Racial, economic disparities in head and neck cancer survival persist

NEW YORK (Reuters Health) - Among patients with head and neck cancer, African Americans and the poor have a far worse prognosis relative to other populations, researchers report in the November 15 issue of the journal Cancer, published online October 6.

This analysis of nearly 21,000 patients with head and neck cancer, predominantly in the oral cavity and larynx, shows that differences in cancer survival based on race and socioeconomic status "remain a major issue despite recognition of these inequalities for more than 30 years," note Dr. Leonidas Koniaris and colleagues from the University of Miami School of Medicine.

Overall, 72% of patients included in the analysis were male, 89.7% were white, 8.4% were African American, and 10.6% were Hispanic.

The overall median survival time was 37 months, but varied significantly by race. Median survival was only 21 months in African Americans compared with 47 months in Hispanics and 40 months in whites. African American head and neck cancer patients presented at a younger age and with more advanced disease compared with white patients.

Marked differences in treatments were evident between whites and African Americans. African American patients were more likely than white patients to receive chemotherapy (26% versus 19%) and radiation (66% versus 56%), while white patients were more likely to undergo surgery (45% versus 32%).

"It may be that larger numbers of African American patients are poor operative candidates because of comorbidities, or have a higher incidence of disease that is inoperable at diagnosis because of extent of disease burden, leading to more frequent use of palliative chemotherapy and radiotherapy," Dr. Koniaris and colleagues suggest.

"The survival of African American patients who do undergo surgery, however, is also significantly shorter than that of surgically treated whites," they note.

Living in communities with high poverty levels was also an independent predictor of worse outcomes - consistent with studies of other cancers that have identified socioeconomic status as one of the main factors responsible for differences in outcome.

Summing up, the researchers conclude that earlier diagnosis of head and neck cancer, particularly in those from low socioeconomic status groups and in African American patients, is needed to improve outcomes.

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