Disparities in Survival Outcomes among Racial/Ethnic Minorities with Head and Neck Squamous Cell Cancer in the United States

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.

Keywords: head and neck cancer; racial disparities; squamous cell.

Figure 1

Selection Criteria.

Figure 2

Overall Survival by Racial/Ethnic Minority for (A) the entire cohort; (B) White vs. non-White; (C) Hispanic Black vs. non-Hispanic Black; (D) Stage I; (E) Stage II; (F) Stage III; (G) Stage IV.

Figure 2

Overall Survival by Racial/Ethnic Minority for (A) the entire cohort; (B) White vs. non-White; (C) Hispanic Black vs. non-Hispanic Black; (D) Stage I; (E) Stage II; (F) Stage III; (G) Stage IV.

Figure 2

Overall Survival by Racial/Ethnic Minority for (A) the entire cohort; (B) White vs. non-White; (C) Hispanic Black vs. non-Hispanic Black; (D) Stage I; (E) Stage II; (F) Stage III; (G) Stage IV.

Figure 2

Overall Survival by Racial/Ethnic Minority for (A) the entire cohort; (B) White vs. non-White; (C) Hispanic Black vs. non-Hispanic Black; (D) Stage I; (E) Stage II; (F) Stage III; (G) Stage IV.

Figure 3

Overall Survival by Racial/Ethnic Minority for the (A) Hypopharynx; (B) Larynx; (C) Nasal Cavity; (D) Nasopharynx; (E) Oropharynx; (F) Pharynx (NOS); (G) Oral Cavity.

Figure 3

Overall Survival by Racial/Ethnic Minority for the (A) Hypopharynx; (B) Larynx; (C) Nasal Cavity; (D) Nasopharynx; (E) Oropharynx; (F) Pharynx (NOS); (G) Oral Cavity.

Figure 3

Overall Survival by Racial/Ethnic Minority for the (A) Hypopharynx; (B) Larynx; (C) Nasal Cavity; (D) Nasopharynx; (E) Oropharynx; (F) Pharynx (NOS); (G) Oral Cavity.

Figure 3

Overall Survival by Racial/Ethnic Minority for the (A) Hypopharynx; (B) Larynx; (C) Nasal Cavity; (D) Nasopharynx; (E) Oropharynx; (F) Pharynx (NOS); (G) Oral Cavity.