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Joseph I, Johns AJ, Kleber K, Luce S, Godoy L, Fannon EE. Operating on A Bias: A Review of Cultural Competency Curricula in Surgical Residencies and a Call for Systemic Change. JOURNAL OF SURGICAL EDUCATION 2024; 81:1249-1257. [PMID: 38944584 DOI: 10.1016/j.jsurg.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/18/2024] [Accepted: 06/02/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Several factors contribute to surgical outcome disparities, including structural racism and implicit bias. Research into how surgical residency programs intervene on Cultural Complications via education remains sparse. We review the literature for how surgical residency programs use education to combat staff and patient exposure to Cultural Complications. METHODS We searched PubMed, SCOPUS, and Google Scholar for curricula aimed at improving cultural competency in surgical residencies. OBGYN curricula were included. Non-US studies were excluded. RESULTS Studies were organized by intervention type: Didactic, Grand Rounds, and M&M. The most common interventions were Didactics, with Grand Rounds being the least common. Target measures improved anywhere from 20-88%. CONCLUSIONS The common types of cultural competency curricula are clear, and certain interventions show improvement in trainees' education. Scarcity of data on these curricula does not necessarily indicate their lack of existence but does suggest additional research is needed into curricular interventions and how they may address cultural complications.
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Affiliation(s)
- Ian Joseph
- University of California, Davis, Department of Surgery, Sacramento, California 95817.
| | - Alexandra J Johns
- University of California, Davis, Department of Surgery, Sacramento, California 95817
| | - Kara Kleber
- University of California, Davis, Department of Surgery, Sacramento, California 95817
| | - Siobhan Luce
- University of California, Davis, Department of Surgery, Sacramento, California 95817
| | - Luis Godoy
- University of California, Davis, Department of Surgery, Sacramento, California 95817
| | - Elise Eh Fannon
- University of California, Davis, Department of Surgery, Sacramento, California 95817
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Ferraro T, Ahmed AK, Lee E, Lee SM, Debbaneh PM, Thakkar P, Joshi A, Tummala N. Race and Ethnicity Independently Predict Adverse Outcomes Following Head and Neck Autograft Surgery. Laryngoscope 2024; 134:3595-3603. [PMID: 38407481 DOI: 10.1002/lary.31367] [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: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE There is growing attention toward the implications of race and ethnicity on health disparities within otolaryngology. While race is an established predictor of adverse head and neck oncologic outcomes, there is paucity in the literature on studies employing national, multi-institutional data to assess the impact of race and ethnicity on head and neck autograft surgery. METHODS Using the National Surgical Quality Improvement Program (NSQIP) database, trends in 30 days outcomes were assessed. Patients with ICD-10 codes for malignant head and neck neoplasms were isolated. Autograft surgeries were selected using Current Procedural Terminology (CPT) codes for free flap and pedicled flap reconstruction. Primary outcomes included surgical complications, reoperation, readmission, extended length of stay and operation time. Each binary categorical variable was compared to racial/ethnic identity via binary logistic regression. RESULTS The study cohort consisted of 2447 patients who underwent head and neck autograft surgery (80.71% free flap reconstruction and 19.39% pedicled flap reconstruction). Black patients had significantly higher odds of overall surgical complications (odds ratio [OR] 1.583, 95% confidence interval [CI] 1.091, 2.298, p = 0.016) with much higher odds of perioperative blood transfusions (OR 2.291, 95% CI 1.532, 3.426, p = <.001). Hispanic patients were more likely to undergo reoperation within 30 days after surgery and were more likely to be hospitalized for more than 30 days post-operatively (OR 1.566, 95% CI 1.015, 2.418, p = 0.043 and OR 12.224, 95% CI 2.698, 55.377, p = 0.001, respectively). CONCLUSIONS Race and ethnicity serve as independent predictors of complications in the post-operative period following head and neck autograft surgery. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3595-3603, 2024.
