 5 groups (unemployed, physically light workers, physically hard worker, university graduate, and freelancer). Data were adjusted to covariables like tumor size, positive lymph nodes, age, alcohol, or tobacco abuse. RESULTS There was no differences between private and statutory insured patients concerning overall (p = 0.858) or disease-specific survival (p = 0.431). Private insured patients received more preoperative PET-CT (p = 0.046) and had a better dental status (p = 0.006). The occupational groups showed also no differences in survival (p = 0.963). The hospitalization of freelancers was in average 2 days shorter. Physically hard workers were diagnosed with bigger tumors (p = 0.018) and consumed more tobacco and alcohol. The 5-year survival rate of married patients was approximately 20% points better than not married patients, without showing a significant difference over the entire observation time (p = 0.084). CONCLUSION In our cohort, socioeconomic factors have just a limited influence on the survival or treatment of patients with oral cancer. A sufficient statutory health insurance system is a reasonable explanation for this.
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Affiliation(s)
- Christoph Klingelhöffer
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Annegret Obst
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Johannes K Meier
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Torsten E Reichert
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Tobias Ettl
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Steffen Mueller
- Department of Cranio- and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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15
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Huang H, Chen K, Deng L, Chen Y, Zhao D, Lin W. Development and validation of a nomogram for prognosis of sinonasal adenocarcinoma (a nomogram for sinonasal adenocarcinoma). Jpn J Clin Oncol 2022; 52:869-879. [PMID: 35642571 DOI: 10.1093/jjco/hyac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The incidence of sinonasal adenocarcinoma is low, and there are few studies on survival and prognosis. Therefore, we aim to develop and validate a prognostic model for predicting the overall survival of sinonasal adenocarcinoma and provide guidance for clinical management. METHODS Patients who were diagnosed as sinonasal adenocarcinoma through Surveillance, Epidemiology, and End Results database between 1975 and 2015 were randomly divided into a training group and validation group. Univariate, multivariate survival analysis was performed to screen independent survival factors. A nomogram was established to predict the overall survival rate of sinonasal adenocarcinoma. Receiver operating characteristic curve and calibration plot were performed to verify the discrimination and accuracy of the model. A decision curve analysis was performed to verify the clinical applicability of the model. RESULTS A total of 423 patients with sinonasal adenocarcinoma were randomly divided into training group (n = 299) and verification group (n = 124). We established and verified the Nomo map including age, marriage, grade, surgery and tumour size. The c-index of Surveillance, Epidemiology, and End Results stage, T stage and this model are 0.635, 0.626 and 0.803, respectively. The survival rate of the high-risk group scored by this model was lower than that of the low-risk group (P < 0.001). Decision curve analysis shows that the model has advantages in predicting survival rates. CONCLUSION Our model is considered to be a useful tool for predicting the overall survival of sinonasal adenocarcinoma, with good discrimination and clinical applicability. We hope that this model will help rhinologists to make clinical decisions and manage patients diagnosed with sinonasal adenocarcinoma.
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Affiliation(s)
- Hesen Huang
- Department of Otolaryngology-Head and Neck Surgery, Xiang'an Hospital of Xiamen University, Xia Men, Fu Jian, China
| | - Kaiqin Chen
- Department of Neurosurgery, Xiang'an Hospital of Xiamen University, Xia Men, Fu Jian, China
| | - Lifeng Deng
- Quanzhou Medical College, Quanzhou, Fujian, China
| | - Yaling Chen
- Department of Otolaryngology-Head and Neck Surgery, Xiang'an Hospital of Xiamen University, Xia Men, Fu Jian, China
| | - Dean Zhao
- Department of Otolaryngology-Head and Neck Surgery, Xiang'an Hospital of Xiamen University, Xia Men, Fu Jian, China
| | - Wei Lin
- Department of Otorhinolaryngology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
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16
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Emerson MA, Farquhar DR, Lenze NR, Sheth S, Mazul AL, Zanation AM, Hackman TG, Weissler MC, Zevallos JP, Yarbrough WG, Brennan P, Abedi-Ardekani B, Olshan AF. Socioeconomic status, access to care, risk factor patterns, and stage at diagnosis for head and neck cancer among black and white patients. Head Neck 2022; 44:823-834. [PMID: 35044015 PMCID: PMC8904304 DOI: 10.1002/hed.26977] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Little is known about how factors combine to influence progression of squamous cell carcinoma of the head and neck (HNSCC). We aimed to evaluate multidimensional influences of factors associated with HNSCC stage by race. METHODS Using retrospective data, patients with similar socioeconomic status (SES), access to care (travel time/distance), and behavioral risk factors (tobacco/alcohol use and dental care) were grouped by latent class analysis. Relative frequency differences (RFD) were calculated to evaluate latent classes by stage, race, and p16 status. RESULTS We identified three latent classes. Advanced T-stage was higher for black (RFD = +20.2%; 95% CI: -4.6 to 44.9) than white patients (RFD = +10.7%; 95% CI: 2.1-19.3) in the low-SES/high-access/high-behavioral risk class and higher for both black (RFD = +29.6%; 95% CI: 4.7-54.5) and white patients (RFD = +23.9%; 95% CI: 15.2-32.6) in the low-SES/low-access/high-behavioral risk class. CONCLUSION Results suggest that SES, access to care, and behavioral risk factors combine to underly the association with advanced T-stage. Additionally, differences by race warrant further investigation.
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Affiliation(s)
- Marc A. Emerson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Douglas R. Farquhar
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nicholas R. Lenze
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Siddharth Sheth
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Divison of Medical Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Angela L. Mazul
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO
| | - Adam M. Zanation
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Trevor G. Hackman
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mark C. Weissler
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jose P. Zevallos
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO
| | - Wendell G. Yarbrough
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Pathology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Paul Brennan
- International Agency for Research on Cancer, WHO, Lyon, France
| | | | - Andrew F. Olshan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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17
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Nallani R, Subramanian TL, Ferguson-Square KM, Smith JB, White J, Chiu AG, Francis CL, Sykes KJ. A Systematic Review of Head and Neck Cancer Health Disparities: A Call for Innovative Research. Otolaryngol Head Neck Surg 2022; 166:1238-1248. [PMID: 35133913 DOI: 10.1177/01945998221077197] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE (1) Describe the existing head and neck cancer health disparities literature. (2) Contextualize these studies by using the NIMHD research framework (National Institute on Minority Health and Health Disparities). (3) Explore innovative ideas for further study and intervention. DATA SOURCES Ovid MEDLINE, Embase, Web of Science, and Google Scholar. REVIEW METHODS Databases were systematically searched from inception to April 20, 2020. The PRISMA checklist was followed (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Two authors reviewed all articles for inclusion. Extracted data included health disparity population and outcomes, study details, and main findings and recommendations. Articles were also classified per the NIMHD research framework. RESULTS There were 148 articles included for final review. The majority (n = 104) focused on health disparities related to at least race/ethnicity. Greater than two-thirds of studies (n = 105) identified health disparities specific to health behaviors or clinical outcomes. Interaction between the individual domain of influence and the health system level of influence was most discussed (n = 99, 66.9%). Less than half of studies (n = 61) offered specific recommendations or interventions. CONCLUSIONS There has been extensive study of health disparities for head and neck cancer, largely focusing on individual patient factors or health care access and quality. This review identifies gaps in this research, with large numbers of retrospective database studies and little discussion of potential contributors and explanations for these disparities. We recommend shifting research on disparities upstream toward a focus on community and societal factors, rather than individual, and an evaluation of interventions to promote health equity.
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Affiliation(s)
- Rohit Nallani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | - Joshua B Smith
- Department of Otolaryngology-Head and Neck Surgery, St Louis University, St Louis, Missouri, USA
| | - Jacob White
- Research and Learning, A.R. Dykes Library, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Carrie L Francis
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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18
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Ravikumar S, Casellas NJ, Shah S, Rieth K. Geographic disparities in head and neck cancer survival in Upstate New York 2011-2019. Head Neck 2021; 44:472-482. [PMID: 34845771 DOI: 10.1002/hed.26945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/18/2021] [Accepted: 11/18/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To examine the association between distance to care-center and urban-rural residence on 5-year overall survival (OS) from head and neck cancer (HNC). MATERIALS AND METHODS Five-year OS was retrospectively measured from date of initial diagnosis for patients with HNC treated at a single tertiary care center. Distances were calculated based on ZIP code of patient's residence and care center. Multilevel Weibull regression was used to adjust for confounders and identify disparities in 5-year all-cause mortality. RESULTS A total of 670 patients included in study. Multivariable analysis revealed older age or late-stage cancer at diagnosis, and HPV negative status were associated with poorer OS. Patients residing in isolated small rural town (HR = 2.20, p = 0.015) or small rural town (HR = 2.07, p = 0.015) had lower OS. Distance to care center was not associated with OS (HR = 0.996, p = 0.11). CONCLUSIONS Greater rurality was associated with poorer OS among HNC patients in Upstate New York.
