Medical Technology

Blacks With Head and Neck Cancer Likely Have Worse Outcomes

NEW YORK (Reuters Health) – In a retrospective study of racial/ethnic minorities with head and neck cancer (HNC), Blacks had worse outcomes, and researchers are not sure why.

“Our previous work has shown that racial differences in HNC survival are apparent as early as 90 days after treatment, for up to 25 years after treatment,” Dr. Nosayaba Osazuwa-Peters of Duke University School of Medicine in Durham told Reuters Health by email.

“But most studies have been based on Black versus white comparisons,” he said. “So, it was surprising that when we zoomed into only minority racial and ethnic groups with HNC, we found that black patients still performed worse overall, after taking clinical factors such as disease stage and treatment, and nonclinical factors such as socioeconomic status and health insurance status into consideration.”

As reported in JAMA Otolaryngology-Head and Neck Surgery, Dr. Osazuwa-Peters and colleagues analyzed SEER data from the 2007 to 2016 on non-Hispanic Black, Asian Pacific Islander, American Indian/Alaska Native, and Hispanic patients with HNC.

Primary outcomes were HNC-specific and all-cause mortality, and stage of presentation. Covariates included nonclinical (age at diagnosis, sex, race and ethnicity, insurance status, marital status, and a composite socioeconomic status) and clinical factors (stage, cancer site, chemotherapy, radiation, and surgery).

Close to 22,000 patients with HNC were included in the study: mean age, 56; 27.6%, women; 42%, non-Hispanic Black; 31.4%, Hispanic; 24.3%, Asian/Pacific Islander; and 2.3%, American Indian/Alaska Natives.

Black patients had highest proportion of individuals with very low socioeconomic status (SES; 37.7%) and the lowest crude 5-year overall survival (46%).

After adjustment, compared with non-Hispanic Blacks, Hispanics had an 11% lower subdistribution hazard ratio (sdHR) of HNC-specific mortality (sdHR, 0.89); Asian/Pacific Islanders had a 15% lower risk (sdHR, 0.85); and there was a trending lower risk for American Indian/Alaska Natives (sdHR, 0.85).

Race, sex, insurance, marital status, and SES were consistently associated with all-cause mortality, HNC-specific mortality, and stage of presentation, with non-Hispanic Blacks faring worse compared with patients in other racial and ethnic minority groups.

About half of participants had stage-of-presentation information. Compared with non-Hispanic Blacks, Hispanics had 23% lower odds (aOR, 0.77) and Asians had 27% lower odds (aOR, 0.73) of presenting at a later stage (distant vs. regional or localized); American Indian/Alaska Natives did not differ from non-Hispanic Blacks (aOR, 1.06).

The authors conclude, “Black patients had significantly worse outcomes that were not completely explained by stage of presentation. There may be unexplored multilevel factors that are associated with social determinants of health and disparities in HNC outcomes.”

Dr. Osazuwa-Peters added, “HNC has the third-worst Black versus white survival gap of all cancers, and eliminating health disparities is a national imperative. However, as we’ve shown in this study, there is more work to do…Black patients still do worse than other minority racial groups, and that is sobering…We posit that access to healthcare may not fully explain disparities, and we call for further focus, including funding, on the biological basis of health disparities in HNC.”

Dr. Daniel Faden, a head and neck surgical oncologist at Mass Eye and Ear in Boston commented on the study in an email to Reuters Health, “We already know from prior studies that Black patients do significantly worse compared to white patients. However, this study does not answer why.”

“Which factors are primarily driving these differences will be complex to parse out,” he said. Like Dr. Osazuwa-Peters, he noted, “Studies are needed looking both the intrinsic biology of head and neck tumors in Blacks compared to other groups, and also understanding the complex interplay between biology and population-level factors.”

“Lastly, there are other factors known to impact outcomes that were not accounted for in this study. and which may disproportionately impact Blacks patients, such as medical comorbidities and treatment facility,” he said.

“It is important for clinicians to recognize that robust literature supports the fact that even after controlling for clinical, sociodemographic and socioeconomic factors, Black patients with HNC have worse outcomes,” Dr. Faden concluded.

SOURCE: JAMA Otolaryngology-Head and Neck Surgery, online December 23, 2021.

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