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Affiliation(s)
- Tatiana Ferraro
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, U.S.A
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Abdulla K Ahmed
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, U.S.A
| | - Esther Lee
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, U.S.A
| | - Sean M Lee
- Office of Clinical Research, The George Washington University School of Medicine & Health Sciences, Washington, DC, U.S.A
| | - Peter M Debbaneh
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente East Bay, Oakland, California, U.S.A
| | - Punam Thakkar
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, U.S.A
| | - Arjun Joshi
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, U.S.A
| | - Neelima Tummala
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, U.S.A
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Nurimba M, Sheth M, Swanson M, Chambers T. The Impact of Race and the Affordable Care Act on Thyroid Carcinoma Outcomes: A National Cancer Database Study. Laryngoscope 2024. [PMID: 38841865 DOI: 10.1002/lary.31559] [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: 04/24/2023] [Revised: 04/16/2024] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE To assess the impact of race and the Affordable Care Act (ACA) of 2010 on disease presentation and overall survival for patients with well-differentiated thyroid carcinoma. STUDY DESIGN Cross-sectional study of patients (n = 51,078) who underwent partial or total thyroidectomy with or without postoperative radioactive iodine (RAI) for well-differentiated thyroid carcinoma between 2004 and 2018 in the National Cancer Database (NCDB). METHODS Cumulative survival (CS) was assessed with Cox proportional hazard regression analyses. RESULTS There were significant disparities in disease presentation at the time of diagnosis, with Black, Asian/Pacific Islander (API), and Hispanic patients were more likely to have metastatic disease (p < 0.001) and higher TNM stage (p < 0.001) at the time of diagnosis compared to White patients. Black patients had significantly increased risk of death (HR 1.147, 95%CI 1.021-1.289) but API patients had improved CS (HR 0.730, 95% CI 0.608-0.877) compared to White patients. Passage of the ACA was associated with lower risk of mortality, regardless of whether patients lived in states that did not expand Medicaid (HR 0.866, 95% CI 0.823-0.910) or whether they lived in expansion states (HR 0.818, 95% CI 0.758-0.884). CONCLUSION Racial disparities significantly impact thyroid carcinoma diagnosis and treatment in the United States but have improved over time. Both expansion and non-expansion states had improved survival outcomes over time, and suggesting analysis of the ACA's long-term impact and ability to address health inequities is still warranted. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2024.
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Affiliation(s)
- Margaret Nurimba
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Megha Sheth
- Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
| | - Mark Swanson
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Tamara Chambers
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
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Aschen SZ, O'Connell GM, Kutler DI, Spector JA. Financial (dis)incentives to surgical management of head and neck cancer care. Head Neck 2024; 46:1362-1369. [PMID: 38265174 DOI: 10.1002/hed.27649] [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: 08/17/2023] [Revised: 12/27/2023] [Accepted: 01/14/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) often require complex surgical reconstruction. This retrospective, cross-sectional study compares financial factors influencing HNC and breast cancer (BC) care to examine care disparities. METHODS Pricing data from 2012 to 2021 was abstracted from the CMS Physician Fee Schedule Look-Up Tool. Nonprofit and research support was quantified by searching the NIH, IRS, and GuideStar databases. New York State Department of Health data from 2015 to 2019 was analyzed to compare costs, charges, and payer mix. RESULTS HNC reconstructive procedures reimburse lower than comparable breast procedures (p < 0.05). Nonprofit and research support for HNC is disproportionately low relative to disease burden. Patients hospitalized for HNC surgical procedures generated higher costs and lower charges than patients with BC (p < 0.05). CONCLUSION Comparatively low procedure reimbursement, low nonprofit support, and high cost of care for patients with HNC relative to patients with BC may contribute to care disparities for patients with HNC.