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Affiliation(s)
- Saiganesh Ravikumar
- Department of Otolaryngology - Head & Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA.,School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Nicolas J Casellas
- Department of Otolaryngology - Head & Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Shalini Shah
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Katherine Rieth
- Department of Otolaryngology - Head & Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
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19
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Li MM, Zhao S, Eskander A, Rygalski C, Brock G, Parikh AS, Haring CT, Swendseid B, Zhan KY, Bradford CR, Teknos TN, Carrau RL, VanKoevering KK, Seim NB, Old MO, Rocco JW, Puram SV, Kang SY. Stage Migration and Survival Trends in Laryngeal Cancer. Ann Surg Oncol 2021; 28:7300-7309. [PMID: 34263369 DOI: 10.1245/s10434-021-10318-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND During the last two decades, significant advancements in the treatment of laryngeal cancer have occurred. Although survival of head and neck cancer patients has improved over time, the temporal trend of laryngeal cancer survival is an area of controversy. METHODS From 2004 to 2016, 77,527 patients who had laryngeal cancer treated with curative intent in the United States were identified in the National Cancer Database. Relative and observed survival rates were assessed for temporal trends. Multinomial logistic regression investigated the relationship between American Joint Committee on Cancer (AJCC) stage and increasing calendar year. RESULTS No significant improvement in 2- or 5-year observed survival (OS) or relative survival (RS) was observed. The 5-year RS ranged from 61.72 to 63.97%, and the 5-year OS ranged from 54.26 to 56.52%. With each increasing year, the proportion of stage 4 disease increased, with risk for stage 4 disease at the time of diagnosis increasing 2.2% annually (adjusted odds ratio [aOR], 1.022; 95% confidence interval [CI], 1.017-1.028; p < 0.001). This increase was driven by a 4.7% yearly increase in N2 disease (aOR, 1.047; 95% CI, 1.041-1.053; p < 0.001), with an annual 1.2% increase in T3 disease (aOR, 1.012; 95% CI, 1.007-1.018; p < 0.001) and a 1.2% increase in T4 disease (aOR, 1.012; 95% CI, 1.005-1.018; p < 0.001). CONCLUSION Despite advances in the field, laryngeal cancer survival in the United States is not improving over time. This may be due to an increase in the proportion of stage 4 disease, driven primarily by increasing nodal disease. To achieve survival improvement commensurate with scientific and technologic advances, efforts should be made to diagnose and treat laryngeal cancer at earlier stages to prevent further stage migration.
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Affiliation(s)
- Michael M Li
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | | | - Guy Brock
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Anuraag S Parikh
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brian Swendseid
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kevin Y Zhan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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20
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Lower disease control rates and survival outcomes among Blacks with pharyngeal squamous cell carcinomas compared with Whites: a retrospective analysis at the University of Florida. Cancer Causes Control 2021; 32:1269-1278. [PMID: 34259972 DOI: 10.1007/s10552-021-01477-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
Disparate clinical outcomes for pharyngeal squamous cell carcinoma (PSCC) of the oropharynx (OPSCC) and hypopharynx (HPSCC) have been observed in Black compared with White patients. Higher tobacco and alcohol use has been associated with decreased survival in Black patients with PSCC. Higher human papilloma virus (HPV) infection rates, associated with specific subsites of the oropharynx, are linked to improved overall survival (OS). Using an institutional cohort of Black and White patients with PSCC, we performed a retrospective analysis using multiple disease endpoints including local control (LC), local-regional control (LRC), freedom from distant metastases (DMFS), OS, cause-specific survival (CSS), and recorded tobacco and alcohol use. 1419 patients [Black (n = 111) and White (n = 1,308)] treated for PSCC from 1973 to 2013 were evaluated. PSCC 5- and 10-year LC, LRC, and DMFS and CSS rates were lower for Blacks. Notably, Black patients with OPSCC had higher stage cancers, higher percentage of soft palate tumors, and lower percentage of base of tongue cancers, were more likely to receive radiotherapy, and had higher tobacco and alcohol use. OS was significantly lower in Black patients at both anatomic sites, with the greatest difference observed for OPSCC. Multivariate analysis showed race and tobacco independently predicted DMFS, OS, and CSS; however, tobacco use had a greater impact on DMFS (HR 2.5, p = 0.021) than race (HR 1.9, p = 0.027). Overall, we propose that the higher burden of tobacco use along with a lower rate of tumors arising from traditional HPV-related subsites were important contributors to disparate disease outcomes seen in our Black patients.
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21
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da Cunha AR, Bigoni A, Antunes JLF, Hugo FN. The impact of inequalities and health expenditure on mortality due to oral and oropharyngeal cancer in Brazil. Sci Rep 2021; 11:12845. [PMID: 34145332 PMCID: PMC8213849 DOI: 10.1038/s41598-021-92207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/07/2021] [Indexed: 11/30/2022] Open
Abstract
This study aims to assess the magnitude and trend of mortality rates due to oral (OC) and oropharyngeal cancer (OPC) in the 133 Intermediate Geographic Regions (IGR) of Brazil between 1996 and 2018 and to analyze its association with sociodemographic variables and provision of health services. It also aims to compare the trend of mortality from neoplasms that have been reported as associated with HPV (OPC) with the trend of neoplasms that have been reported as not associated with HPV (OC). We obtained mortality data from the Mortality Information System in Brazil and analyzed the trends using the Prais-Winsten method. Then, we assessed the relationship between mortality trends and socioeconomic, health spending, and health services provision variables. The median of the annual percent change of the country’s mortality rates was 0.63% for OC and 0.83% for OPC. Trends in mortality in the IGRs correlated significantly with the Human Development Index and government expenditure on ambulatory health care and hospitalizations. Mortality from both types of cancer decreased in those IGR in which the government spent more on health and in the more socioeconomically developed ones. This study found no epidemiological indication that HPV plays the leading etiological factor in OPC in Brazil.
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Affiliation(s)
- Amanda Ramos da Cunha
- Faculty of Dentistry, Federal University of Rio Grande do Sul, 2492 Ramiro Barcelos St, Porto Alegre, RS, 90035-003, Brazil.
| | - Alessandro Bigoni
- School of Public Health, University of São Paulo, 715 Doutor Arnaldo Ave, São Paulo, SP, 01246-904, Brazil
| | | | - Fernando Neves Hugo
- Faculty of Dentistry, Federal University of Rio Grande do Sul, 2492 Ramiro Barcelos St, Porto Alegre, RS, 90035-003, Brazil
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22
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Harris JA, Hunter WP, Ji YD, Hanna GJ. Effects of racial residential segregation on oral squamous cell carcinoma prognosis and survival. Oral Oncol 2021; 119:105364. [PMID: 34091188 DOI: 10.1016/j.oraloncology.2021.105364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study is to evaluate the impact of racial residential segregation on disease prognosis and overall survival in Black patients diagnosed with oral squamous cell carcinoma (OSCC), relative to White patients. MATERIALS AND METHODS This retrospective cohort study identified individuals diagnosed with OSCC between 2005 and 2015 using the Surveillance, Epidemiology and End Results Database. Patients were included with cancers diagnosed in the following locations: lip, tongue, gum, floor of mouth, palate, and other/unspecified. Tumors located at the base of tongue, tonsils, and oropharynx were excluded. The primary predictor variable was the degree of residential segregation. The primary outcome was overall survival. A Kaplan Meier survival analysis and univariate/multivariate analyses were performed to account for potential confounders of survival. RESULTS A total of 35,769 patients met inclusion criteria. At the time of initial diagnosis, Black patients presented with OSCC of higher grades and more advanced stages (p < 0.001). A greater number of Black subjects were dead by the time of last follow-up compared to White subjects (p < 0.001). Across the entire spectrum of residential segregation, cumulative survival was worse among Black patients compared to Whites (p < 0.001). Multivariate analysis identified highly segregated counties, advanced age, higher grade/advanced stage at time of diagnosis, lack of surgery, and no chemotherapy treatment as poor prognostic factors for survival among Black individuals. CONCLUSION Racial residential segregation results in poorer long-term cancer survival among Black patients. Understanding the links between residential segregation and inequities in cancer outcomes will allow policymakers to better implement targeted, population-based interventions in treating various cancers.
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Affiliation(s)
- Jack A Harris
- Harvard School of Dental Medicine, Boston, MA, United States.
| | | | - Yisi D Ji
- Harvard Medical School, Boston, MA, United States
| | - Glenn J Hanna
- Harvard Medical School, Boston, MA, United States; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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23
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Cox SR, Daniel CL. Racial and Ethnic Disparities in Laryngeal Cancer Care. J Racial Ethn Health Disparities 2021; 9:800-811. [PMID: 33733426 DOI: 10.1007/s40615-021-01018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
There is a long history of racial and ethnic disparities in healthcare and they continue to persist in contemporary society. These disparities have the potential to negatively affect morbidity and mortality in racial and ethnic minorities diagnosed with laryngeal cancer. Diagnosis, medical treatment, and rehabilitation for laryngeal cancer have improved considerably, leading to improvements in overall survival rates and physical, social, and psychological functioning. Yet members of minority and underrepresented groups are at an increased risk for experiencing reduced access to quality care and delays between diagnosis and treatment, and as a result have lower survival rates. Increasing health providers' awareness of racial and ethnic disparities in laryngeal cancer is necessary to facilitate changes in patient and provider education, clinical practice, and health policies. The purpose of this review is to summarize current literature on disparities in laryngeal cancer diagnosis, treatment, and rehabilitation among Black and Hispanic patients. We present recent data from the Surveillance, Epidemiology, and End Results database to examine trends in laryngeal cancer and patient, provider, and health systems factors that may perpetuate these disparities. In addition, we offer interventions to address racism and other racial and ethnic biases in laryngeal cancer care and describe research and legislative actions that are needed to reduce disparities in this area.
