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. 2021 Jan;43(1):89-97.
doi: 10.1002/hed.26460. Epub 2020 Sep 11.

Untreated head and neck cancer: Natural history and associated factors

Paul Zolkind  1 , Jake J Lee  1 , Ryan S Jackson  1 , Patrik Pipkorn  1 , Sean T Massa  1
Affiliations

Untreated head and neck cancer: Natural history and associated factors

Paul Zolkind et al. Head Neck. 2021 Jan.

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.

Keywords: epidemiology; head and neck cancer; natural history; socioeconomic factors; treatment disparity.

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Figures

Figure 1:
Figure 1:
Flow diagram for study cohort section
Figure 2:
Figure 2:
Patient outcomes without oncologic treatment. A, Overall survival by stage. B, Overall survival by tumor subsite. C, Median survival by both stage and subsite. Arrows indicate that median survival not reached [Color figure can be viewed at wileyonlinelibrary.com]
Figure 3:
Figure 3:
Cumulative mortality following head and neck cancer (HNC) diagnosis secondary to cancer (solid lines) or other cause (dashed line) [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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