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Affiliation(s)
- Seth Z Aschen
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - David I Kutler
- Department of Otolaryngology, Weill Cornell Medicine, New York, New York, USA
| | - Jason A Spector
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, New York, USA
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Gilja S, Kumar A, Kapustin D, Su V, Rubin SJ, Chai R, Roof SA, Khan MN. The Impact of Hospital Safety-Net Burden Status on Patients with HPV-Positive Oropharyngeal Cancer. Laryngoscope 2024; 134:1733-1740. [PMID: 37933810 DOI: 10.1002/lary.31131] [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: 06/26/2023] [Revised: 09/11/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES The objective of this study was to compare treatment characteristics and outcomes between patients with HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) treated at hospitals of varying safety-net burden status. METHODS Patients with cT1-4, N0-3, M0 HPV-positive OPSCC who underwent definitive surgery or radiation were included. Patients were grouped based on their treating hospital safety-net burden status, defined as the percentage of uninsured and Medicaid-insured patients with OPSCC treated at the facility and stratified as low burden (LBH: 0-25th percentile), medium burden (MBH: 25th-75th percentile), or high burden (HBH: 75th-100th percentile). The primary outcome was primary treatment with surgery versus radiation, evaluated with multivariable-adjusted logistic regression. Secondary outcomes included TORS versus open surgical approach, and overall survival evaluated with Cox proportional hazards analysis. RESULTS Of the 19,810 patients with cT1-4, N0-3, M0 HPV-positive OPSCC included in this study, 4921 (24.8%) were treated at LBH, 12,201 (61.6%) were treated at MBH, and 2688 (13.6%) were treated at HBH. In multivariable-adjusted analysis, compared with treatment at LBH, treatment at HBH was associated with more frequent radiation over surgical treatment (OR: 1.26, 95% CI: 1.12-1.40, p < 0.001). For patients undergoing surgery, patients at HBH had less frequent transoral robotic surgery (OR: 0.30, 95% CI 0.24-0.38, p < 0.001) compared with patients treated at LBH. Overall survival of patients treated at HBH was worse than that of patients treated at LBH (HR: 1.27, 95% CI 1.13-1.43, p < 0.001). CONCLUSION These findings highlight underlying disparities at higher safety-net burden facilities that impact patterns of care and outcomes for patients with OPSCC. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1733-1740, 2024.
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Affiliation(s)
- Shivee Gilja
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Arvind Kumar
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Danielle Kapustin
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Vivian Su
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Samuel J Rubin
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Raymond Chai
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Mohemmed N Khan
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sina, New York, New York, USA
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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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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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Li V, Alibhai SMH, Noel K, Fazelzad R, Haase K, Mariano C, Durbano S, Sattar S, Newton L, Dawe D, Bell JA, Hsu T, Wong ST, Lofters A, Bender JL, Manthorne J, Puts MTE. Access to cancer clinical trials for racialised older adults: an equity-focused rapid scoping review protocol. BMJ Open 2024; 14:e074191. [PMID: 38245013 PMCID: PMC10807002 DOI: 10.1136/bmjopen-2023-074191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The intersection of race and older age compounds existing health disparities experienced by historically marginalised communities. Therefore, racialised older adults with cancer are more disadvantaged in their access to cancer clinical trials compared with age-matched counterparts. To determine what has already been published in this area, the rapid scoping review question are: what are the barriers, facilitators and potential solutions for enhancing access to cancer clinical trials among racialised older adults? METHODS We will use a rapid scoping review methodology in which we follow the six-step framework of Arksey and O'Malley, including a systematic search of the literature with abstract and full-text screening to be conducted by two independent reviewers, data abstraction by one reviewer and verification by a second reviewer using an Excel data abstraction sheet. Articles focusing on persons aged 18 and over who identify as a racialised person with cancer, that describe therapies/therapeutic interventions/prevention/outcomes related to barriers, facilitators and solutions to enhancing access to and equity in cancer clinical trials will be eligible for inclusion in this rapid scoping review. ETHICS AND DISSEMINATION All data will be extracted from published literature. Hence, ethical approval and patient informed consent are not required. The findings of the scoping review will be submitted for publication in a peer-reviewed journal and presentation at international conferences.