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Affiliation(s)
- Steven R Cox
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY, 11530, USA.
| | - Carolann L Daniel
- School of Social Work, Adelphi University, Garden City, NY, 11530, USA
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24
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Nittala MR, Kanakamedala MR, Mundra E, Vengaloor Thomas T, Bhanat E, Woods WC, Vijayakumar S. Factors Affecting Outcomes in Patients With Stage III & IV Squamous Cell Carcinoma of Oropharynx: The Importance of p16 Status, BMI, and Race. Cureus 2021; 13:e13674. [PMID: 33824825 PMCID: PMC8012264 DOI: 10.7759/cureus.13674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To identify racial disparities in survival outcomes among Stage III & IV patients with squamous cell carcinomas (SCCa) of the oropharynx treated with definitive radiation therapy (RT), with concurrent chemotherapy. Method This is a retrospective analysis of patients with stage III & IV SCCa of oropharynx treated with definitive RT at the State Academic Medical Center. All patients were treated to 70 Gy utilizing intensity-modulated radiation treatment (IMRT), and received concurrent chemotherapy with weekly cisplatin or cetuximab. Chi-square test was used to test the goodness of fit, overall survival (OS), and locoregional control (LRC) comparing races were generated by using Log-rank test & Kaplan-Meier method. The covariables associated with the OS and LRC were determined by the Cox regression model. A p-value of less than 0.05 was considered statistically significant. The SPSS 24.0 software (IBM Corp., Armonk, NY) was used. Results In the total 73 eligible patients, 54.8% were black, and 45.2% white patients. Stage distribution (per American Joint Committee on Cancer-AJCC 8th Ed) between black patients vs. white patients, Stage III (45.5% vs. 54.5%) and for Stage IV (56.5% vs. 43.5%); p=0.499. Median follow-up for the entire group was 41 months (range: 4-144 months). In the univariate analysis, variables p16 status, body mass index (BMI), alcohol history and tumor subsite were found to be significant. In the multivariate analysis, only BMI has shown to be significant. Three-year LRC for black patients was 37.8% vs.66.8% in white patients (p=0.354) and three-year OS for black patients was 51.8% vs. 80.9% for white patients (p=0.063), respectively. Five-year OS for p16 positive patients was 69.7% vs. 43% for p16 negative patients (p=0.034). Five-year OS for Stage IV black patients was 34% vs. 69.5% for Stage IV white patients (p=0.014). Conclusion Among all the co-variables examined, only BMI has shown affecting the OS outcomes; gender and BMI shown to be affecting the LRC. Racial factor appears to be significant in Stage IV patients.
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Affiliation(s)
- Mary R Nittala
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | | | - Eswar Mundra
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | | | - Eldrin Bhanat
- Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, USA
| | - William C Woods
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
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25
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Marks JA, Switchenko JM, Steuer CE, Ryan M, Patel MR, McDonald MW, Higgins K, Beitler JJ, Shin DM, Gillespie TW, Saba NF. Socioeconomic Factors Influence the Impact of Tumor HPV Status on Outcome of Patients With Oropharyngeal Squamous Cell Carcinoma. JCO Oncol Pract 2021; 17:e313-e322. [PMID: 33434083 DOI: 10.1200/op.20.00671] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Human papilloma virus (HPV) association remains one of the most important predictors of clinical outcome in oropharyngeal squamous cell carcinoma (OPSCC). We aimed to determine whether the relationship between HPV status and overall survival was influenced by socioeconomic factors. MATERIALS AND METHODS Using the National Cancer Database, we examined the relationship between socioeconomic status and overall survival, controlling for demographics and socioeconomic variables (age at diagnosis, race, sex, clinical stage, facility type, facility location, insurance status, median-income quartiles, percent of no high-school education quartiles, rural-urban dwelling, Charlson-Deyo score, primary site, and treatment type). RESULTS HPV-positive patients with private insurance have improved overall survival compared with HPV-positive patients who are uninsured (hazard ratio [HR], 0.51, 95% CI, 0.41 to 0.63, P < .001). HPV-negative patients with private insurance have improved overall survival compared with HPV-negative patients who were uninsured (HR, 0.62, 95% CI, 0.53 to 0.73, P < .001). HPV-positive patients living in the south had improved overall survival compared with HPV-positive patients living in the west (HR, 0.83, 95% CI, 0.72 to 0.96, P = .013). As assessed through interaction, relationships between survival and insurance (P = .004), rural-urban status (P = .009), and facility location (P = .021) statistically differed between HPV-positive and HPV-negative patients. CONCLUSION HPV status impact on overall survival for patients with OPSCC is influenced by socioeconomic factors including insurance status and treatment facility. A deeper understanding of these interactions is needed to improve equity of care for patients with OPSCC.
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Affiliation(s)
- Jennifer A Marks
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jeffrey M Switchenko
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Conor E Steuer
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Martha Ryan
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Mihir R Patel
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA
| | - Mark W McDonald
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA
| | - Johnathan J Beitler
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA.,Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA.,Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | | | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
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26
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Sheth S, Farquhar DR, Lenze NR, Mazul A, Brennan P, Anantharaman D, Abedi-Ardekani B, Zevallos JP, Hayes DN, Olshan F. Decreased overall survival in black patients with HPV-associated oropharyngeal cancer. Am J Otolaryngol 2021; 42:102780. [PMID: 33152576 PMCID: PMC7988501 DOI: 10.1016/j.amjoto.2020.102780] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Racial disparities for overall survival (OS) in head and neck cancer have been well described. However, the extent to which these disparities exist for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC), and the contribution of demographic, clinical, and socioeconomic status (SES) variables, is unknown. MATERIALS AND METHODS Patients were identified from the Carolina Head and Neck Cancer Epidemiology Study (CHANCE), a population-based study in North Carolina. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for OS in black versus white patients with sequential adjustment sets. RESULTS A total of 157 HPV-associated OPSCC patients were identified. Of these, 93% were white and 7% were black. Black patients with HPV-associated OPSCC were more likely to be younger, have an income <$20,000, live farther away from clinic where biopsy was performed, and have advanced T stage at diagnosis. Black patients had worse OS in the unadjusted analysis (HR 4.9, 95% CI 2.2-11.1, p < 0.0001). The racial disparity in OS slightly decreased when sequentially adjusting for demographic, clinical, and SES variables. However, HR for black race remained statistically elevated in the final adjustment set which controlled for age, sex, stage, smoking, alcohol use, and individual-level household income, insurance, and education level (HR 3.4, 95% CI 1.1-10.1, p = 0.028). CONCLUSION This is the first population-based study that confirms persistence of racial disparities in HPV-associated OPSCC after controlling for demographic, clinical, and individual-level socioeconomic factors.
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Affiliation(s)
- Siddharth Sheth
- Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Douglas R Farquhar
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Nicholas R Lenze
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Angela Mazul
- Department of Otolaryngology, Washington University in Saint Louis, School of Medicine, St. Louis, MO 63110, USA
| | - Paul Brennan
- International Agency for Research on Cancer, France
| | | | | | - Jose P Zevallos
- Department of Otolaryngology, Washington University in Saint Louis, School of Medicine, St. Louis, MO 63110, USA
| | - D Neil Hayes
- Department of Medicine, Division of Hematology-Oncology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; UTHSC Center for Cancer Research, University of Tennessee, Memphis, TN 38163, USA
| | - F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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27
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Brouwer AF, He K, Chinn SB, Mondul AM, Chapman CH, Ryser MD, Banerjee M, Eisenberg MC, Meza R, Taylor JMG. Time-varying survival effects for squamous cell carcinomas at oropharyngeal and nonoropharyngeal head and neck sites in the United States, 1973-2015. Cancer 2020; 126:5137-5146. [PMID: 32888317 DOI: 10.1002/cncr.33174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/13/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Anatomical site is strongly associated with head and neck cancer etiology, and etiology and patient sociodemographic characteristics are prognostic factors for survival. It is not known whether the effects of these predictors persist over the postdiagnosis period or are strongest proximal to the time of diagnosis. METHODS Using survival times and causes of death for 180,434 patients with head and neck cancer in the Surveillance, Epidemiology, and End Results cancer registry (1973-2015), the empirical cumulative incidences of cancer-specific death and other-cause death were calculated with a competing risks framework, and the time-dependent effects (hazard ratios) of anatomical tumor site (oropharynx, oral cavity, or hypopharynx/larynx), age, sex, race, and year of diagnosis on cancer-specific death and other-cause death, stratified by tumor stage, were estimated. RESULTS All effects were significantly time-varying (P < .001). Patients with nonoropharyngeal cancer had a higher hazard of cancer-specific death but a similar cumulative fraction of deaths because of a higher rate of death from other causes. Cancer-specific survival has not changed for patients with nonoropharyngeal cancer over the past decades but has improved since 2000 for patients with oropharyngeal cancer. The effects of age and sex on cancer survival were strongest proximal to the diagnosis, whereas the effect of race persisted over time. CONCLUSIONS Recent improvements in survival for patients with oropharyngeal cancer may be due more to an increasing fraction of cancers attributable to human papillomavirus than to increasing treatment effectiveness. The prognostic strength of anatomical site and other predictors changes over the postdiagnosis period. LAY SUMMARY It is generally assumed that the effects of tumor and personal characteristics on the survival of patients with head and neck cancer are fixed over time, but this study shows that many factors are most important only in the first few years after diagnosis. Also, recent improvements in the survival of patients with head and neck cancer appear to benefit only patients with cancers of the oropharynx. The improvements may be due more to an increasing fraction of cancers caused by human papillomavirus (which generally have better outcomes) than to advances in head and neck cancer treatment overall.
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Affiliation(s)
- Andrew F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Kevin He
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Alison M Mondul
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Christina H Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Marc D Ryser
- Department of Population Health Sciences, Duke University, Durham, North Carolina.,Department of Mathematics, Duke University, Durham, North Carolina
| | - Mousumi Banerjee
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Marisa C Eisenberg
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.,Department of Mathematics, University of Michigan, Ann Arbor, Michigan.,Department of Complex Systems, University of Michigan, Ann Arbor, Michigan
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Jeremy M G Taylor
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
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28
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Lenze NR, Farquhar D, Sheth S, Zevallos JP, Blumberg J, Lumley C, Patel S, Hackman T, Weissler MC, Yarbrough WG, Zanation AM, Olshan AF. Socioeconomic Status Drives Racial Disparities in HPV-negative Head and Neck Cancer Outcomes. Laryngoscope 2020; 131:1301-1309. [PMID: 33170518 DOI: 10.1002/lary.29252] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/29/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine drivers of the racial disparity in stage at diagnosis and overall survival (OS) between black and white patients with HPV-negative head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN Retrospective cohort study. METHODS Data were examined from of a population-based HNSCC study in North Carolina. Multivariable logistic regression and Cox proportional hazards models were used to assess racial disparities in stage at diagnosis and OS with sequential adjustment sets. RESULTS A total of 340 black patients and 864 white patients diagnosed with HPV-negative HNSCC were included. In the unadjusted model, black patients had increased odds of advanced T stage at diagnosis (OR 2.0; 95% CI [1.5-2.5]) and worse OS (HR 1.3, 95% CI 1.1-1.6) compared to white patients. After adjusting for age, sex, tumor site, tobacco use, and alcohol use, the racial disparity persisted for advanced T-stage at diagnosis (OR 1.7; 95% CI [1.3-2.3]) and showed a non-significant trend for worse OS (HR 1.1, 95% CI 0.9-1.3). After adding SES to the adjustment set, the association between race and stage at diagnosis was lost (OR: 1.0; 95% CI [0.8-1.5]). Further, black patients had slightly favorable OS compared to white patients (HR 0.8, 95% CI [0.6-1.0]; P = .024). CONCLUSIONS SES has an important contribution to the racial disparity in stage at diagnosis and OS for HPV-negative HNSCC. Low SES can serve as a target for interventions aimed at mitigating the racial disparities in head and neck cancer. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1301-1309, 2021.
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Affiliation(s)
- Nicholas R Lenze
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Douglas Farquhar
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Siddharth Sheth
- Division of Hematology and Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Jose P Zevallos
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
| | - Jeffrey Blumberg
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Catherine Lumley
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Samip Patel
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Trevor Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Mark C Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Wendell G Yarbrough
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A.,Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Adam M Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
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Vengaloor Thomas T, Krishna K, Ahmed HZ, Mundra E, Abraham A, Bhanat E, Nittala MR, Packianathan S, Vijayakumar S. A 25-year Experience at an Academic Medical Center in the United States: Are There Racial Disparities in the Prognosis of Patients Diagnosed With Hypopharyngeal Carcinoma? Cureus 2020; 12:e11306. [PMID: 33282583 PMCID: PMC7714743 DOI: 10.7759/cureus.11306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction This study attempted to identify disparities in outcomes between African American (AA) and Caucasian American (CA) patients treated for hypopharyngeal carcinoma at a tertiary care institution over the past 25 years. Methods An institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPPA)-compliant retrospective analysis was performed on patients with squamous cell carcinoma of the hypopharynx treated at our institution between January 1994 and December 2018. Data regarding demographics, stage, treatment, and follow-up were collected. Outcomes, including median survival and overall survival, were calculated using the Kaplan-Meier method. All analyses were performed using the Social Packages for the Social Sciences (SPSS) v. 24 (IBM Corp., Armonk, NY). Results We identified 144 hypopharyngeal carcinoma patients who were treated during this period. Our patient cohort consisted of 61.8% AA and 35.4% CA (P=0.538). Overall, 96% of them presented at an advanced stage (Stages III & IV) of the disease, and only 4% presented in the early stages (Stages I & II). There was no significant difference between AA and CA patients who presented with advanced disease (96.6% vs. 94.1%). In our patient cohort, 15.3% of patients did not receive any therapy; however, 51.4%, 22.9%, and 10.4% of them underwent definitive chemoradiotherapy, definitive surgery, or palliative chemotherapy, respectively. There were no significant differences in patient racial proportions within each treatment group. The median follow-up of the entire cohort was 13 months. There was no significant difference between the median survival of AA and that of CA patients (16 months vs. 15 months; p=0.917). Moreover, there was no significant difference in the overall survival between AA and CA patients at three years (27.2% vs. 36.3%; p=0.917) and five years (20.4 % vs. 16.7 %; p=0.917). Conclusions A retrospective review of patients with hypopharyngeal cancer treated at our institution over the previous 25 years did not identify significant racial disparities regarding the stage at presentation or prognosis. This study suggests that when patients have equal access to care, they appear to have a similar prognosis despite racial differences. Further studies are needed to validate this hypothesis.
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Affiliation(s)
| | - Kati Krishna
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Hiba Z Ahmed
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Eswar Mundra
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Anu Abraham
- Pathology, University of Mississippi Medical Center, Jackson, USA
| | - Eldrin Bhanat
- Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, USA
| | - Mary R Nittala
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Satya Packianathan
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
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Russo DP, Tham T, Bardash Y, Kraus D. The effect of race in head and neck cancer: A meta-analysis controlling for socioeconomic status. Am J Otolaryngol 2020; 41:102624. [PMID: 32663732 DOI: 10.1016/j.amjoto.2020.102624] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the association between race and ethnicity and prognosis in head and neck cancers (HNC), while controlling for socioeconomic status (SES). MATERIALS AND METHODS Medline, Scopus, EMBASE, and the Cochrane Library were used to identify studies for inclusion, from database inception till March 5th 2019. Studies that analyzed the role of race and ethnicity in overall survival (OS) for malignancies of the head and neck were included in this study. For inclusion, the study needed to report a multivariate analysis controlling for some proxy of SES (for example household income or employment status). Pooled estimates were generated using a random effects model. Subgroup analysis by tumor sub-site, meta-regression, and sensitivity analyses were also performed. RevMan 5.3, Meta Essentials, and OpenMeta[Analyst] were used for statistical analysis. RESULTS Ten studies from 2004 to 2019 with a total of 108,990 patients were included for analysis in this study. After controlling for SES, tumor stage, and treatment variables, blacks were found to have a poorer survival compared to whites (HR = 1.27, 95%CI: 1.18-1.36, p < 0.00001). Subgroup analysis by sub-site and sensitivity analysis agreed with the primary result. No differences in survival across sub-sites were observed. Meta-regression did not identify any factors associated with the pooled estimate. CONCLUSIONS In HNC, blacks have poorer OS compared to whites even after controlling for socioeconomic factors.
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Affiliation(s)
- Daniel P Russo
- Department of Otolaryngology, Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America; New York Head & Neck Institute, Otolaryngology - Head and Neck Surgery, United States of America.
| | - Tristan Tham
- Department of Otolaryngology, Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America; New York Head & Neck Institute, Otolaryngology - Head and Neck Surgery, United States of America
| | - Yonatan Bardash
- Department of Otolaryngology, Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America; New York Head & Neck Institute, Otolaryngology - Head and Neck Surgery, United States of America
| | - Dennis Kraus
- Department of Otolaryngology, Head and Neck Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America; New York Head & Neck Institute, Otolaryngology - Head and Neck Surgery, United States of America
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Zolkind P, Lee JJ, Jackson RS, Pipkorn P, Massa ST. Untreated head and neck cancer: Natural history and associated factors. Head Neck 2020; 43:89-97. [PMID: 32914515 DOI: 10.1002/hed.26460] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/28/2020] [Accepted: 08/26/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study aims to provide modern estimates of survival for untreated head and neck cancer (HNC) and to identify patient- and tumor-specific factors associated with not receiving definitive treatment. METHODS Adults with mucosal HNC were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Median overall survival of untreated patients was calculated and stratified by site and stage. Cause-specific survival and factors associated with no treatment were investigated with advanced statistics. RESULTS The study cohort included 6477 patients who received no treatment. Overall, untreated patients had a median survival of 12 months, with significant variability by site and stage. Multivariable analysis identified advanced age, black race, unmarried status, and lack of private insurance as associated with no treatment. CONCLUSIONS Survival of HNC without treatment is dismal, yet substantial variation exists by tumor site and stage. Higher rates of no treatment among the poor and racial minorities are potentially driven by disparities in care availability and provision.