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Affiliation(s)
- Vivian Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine and Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Kristin Haase
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline Mariano
- BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lorelei Newton
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - David Dawe
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer A Bell
- Clinical and Organizational Ethics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tina Hsu
- Department of Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Sabrina T Wong
- Division of Intramural Research, National Institute of Nursing Research, Bethesda, Maryland, USA
| | - Aisha Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontario, Canada
| | - Jacqueline L Bender
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Lin ME, Castellanos CX, Bagrodia N, West JD, Kokot NC. Differences in presentation, treatment, and outcomes among minority head and neck cancer patient groups in Los Angeles County. Am J Otolaryngol 2024; 45:104031. [PMID: 37639986 DOI: 10.1016/j.amjoto.2023.104031] [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: 06/25/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
IMPORTANCE While minorities represent around 20 % of all HNC patients, these demographics are largely understudied. Furthermore, trends in national studies may not always be fully replicated in locoregional populations, indicating a need for more nuanced study. OBJECTIVE To better understand our patient population, we sought to understand differences in presentation, management, and outcome between Caucasians and minority groups with HNC. DESIGN Retrospective cohort analysis of the Los Angeles County Surveillance Epidemiology and End Results (SEER) database. SETTING Los Angeles County. PARTICIPANTS All patients in Los Angeles County diagnosed with cancer of the head and neck from January 1, 1988 to December 31, 2018. MAIN OUTCOMES AND MEASURES The primary outcome in our study was significant differences between racial and ethnic groups in age of diagnosis, sex, socioeconomic quintile, insurance status, stage at diagnosis, treatment modality, time to first treatment, and cancer-specific cause of death. RESULTS Our 18,510-patient cohort was largely male (64.35 %), white (69.57 %), and were on average 62.84 years old (SD = 20.07). When stratifying patients by race and ethnicity, significant differences were found in average age at diagnosis, sex, socioeconomic quintile, insurance status, and stage at diagnosis, treatment modalities utilized, and time to first treatment (all p < 0.001). Relative to all other head and neck patients, minority groups were significantly younger, had lower proportions of male patients, were less likely to pursue surgery, were more likely to pursue chemotherapy or radiation, and endorsed longer time to first treatment (all p < 0.001). The distribution of socioeconomic quintile (all p < 0.001), insurance status (all p < 0.001), and stage at diagnosis (all p < 0.05) also significantly varied between minority and reference groups. Only African Americans exhibited significantly higher rates of cancer-specific cause of death relative to non-African Americans (p < 0.001). CONCLUSIONS AND RELEVANCE Pervasive socioeconomic disparities between Caucasian HNC patients and those of other minority racial and ethnic groups in Los Angeles County that likely and significantly impact the diagnosis and management of HNC and its resultant outcomes. We encourage others to similarly examine their local populations to tailor the quality of care provided to patients.
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Affiliation(s)
- Matthew Ern Lin
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Carlos X Castellanos
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Department of Head and Neck Surgery, Los Angeles, CA, USA
| | - Neelesh Bagrodia
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jonathan D West
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Niels C Kokot
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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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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11
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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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12
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Liu G, Yang Z, Wang D. A Bayesian network predicting survival of cervical cancer patients-Based on surveillance, epidemiology, and end results. Cancer Sci 2023; 114:1131-1141. [PMID: 36285478 PMCID: PMC9986069 DOI: 10.1111/cas.15624] [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: 05/12/2022] [Revised: 08/31/2022] [Accepted: 10/14/2022] [Indexed: 12/25/2022] Open
Abstract
This study aimed to build a comprehensive model for predicting the overall survival (OS) of cervical cancer patients who received standard treatments and to build a series of new stages based on the International Federation of Gynecologists and Obstetricians (FIGO) stages for better such predictions. We collected the cervical cancer patients diagnosed since the year 2000 from the Surveillance, Epidemiology, and End Results (SEER) database. Cervical cancer patients who received radiotherapy or surgery were included. Log-rank tests and Cox regression were used to identify potential factors of OS. Bayesian networks (BNs) were built to predict 3- and 5-year survival. We also grouped the patients into new stages by clustering their 5-year survival probabilities based on FIGO stage, age, and tumor differentiation. Cox regression suggested black ethnicity, adenocarcinoma, and single status as risks for poorer prognosis, in addition to age and stage. A total of 43,749 and 39,333 cases were finally eligible for the 3- and 5-year BNs, respectively, with 11 variables included. Cluster analysis and Kaplan-Meier curves indicated that it was best to divide the patients into nine modified stages. The BNs had excellent performance, with area under the curve and maximum accuracy of 0.855 and 0.804 for 3-year survival, and 0.851 and 0.787 for 5-year survival, respectively. Thus, BNs are excellent candidates for predicting cervical cancer survival. It is necessary to consider age and tumor differentiation when estimating the prognosis of cervical cancer using FIGO stages.