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Affiliation(s)
- Paul Zolkind
- Department of otolaryngology, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Jake J Lee
- Department of otolaryngology, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Ryan S Jackson
- Department of otolaryngology, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of otolaryngology, Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Sean T Massa
- Department of otolaryngology, Washington University in St. Louis, Saint Louis, Missouri, USA
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Clarke JA, Despotis AM, Ramirez RJ, Zevallos JP, Mazul AL. Head and Neck Cancer Survival Disparities by Race and Rural–Urban Context. Cancer Epidemiol Biomarkers Prev 2020; 29:1955-1961. [DOI: 10.1158/1055-9965.epi-20-0376] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/13/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022] Open
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Babu A, Wassef DW, Sangal NR, Goldrich D, Baredes S, Park RCW. The Affordable Care Act: Implications for underserved populations with head & neck cancer. Am J Otolaryngol 2020; 41:102464. [PMID: 32307190 DOI: 10.1016/j.amjoto.2020.102464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE This study was done to determine the direct impact implementation of the Affordable Care Act (ACA) on patients with Head and Neck Cancer (HNCA) in states that chose to expand Medicaid compared to in states that did not, as well as assess whether this impact varied among different demographic groups. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of HNCA diagnosed from 2011 to 2014. Rates of uninsured status were compared before and after Medicaid expansion and contrasted between states that did and did not expand coverage, stratified by patient and tumor characteristics, and assessed via multivariate regression. RESULTS Overall rates of uninsured status (UR) were decreased by 63.08% in states that expanded coverage (ES) but only by 2.6% in states that did not (NS). In NS, there was an increase in proportion of black patients who were uninsured over the study period (13.7%, p = 0.077) whereas in ES, this proportion decreased by 73.3%. When stratified by primary site, patients with laryngeal cancer had the highest UR with an increase by 16.7% in NS and a decrease by 70.5% in ES. Multivariate analysis yielded predictors of uninsured status including residence in a NS, Hispanic ethnicity, and black race. CONCLUSIONS Implementation of the ACA resulted in expanded insurance coverage for patients diagnosed with HNCA concentrated mainly in states that expanded Medicaid coverage and for patients derived from vulnerable populations, including black and Hispanic patients. In states that did not expand Medicaid, vulnerable populations were disproportionately affected.
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Pannu JS, Simpson MC, Donovan CL, Adjei Boakye E, Mass K, Challapalli SD, Varvares MA, Osazuwa-Peters N. Sociodemographic correlates of head and neck cancer survival among patients with metastatic disease. Head Neck 2020; 42:2505-2515. [PMID: 32542851 DOI: 10.1002/hed.26284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 04/10/2020] [Accepted: 05/12/2020] [Indexed: 12/25/2022] Open
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.
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Affiliation(s)
- Jaibir S Pannu
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Saint Louis University Cancer Center, St. Louis, Missouri, USA
| | - Connor L Donovan
- Fulbright College of Arts and Sciences, University of Arkansas, Fayetteville, Arkansas, USA
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Katherine Mass
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Sai D Challapalli
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Mark A Varvares
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA.,Saint Louis University Cancer Center, St. Louis, Missouri, USA
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Racial/ethnic disparities in penile squamous cell carcinoma incidences, clinical characteristics, and outcomes: A population-based study, 2004-2016. Urol Oncol 2020; 38:688.e11-688.e19. [PMID: 32340796 DOI: 10.1016/j.urolonc.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/23/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE This study assessed the impact of race/ethnicity on penile squamous cell carcinoma (PSCC) incidence rates, clinical characteristics, and outcomes. MATERIALS AND METHODS Surveillance, Epidemiology and End Results data from 2004 to 2016 was used for this study. We evaluated racial/ethnic differences in clinical characteristics using χ2 tests. Overall survival (OS) and PSCC-specific survival (PSCC-SS) were estimated using the Kaplan-Meier method, and differences were determined using the log-rank test. Cox regression models were performed to assess independent predictors for PSCC patient survival. RESULTS A total of 2,720 PSCC patients were included for incidence analysis, and 2,438 patients were identified for the χ2 testing and survival analyses.The overall incidence of PSCC during 2004 to 2016 was 0.30 per 100,000. Only non-Hispanic white (NHW) patients had a statistically significant increase in age-adjusted incidence rates (annual percent change = 2.26, 95% confidence interval [CI]: 0.78-3.76; P = 0.01). In univariate analysis, race/ethnicity was an independent prognostic factor for OS and PSCC-SS. After adjusting for age, marital status, income, grade, TNM (tumor, node, metastasis) stage, and treatment strategies, non-Hispanic black patients still had a statistically significant hazard ratio of 1.35 (95% CI: 1.08-1.68; P = 0.007) for OS, and a hazard ratio of 1.36 (95% CI: 1.01-1.82; P = 0.045) for PSCC-SS compared to NHW. CONCLUSION NHW patients had a statistically significant increase in age-adjusted incidence rate during the period 2004 to 2016. Race/ethnicity is an independent prognostic factor for OS and PSCC-SS, and non-Hispanic black were proven to have unfavorable OS and PSCC-SS compared with NHW.
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Kompelli A, Cartmell KB, Sterba KR, Alberg AJ, Xiao CC, Sood AJ, Garrett-Mayer E, White-Gilbertson SJ, Rosenzweig SA, Day TA. An assessment of racial differences in epidemiological, clinical and psychosocial factors among head and neck cancer patients at the time of surgery. World J Otorhinolaryngol Head Neck Surg 2020; 6:41-48. [PMID: 32426702 PMCID: PMC7221208 DOI: 10.1016/j.wjorl.2019.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/27/2018] [Accepted: 01/08/2019] [Indexed: 01/18/2023] Open
Abstract
Objective Racial disparities have been well characterized and African American (AA) patients have 30% lower 5-year survival rates than European Americans (EAs) for head and neck squamous carcinoma (HNSCC). This poorer survival can be attributed to a myriad of different factors. The purpose of this study was to characterize AA-EA similarities and differences in sociodemographic, lifestyle, clinical, and psychosocial characteristics in HNSCC patients near the time of surgery. Methods Setting: Single tertiary care center. Participants: Thirty-nine newly diagnosed, untreated HNSCC patients (n = 24 EAs,n = 15 AAs) who were to undergo surgery were recruited. Study Design: Cross-sectional study Sociodemographic, lifestyle factors, and disease factors (cancer site, AJCC clinical and pathologic stage, and HPV status)were assessed. Risk factors, leisure time, quality of life and social support were also assessed using validated questionnaires. Exposures: EA and AA patients were similar in the majority of sociodemographic factors assessed. AAs had a higher trend toward pathologically later stage disease compared to EAs and significantly increased time to treatment. Results EA and AA patients were similar in the majority of sociodemographic factors assessed. AAs had a higher trend toward pathologically later stage disease compared to EAs. AAs also had significantly increased time to treatment (P = 0.05). The majority of AA patients (62%) had later stage pathologic disease. AA were less likely to complete high school or college (P = 0.01) than their EA counterparts. Additionally, AAs were more likely to report having a gap in health insurance during the past decade (37% vs. 15%). Conclusions This preliminary study demonstrates a similar profile of demographics, clinical and psychosocial characteristics preoperatively for AAs and EAs. Key differences were AAs tending to have later pathologic stage disease, educational status, delays in treatment initiation, and gaps in health insurance.