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Affiliation(s)
- Guangcong Liu
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute Shenyang, Shenyang, People's Republic of China
| | - Zhuo Yang
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute Shenyang, Shenyang, People's Republic of China
| | - Danbo Wang
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute Shenyang, Shenyang, People's Republic of China
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13
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Singh P, Debbaneh P, Rivero A. Racial Disparities in Tympanoplasty Surgery: A 30-Day Morbidity and Mortality National Cohort Study. Otol Neurotol 2022; 43:e1129-e1135. [PMID: 36351227 DOI: 10.1097/mao.0000000000003737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the impact of race and ethnicity on 30-day complications after tympanoplasty surgery. METHODS The National Surgical Quality Improvement Program database was queried for tympanoplasty procedures from 2005 to 2019. Demographic, comorbidity, and postoperative complication data were compared according to race using univariate and binary logistic regression analyses. RESULTS A total of 11,701 patients were included, consisting of 80.3% White, 3.0% Black, 7.7% Asian, 5.7% Hispanic, 2.5% American Indian/Alaska Native, and 0.8% other. Binary logistic regression model indicated that Black patients had increased odds of unplanned readmittance (p = 0.033; odds ratio [OR], 3.110) and deep surgical site infections (p = 0.008; OR, 6.292). American Indian/Alaska Native patients had increased odds of reoperation (p = 0.022; OR, 6.343), superficial surgical site infections (p < 0.001; OR, 5.503), urinary tract infections (p < 0.001; OR, 18.559), surgical complications (p < 0.001; OR, 3.820), medical complications (p = 0.001; OR, 10.126), and overall complications (p < 0.001; OR, 4.545). CONCLUSION Although Black and American Indian/Alaskan Native patients were more likely to have complications after tympanoplasty surgery after adjusting for comorbidities, age, and sex, these results are tempered by an overall low rate of complications. Future studies should be devoted to understanding the drivers of these health inequities in access to otologic care and surgical treatment to improve outcomes and achieve equitable care.