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Affiliation(s)
- Anvesh Kompelli
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina (MUSC), Charleston, SC, 29425, USA
| | - Kathleen B Cartmell
- College of Nursing, MUSC, Charleston, SC, 29425, USA.,Hollings Cancer Center, MUSC, Charleston, SC, 29425, USA
| | - Katherine R Sterba
- Hollings Cancer Center, MUSC, Charleston, SC, 29425, USA.,Department of Public Health Sciences, MUSC, Charleston, SC, 29425, USA
| | - Anthony J Alberg
- Hollings Cancer Center, MUSC, Charleston, SC, 29425, USA.,Department of Public Health Sciences, MUSC, Charleston, SC, 29425, USA
| | - Christopher C Xiao
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina (MUSC), Charleston, SC, 29425, USA
| | - Amit J Sood
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina (MUSC), Charleston, SC, 29425, USA
| | - Elizabeth Garrett-Mayer
- Hollings Cancer Center, MUSC, Charleston, SC, 29425, USA.,Department of Public Health Sciences, MUSC, Charleston, SC, 29425, USA
| | | | - Steven A Rosenzweig
- Hollings Cancer Center, MUSC, Charleston, SC, 29425, USA.,Department of Pharmacology, MUSC, Charleston, SC, 29425, USA
| | - Terry A Day
- Department of Otolaryngology- Head and Neck Surgery, Medical University of South Carolina (MUSC), Charleston, SC, 29425, USA.,Hollings Cancer Center, MUSC, Charleston, SC, 29425, USA
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Stubbs VC, Rajasekaran K, Cannady SB, Newman JG, Ibrahim SA, Brant JA. Social determinants of health and survivorship in parotid cancer: An analysis of the National Cancer Database. Am J Otolaryngol 2020; 41:102307. [PMID: 31732319 DOI: 10.1016/j.amjoto.2019.102307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/24/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Given the rarity of parotid cancer, there is relatively few data published regarding outcomes. Utilizing the large sample population of the National Cancer Database (NCDB), we aim to examine the relationship between two key social determinants of health, demographics and socioeconomic status (SES), and parotid malignancy survival rates. METHODS Our analytic sample consists of patients with a diagnosis of primary malignancy of the parotid gland between 2004 and 2012 in the NCDB. We used univariable and multivariable Cox proportional hazard models to evaluate the relationship between overall survival rate and two key social determinants of health: demographics and SES. RESULTS 15,815 cases met inclusion criteria. Average age was 60.1 years and 8255 were male (52.2%). Median overall survival was 121 months with 5-year overall survival of 67.4%. Male sex and older age at diagnosis were associated with poorer overall survival (p < 0.0001). We found that Asian Americans compared to whites had better overall survival (HR 0.75; 95% CI [0.58-0.95]). Black patients had improved survival compared to whites on univariate (HR 0.71; 95% CI [0.64-0.79]); but not multivariate analysis. Hispanic ethnicity and higher education level were protective (HR 0.76 95% CI [0.63-0.91] and HR 0.84 95% CI [0.74-0.96], respectively). We found no significant survival association based on income level. CONCLUSION In this national sample of patients with parotid malignancy, a rare form of cancer, we found a significant correlation between important social determinants of health and overall survival rate. Females, Asian-Americans, Hispanics, and patients with higher education level have better overall survival.
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Affiliation(s)
- Vanessa C Stubbs
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States of America.
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Steven B Cannady
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Jason G Newman
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Said A Ibrahim
- Department of Healthcare Policy & Research, Division of Healthcare Delivery Science & Innovation, Weill Cornell Medicine, New York, NY, United States of America
| | - Jason A Brant
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, United States of America
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Yu AJ, Choi JS, Swanson MS, Kokot NC, Brown TN, Yan G, Sinha UK. Association of Race/Ethnicity, Stage, and Survival in Oral Cavity Squamous Cell Carcinoma: A SEER Study. OTO Open 2019; 3:2473974X19891126. [PMID: 31840132 PMCID: PMC6904786 DOI: 10.1177/2473974x19891126] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 11/07/2019] [Indexed: 11/27/2022] Open
Abstract
Objective Survival differences in oral cancer between black and white patients have
been reported, but the contributing factors, especially the role of stage,
are incompletely understood. Furthermore, the outcomes for Hispanic and
Asian patients have been scarcely examined. Study Design Retrospective, population-based national study. Setting Surveillance, Epidemiology, and End Results 18 Custom database (January 1,
2010, to December 31, 2014). Subjects and Methods In total, 7630 patients with primary squamous cell carcinoma in the oral
cavity were classified as non-Hispanic white (white), non-Hispanic black
(black), Hispanic, or Asian. Cox regression was used to obtain unadjusted
and adjusted hazard ratios (HRs) of 5-year mortality for race/ethnicity with
sequential adjustments for stage and other covariates. Logistic regression
was used to examine the relationship between race/ethnicity and stage with
adjusted odds ratios (aORs). Results The cohort consisted of 75.0% whites, 7.6% blacks, 9.1% Hispanics, and 8.3%
Asians. Compared to whites, the unadjusted HR for all-cause mortality for
blacks was 1.68 (P < .001), which attenuated to 1.15
(P = .039) after adjusting for stage and became
insignificant after including insurance. The unadjusted HRs for all-cause
mortality were not significant for Hispanics and Asians vs whites. Compared
to whites, blacks and Hispanics were more likely to present at later stages
(aORs of 2.63 and 1.42, P < .001, respectively). Conclusion The greater mortality for blacks vs whites was largely attributable to the
higher prevalence of later stages at presentation and being uninsured among
blacks. There was no statistically significant difference in mortality for
Hispanics vs whites or Asians vs whites.
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Affiliation(s)
- Alison J Yu
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Tina and Rick Caruso Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Janet S Choi
- Tina and Rick Caruso Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Mark S Swanson
- Tina and Rick Caruso Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Niels C Kokot
- Tina and Rick Caruso Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Tamara N Brown
- Tina and Rick Caruso Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Guofen Yan
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Uttam K Sinha
- Tina and Rick Caruso Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Nocon CC, Ajmani GS, Bhayani MK. A contemporary analysis of racial disparities in recommended and received treatment for head and neck cancer. Cancer 2019; 126:381-389. [PMID: 31580491 DOI: 10.1002/cncr.32342] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 12/24/2022]
Abstract
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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Affiliation(s)
- Cheryl C Nocon
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.,Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Gaurav S Ajmani
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Mihir K Bhayani
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.,Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
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Ghani WMN, Ramanathan A, Prime SS, Yang YH, Razak IA, Abdul Rahman ZA, Abraham MT, Mustafa WMW, Tay KK, Kallarakkal TG, Doss JG, Cheong SC, Bustam AZ, Zain RB. Survival of Oral Cancer Patients in Different Ethnicities. Cancer Invest 2019; 37:275-287. [DOI: 10.1080/07357907.2019.1635614] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Wan Maria Nabillah Ghani
- Faculty of Dentistry, Oral Cancer Research and Coordinating Centre (OCRCC), University of Malaya, Kuala Lumpur, Malaysia
| | - Anand Ramanathan
- Department of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Stephen Stewart Prime
- Centre for Clinical and Diagnostic Oral Sciences, Institute of Dentistry, Barts and the London School of Dentistry, Queen Mary University of London, London, UK
| | - Yi-Hsin Yang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ishak Abdul Razak
- Faculty of Dentistry, MAHSA University, Bandar Saujana Putra, Malaysia
| | - Zainal Ariff Abdul Rahman
- Department of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Keng Kiong Tay
- Oral Health Division, Ministry of Health, Putrajaya, Malaysia
| | - Thomas George Kallarakkal
- Department of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Jennifer Geraldine Doss
- Faculty of Dentistry, Oral Cancer Research and Coordinating Centre (OCRCC), University of Malaya, Kuala Lumpur, Malaysia
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Malaysia Kuala Lumpur, Malaysia
| | - Sok Ching Cheong
- Oral Cancer Research Team, Cancer Research Malaysia, Subang Jaya, Malaysia
| | - Anita Zarina Bustam
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rosnah Binti Zain
- Faculty of Dentistry, Oral Cancer Research and Coordinating Centre (OCRCC), University of Malaya, Kuala Lumpur, Malaysia
- Faculty of Dentistry, MAHSA University, Bandar Saujana Putra, Malaysia
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Elkashty OA, Ashry R, Tran SD. Head and neck cancer management and cancer stem cells implication. Saudi Dent J 2019; 31:395-416. [PMID: 31700218 PMCID: PMC6823822 DOI: 10.1016/j.sdentj.2019.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/27/2019] [Indexed: 12/20/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCCs) arise in the mucosal linings of the upper aerodigestive tract and are heterogeneous in nature. Risk factors for HNSCCs are smoking, excessive alcohol consumption, and the human papilloma virus. Conventional treatments are surgery, radiotherapy, chemotherapy, or a combined modality; however, no international standard mode of therapy exists. In contrast to the conventional model of clonal evolution in tumor development, there is a newly proposed theory based on the activity of cancer stem cells (CSCs) as the model for carcinogenesis. This “CSC hypothesis” may explain the high mortality rate, low response to treatments, and tendency to develop multiple tumors for HNSCC patients. We review current knowledge on HNSCC etiology and treatment, with a focus on CSCs, including their origins, identifications, and effects on therapeutic options.