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Affiliation(s)
- Priyanka Singh
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Peter Debbaneh
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente, Oakland, California
| | - Alexander Rivero
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente, Oakland, California
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14
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Lehrich BM, Birkenbeuel JL, Roman K, Mahmoodi A, Goshtasbi K, Sahyouni R, Hsu FP, Kuan EC. Treatment selection towards active surveillance over definitive treatment for pituitary adenomas is influenced by sociodemographic factors. Clin Neurol Neurosurg 2022; 222:107455. [DOI: 10.1016/j.clineuro.2022.107455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/11/2022] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
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15
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Jin W, Rich B, Yechieli R, Freedman L, Samuels MA, Abramowitz M, Carmona R, Samuels SE. A Single Axial Slice of the Sternocleidomastoids and Paravertebral Muscles Associated with Worse Local Progression-Free Survival and Severe Toxicity in Sarcopenic Head and Neck Cancer Patients Undergoing Radiotherapy. Cureus 2022; 14:e22463. [PMID: 35345685 PMCID: PMC8942181 DOI: 10.7759/cureus.22463] [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] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The objective of this study is to contrast the predictive ability of targeted muscle groups as radiographic proxies of sarcopenia on computerized tomography (CT) with body mass index (BMI) in head and neck cancer patients (H&NCP) undergoing radiation at a safety net hospital, and to evaluate sarcopenia with survival, local progression, toxicities and treatment delays. Methods A retrospective review included 52 H&NCP treated between 2017-2019. The posterior neck muscles (PN), sternocleidomastoids (SCM), and their summed volume (AM) were contoured at C3 on patients’ pre-treatment CT scans, then normalized to obtain skeletal muscle index (MI) values. Pre-treatment BMI was also evaluated. Cutoffs for sarcopenia were determined by receiver operating characteristic curves. Overall survival and local recurrence-free survival were evaluated by Kaplan-Meier. Acute grade 3 or higher toxicities were evaluated by binomial logistic regression. Results Using all neck muscles (AM-MI) produced the best model for predicting outcomes, outperforming individual muscle groups and BMI. Local progression-free survival was worse in sarcopenic patients at 25.81 months versus 35.40 months (p=0.026). Acute grade 3 or higher toxicities were associated with sarcopenia (p=0.005). Conclusions In this small, retrospective single-institution experience at a safety net hospital, a single axial slice of the combined sternocleidomastoids and paravertebral muscles at C3 performed better than either muscle group alone or pre-treatment BMI at predicting oncologic outcomes.
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16
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Cramer JD, Grauer J. Modeling oral cancer screening in the United States population. Oral Oncol 2021; 124:105656. [PMID: 34864525 DOI: 10.1016/j.oraloncology.2021.105656] [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: 08/05/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the impact of oral cancer screening if applied to the United States (US) population or various high-risk populations in the US. METHODS We modeled the effects of applying an oral cancer screening program to the US population assuming a similar mortality reduction as seen in the randomized Kerala trial. We combined data on the incidence of oral cancer in the Surveillance, End Results, and Epidemiology database, data on the relative risk in various high-risk groups from the Prostate, Lung, Cervical, and Ovarian screening trial, and the National Lung Screening Trial and data on the prevalence of cigarette use from the National Health Interview Survey. RESULTS When extrapolating to the US population we predict the number needed to screen to prevent one oral cancer death (NNS) = 9,845 in all individuals aged 35 + . Screening efficiency would increase if applied to higher-risk populations. If oral cancer screening were applied to male ≥ 60 pack-year current smokers or former smokers who have quit within 15 years aged 50-79 we predict a 4.6% reduction in oral cancer mortality with an NNS = 1,485. CONCLUSIONS Targeted screening of individuals at high risk for oral cancer has the potential to maximize the efficiency of screening and meaningfully impact oral cancer mortality. We suggest a future screening trial in high-risk individuals be considered to clarify the role of oral cancer screening in the US.
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Affiliation(s)
- John D Cramer
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Jordan Grauer
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
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17
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Fagan JJ, Noronha V, Graboyes EM. Making the Best of Limited Resources: Improving Outcomes in Head and Neck Cancer. Am Soc Clin Oncol Educ Book 2021; 41:1-11. [PMID: 33793315 PMCID: PMC8059263 DOI: 10.1200/edbk_320923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The overwhelming majority of head and neck cancers and related deaths occur in low- and middle-income countries, which have challenges related to burden of disease versus access to care. Yet the additional health care burden of the COVID-19 pandemic has also impacted access to care for patients with head and neck cancer in the United States. This article focuses on challenges and innovation in prioritizing head and neck cancer care in Sub-Saharan Africa, the Indian experience of value-added head and neck cancer care in busy and densely populated regions, and strategies to optimize the management of head and neck cancer in the United States during the COVID-19 pandemic.
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Affiliation(s)
- Johannes J. Fagan
- Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Evan Michael Graboyes
- Departments of Otolaryngology-Head and Neck Surgery and Public Health Sciences, Medical University of South Carolina, Charleston, SC
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