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Key Words
- ABC, ATP-binding cassette transporters
- ATC, amplifying transitory cell
- Antineoplastic agents
- BMI-1, B cell-specific Moloney murine leukemia virus integration site 1
- Cancer stem cells
- Cancer treatment
- Carcinoma
- EGFR, epidermal growth factor receptor
- HIFs, hypoxia-inducible factors
- Head and neck cancer
- MDR1, Multidrug Resistance Protein 1
- NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells
- PI3K, phosphatidylinositol-4,5-bisphosphate 3-kinase
- Squamous cell
- TKIs, tyrosine kinase inhibitors
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Affiliation(s)
- Osama A Elkashty
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada.,Oral Pathology Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Ramy Ashry
- Oral Pathology Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Simon D Tran
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dentistry, McGill University, Montreal, QC, Canada
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Chaudhary S, Ganguly K, Muniyan S, Pothuraju R, Sayed Z, Jones DT, Batra SK, Macha MA. Immunometabolic Alterations by HPV Infection: New Dimensions to Head and Neck Cancer Disparity. J Natl Cancer Inst 2019; 111:233-244. [PMID: 30615137 PMCID: PMC6410958 DOI: 10.1093/jnci/djy207] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/29/2018] [Accepted: 11/05/2018] [Indexed: 12/12/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer, with high morbidity and mortality. Racial disparity in HNSCC is observed between African Americans (AAs) and whites, effecting both overall and 5-year survival, with worse prognosis for AAs. In addition to socio-economic status and demographic factors, many epidemiological studies have also identified factors including coexisting human papillomavirus (HPV) infection, primary tumor location, and a variety of somatic mutations that contribute to the prognostic incongruities in HNSCC patients among AAs and whites. Recent research also suggests HPV-induced dysregulation of tumor metabolism and immune microenvironment as the major regulators of HNSCC patient prognosis. Outcomes of several preclinical and clinical studies on targeted therapeutics warrant the need to elucidate the inherent mechanistic and population-based disparities underlying patient responses. This review systematically reports the underlying reasons for inconsistency in disease prognosis and therapy responses among HNSCC patients from different racial populations. The focus of this review is twofold: aside from discussing the causes of racial disparity, we also seek to identify the consequences of such disparity in terms of HPV infection and its associated mutational, metabolic, and immune landscapes. Considering the clinical impact of differential patient outcomes among AA and white populations, understanding the underlying cause of this disparity may pave the way for novel precision therapy for HNSCC.
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Affiliation(s)
- Sanjib Chaudhary
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE
| | - Koelina Ganguly
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE
| | - Sakthivel Muniyan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE
| | - Ramesh Pothuraju
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE
| | - Zafar Sayed
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Dwight T Jones
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Surinder K Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Muzafar A Macha
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE
- Department of Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE
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Racial and socioeconomic disparities associated with 90-day mortality among patients with head and neck cancer in the United States. Oral Oncol 2018; 89:95-101. [PMID: 30732966 DOI: 10.1016/j.oraloncology.2018.12.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/11/2018] [Accepted: 12/22/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To quantify head and neck cancer (HNC) mortality rates and identify racial and socioeconomic factors associated with 90-day mortality. METHODS The National Cancer Database (2004-2014) was queried for eligible HNC cases (n = 260,011) among adults treated with curative intent. Outcome of interest was any-cause 90-day mortality. Kaplan-Meier curves (Log-rank tests) estimated crude survival differences. A Cox proportional hazards model with further adjustments using the Šidák multiple comparison method adjusted for racial, socioeconomic and clinical factors. RESULTS There were 9771 deaths (90-day mortality rate = 3.8%). There were crude differences in sex, race/ethnicity, comorbidity, distance, income, and insurance (Log-rank p-value < 0.0001). In the final model, blacks (aHR = 1.10, 95% CI 1.00, 1.21) and males (aHR = 1.07; 95% CI 1.00, 1.15) had greater 90-day mortality hazard, as did those uninsured (aHR = 1.72; 95% CI 1.48, 1.99), covered by Medicaid (aHR = 1.72; 95% CI 1.53, 1.93) or Medicare (aHR = 1.40; 95% CI 1.27, 1.53). Residence in lower median income zip code was associated with greater 90-day mortality [(aHR <$30,000 = 1.30; 95% CI 1.18, 1.44); (aHR $30,000-$34,999 = 1.24; 95% CI 1.13, 1.36); (aHR $35,000-$45,999 = 1.18; 95% CI 1.08, 1.27)]; and farther travel distance for treatment was associated with decreased 90-day mortality [(aHR 50-249.9 miles = 0.86; 95% CI 0.77, 0.97); (aHR > 250 miles = 0.70; 95% CI 50, 0.99)]. CONCLUSIONS There are significant race and socioeconomic disparities among patients with HNC, and these disparities impact mortality within 90 days of treatment.
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Lumley CJ, Kaffenberger TM, Desale S, Tefera E, Han CJ, Rafei H, Maxwell JH. Post-diagnosis aspirin use and survival in veterans with head and neck cancer. Head Neck 2018; 41:1220-1226. [PMID: 30537085 DOI: 10.1002/hed.25518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/26/2018] [Accepted: 10/06/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Our objective was to determine the effect of post-diagnosis aspirin use on survival in veterans with head and neck squamous cell carcinoma. METHODS Retrospective cohort study of 584 veterans with head and neck squamous cell carcinoma treated at the Washington DC VA Medical Center between 1995 and 2015. Charts were queried for clinical-pathologic data, aspirin prescriptions, and outcome. The Kaplan-Meier method was used to determine overall survival (OS) and disease-specific survival (DSS) among aspirin users and nonusers. RESULTS A total of 329 patients met inclusion criteria. Primary subsites included oropharynx (n = 143), larynx (n = 105), oral cavity (n = 62), and hypopharynx (n = 19). Eighty-four patients were aspirin users (25.5%). Aspirin users demonstrated significantly better 3-year OS and DSS (78.6% and 88.1%) compared to nonaspirin users (OS: 55.9% and DSS: 70.2%; P = .0003 and P = .0019, respectively). On multivariate analysis, aspirin use remained independently associated with improved survival. CONCLUSION Aspirin use following diagnosis and curative treatment of head and neck squamous cell carcinoma is associated with improved OS and DSS.
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Affiliation(s)
- Catherine J Lumley
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Thomas M Kaffenberger
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sameer Desale
- Department of Biostatistics and Biomedical informatics, MedStar Health Research Institute, Washington, District of Columbia
| | - Eshetu Tefera
- Department of Biostatistics and Biomedical informatics, MedStar Health Research Institute, Washington, District of Columbia
| | - Chihun Jim Han
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Hind Rafei
- Department of Medicine, George Washington University School of Medicine, Washington, District of Columbia
| | - Jessica H Maxwell
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia.,Department of Surgery, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia
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Faraji F, Rettig EM, Tsai HL, El Asmar M, Fung N, Eisele DW, Fakhry C. The prevalence of human papillomavirus in oropharyngeal cancer is increasing regardless of sex or race, and the influence of sex and race on survival is modified by human papillomavirus tumor status. Cancer 2018; 125:761-769. [PMID: 30521092 DOI: 10.1002/cncr.31841] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the influence of sex and race/ethnicity upon prevalence trends of human papillomavirus (HPV) in oropharyngeal cancer (OPC) and survival after OPC. METHOD This was a cohort study of patients included in the United States National Cancer Database who had been diagnosed with OPC between 2010 and 2015. Outcomes were HPV status of tumor specimens and overall survival. Sex- and race-stratified trends in HPV prevalence were estimated using generalized linear modeling. The influence of sex, race, and HPV tumor status on overall survival was compared by Kaplan-Meier method and Cox Proportional Hazards models. RESULTS This analysis included 20,886 HPV-positive and 10,364 HPV-negative OPC patients. The prevalence of HPV-positive tumors was higher among men (70.6%) than women (56.3%) and increased significantly over time at a rate of 3.5% and 3.2% per year among men and women, respectively. The prevalence of HPV-positive tumors was highest among whites (70.2%), followed by Hispanics (61.3%), Asians (55.8%), and blacks (46.3%). Blacks and Hispanics experienced significantly more rapid increases in prevalence of HPV-positive tumors over time compared with whites (6.5% vs 5.6% vs 3.2% per year, respectively). In HPV-positive OPC, neither sex nor race/ethnicity was associated with survival among patients with HPV-positive OPC. In contrast, for HPV-negative OPC, risk of death was significantly higher for women versus men (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 1.08-1.26) and blacks versus whites (aHR, 1.21; 95% CI, 1.10-1.33). CONCLUSION The prevalence of HPV-positive tumors is increasing for all sex and race/ethnicity groups in the United States. Sex and race are independently associated with survival for HPV-negative but not HPV-positive OPC.
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Affiliation(s)
- Farhoud Faraji
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleni M Rettig
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hua-Ling Tsai
- Department of Oncology, Division of Biostatistics and Bioinformatics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Margueritta El Asmar
- Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, Maryland
| | - Nicholas Fung
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Morse E, Berson E, Fujiwara R, Judson B, Mehra S. Hypopharyngeal Cancer Treatment Delays: Benchmarks and Survival Association. Otolaryngol Head Neck Surg 2018; 160:267-276. [DOI: 10.1177/0194599818797605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective To characterize treatment delays in hypopharyngeal cancer, identify factors associated with delays, and associate delays with overall survival. Study Design Retrospective cohort. Setting Commission on Cancer hospitals nationwide. Subjects and Methods We included patients in the National Cancer Database who were treated for hypopharyngeal cancer with primary radiation, concurrent chemoradiation, or induction chemotherapy and radiation. We identified median durations of diagnosis to treatment initiation (DTI), radiation treatment duration (RTD), and diagnosis to treatment end (DTE). We associated delays with patient, tumor, and treatment factors and overall survival via multivariable logistic and Cox proportional hazards regression, respectively. Results A total of 3850 patients treated with primary radiation or concurrent chemoradiation were included. Median durations of DTI, RTD, and DTE were 37, 52, and 92 days, respectively. Nonwhite race was associated with delays in DTI (odds ratio [OR] = 0.64; 95% CI, 0.51-0.80; P < .001) and DTE (OR = 0.60; 95% CI, 0.49-0.75; P < .001). Medicaid insurance was associated with delays in DTI (OR = 1.43; 95% CI, 1.07-1.90; P = .015), RTD (OR = 1.39; 95% CI, 1.06-1.83; P = .018), and DTE (OR = 1.48; 95% CI, 1.12-1.97; P = .007). Delays in RTD (hazard ratio [HR] = 1.24; 95% CI, 1.11-1.37; P < .001), not DTI (HR = 0.92; 95% CI, 0.82-1.03; P = .150) or DTE (HR = 1.01; 95% CI, 0.90-1.15; P = .825), were associated with impaired overall survival. We identified 922 patients who received induction chemotherapy. Delays in DTI, RTD, and DTE were not associated with overall survival in this cohort (HR = 1.10; 95% CI, 0.87-1.39; P = 0.435; HR = 1.05; 95% CI, 0.83-1.32; P = 0.686; HR = 1.11; 95% CI, 0.88-1.41; P = 0.377, respectively). Conclusions The median durations identified can serve as national benchmarks. Delays during radiation are associated with impaired overall survival among patients treated with primary radiation or chemoradiation but not patients treated with induction chemotherapy.
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Affiliation(s)
- Elliot Morse
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Elisa Berson
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Rance Fujiwara
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Benjamin Judson
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
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Cheraghlou S, Schettino A, Zogg CK, Judson BL. Changing prognosis of oral cancer: An analysis of survival and treatment between 1973 and 2014. Laryngoscope 2018; 128:2762-2769. [PMID: 30194691 DOI: 10.1002/lary.27315] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/14/2018] [Accepted: 05/07/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES/HYPOTHESIS Oral cavity cancer is the most commonly occurring malignancy of the head and neck. There are limited data suggesting a change in prognosis of oral cavity cancers. We aimed to evaluate temporal trends in demographics, treatment, and prognosis of oral cavity cancer diagnosed between 1973 and 2014 inclusive. STUDY DESIGN Retrospective database analysis. METHODS A retrospective study of 16,030 adult patients diagnosed with oral cavity cancer between 1973 and 2014 inclusive and treated surgically in the Surveillance, Epidemiology, and End Results (SEER) 9 registry was conducted. A supplemental analysis was conducted using data from the National Cancer Database. Multivariate Cox survival regressions and univariate Kaplan-Meier analyses were conducted. RESULTS The prognosis of both early- and late-stage disease has significantly improved between 1973 and 2014. Among patients with early-stage disease, 3-year survival increased from 78.0% (standard error [SE] = 1.3) for those diagnosed from 1973 to 1980 to 92.2% (SE = 1.1) for those diagnosed from 2011 to 2014. Among patients with late-stage disease, 3-year survival ranged from 51.9% (SE = 1.5) for those diagnosed from 1973 to 1980 to 70.3% (SE = 1.9) for those diagnosed from 2011 to 2014. For patients with late-stage disease, this improved prognosis occurred in tandem with increasing usage of chemoradiotherapy as adjuvant therapy. There has also been increasing utilization of neck dissection for early- and late-stage disease, along with higher nodal yields from performed dissections. CONCLUSIONS The prognosis of oral cavity cancer has improved significantly from the early 1970s to recent years. In late-stage oral cancer, this change has been associated with an increased use of adjuvant therapy and adjuvant chemoradiotherapy in particular. LEVEL OF EVIDENCE 4 Laryngoscope, 128:2762-2769, 2018.
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Affiliation(s)
- Shayan Cheraghlou
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Amy Schettino
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Cheryl K Zogg
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin L Judson
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut, U.S.A
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Albert A, Giri S, Kanakamedala M, Mangana S, Bhanat E, Shenoy V, Thomas TV, Joseph S, Gonzalez M, Shalaby A, Vijayakumar S. Racial disparities in tumor features and outcomes of patients with squamous cell carcinoma of the tonsil. Laryngoscope 2018; 129:643-654. [DOI: 10.1002/lary.27395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Ashley Albert
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Shankar Giri
- Department of Radiation Oncology; G.V. (Sonny) Montgomery VA Medical Center; Jackson Mississippi U.S.A
| | - Madhava Kanakamedala
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Sophy Mangana
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Eldrin Bhanat
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Veena Shenoy
- Department of Pathology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Toms Vengaloor Thomas
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Sanjay Joseph
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Maria Gonzalez
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Akram Shalaby
- Department of Pathology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
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Torrecillas V, Shepherd HM, Francis S, Buchmann LO, Monroe MM, Lloyd S, Cannon D, Hitchcock YJ, Weis JR, Hunt JP, Houlton JJ, Cannon RB. Adjuvant radiation for T1-2N1 oral cavity cancer survival outcomes and utilization treatment trends: Analysis of the SEER database. Oral Oncol 2018; 85:1-7. [PMID: 30220313 DOI: 10.1016/j.oraloncology.2018.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/20/2018] [Accepted: 07/29/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Evaluate current practice patterns in the use of adjuvant radiation for T1-2N1 OCSCC patients and investigate its efficacy in the population-based setting. MATERIALS AND METHODS This study extracted patients who were treated surgically for T1N1 and T2N1 OCSCC without adverse nodal features from the SEER database from 2004 to 2013. Patients with distant metastatic disease, unknown surgery or radiation status, or prior malignancies were excluded. Patients were divided into those who underwent surgical resection with and without adjuvant radiation. Disease-specific survival (DSS) and overall survival (OS) were the primary outcomes measured. RESULTS 746 patients met inclusion criteria and 70% received adjuvant radiation therapy. Treatment with adjuvant radiation therapy was significantly associated with improved 5-year DSS (65% versus 51%; p < 0.001) and OS (54% versus 44%; p = 0.007) for T1N1 tumors. Likewise, improved 5-year DSS (58% versus 38%; p = 0.009) and OS (48% versus 28%; p = 0.004) was shown in T2N1 tumors. Patients with T2N1 tumors wer significantly more likely to receive adjuvant radiation (75% versus 63%; p < 0.001). Those with insurance and high risk primary subsites: buccal, retromolar trigone, and hard palate were more likely to receive adjuvant radiation. The percent utilization of adjuvant radiation remained constant through the study period for T2N1 tumors (72-74%) but significantly decreased for T1N1 (71-55%) (p = 0.047). CONCLUSION Adjuvant radiation therapy is independently associated with a significant survival benefit for patients with both T1N1 and T2N1 OCSCC. However, this study demonstrates that patients with T1N1 cancer are less likely to receive adjuvant radiation and utilization is decreasing.
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Affiliation(s)
- Vanessa Torrecillas
- The University of Utah School of Medicine, Otolaryngology Head and Neck Surgery, 50 North Medical Drive 3C-120, Salt Lake City, UT 84132, USA.
| | - Hailey M Shepherd
- The University of Utah School of Medicine, Otolaryngology Head and Neck Surgery, 50 North Medical Drive 3C-120, Salt Lake City, UT 84132, USA
| | - Sam Francis
- The University of Utah School of Medicine, Department of Radiation Oncology, 1950 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Luke O Buchmann
- The University of Utah School of Medicine, Otolaryngology Head and Neck Surgery, 50 North Medical Drive 3C-120, Salt Lake City, UT 84132, USA
| | - Marcus M Monroe
- The University of Utah School of Medicine, Otolaryngology Head and Neck Surgery, 50 North Medical Drive 3C-120, Salt Lake City, UT 84132, USA
| | - Shane Lloyd
- The University of Utah School of Medicine, Department of Radiation Oncology, 1950 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Donald Cannon
- The University of Utah School of Medicine, Department of Radiation Oncology, 1950 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Ying J Hitchcock
- The University of Utah School of Medicine, Department of Radiation Oncology, 1950 Circle of Hope, Salt Lake City, UT 84112, USA
| | - John R Weis
- The University of Utah School of Medicine, Division of Oncology, 1950 Circle of Hope, Salt Lake City, UT 84112, USA
| | - Jason P Hunt
- The University of Utah School of Medicine, Otolaryngology Head and Neck Surgery, 50 North Medical Drive 3C-120, Salt Lake City, UT 84132, USA
| | - Jeffrey J Houlton
- The University of Washington School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Seattle, WA, USA
| | - Richard B Cannon
- The University of Utah School of Medicine, Otolaryngology Head and Neck Surgery, 50 North Medical Drive 3C-120, Salt Lake City, UT 84132, USA
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Morse E, Fujiwara RJ, Judson B, Mehra S. Treatment delays in laryngeal squamous cell carcinoma: A national cancer database analysis. Laryngoscope 2018; 128:2751-2758. [DOI: 10.1002/lary.27247] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/13/2018] [Accepted: 03/29/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Elliot Morse
- Department of Surgery, Division of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Rance J.T. Fujiwara
- Department of Surgery, Division of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Benjamin Judson
- Department of Surgery, Division of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Saral Mehra
- Department of Surgery, Division of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
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