The first two authors contributed equally to this article.
African American and poor patients have a dramatically worse prognosis for head and neck cancer
An examination of 20,915 patients
Article first published online: 6 OCT 2008
Copyright © 2008 American Cancer Society
Volume 113, Issue 10, pages 2797–2806, 15 November 2008
How to Cite
Molina, M. A., Cheung, M. C., Perez, E. A., Byrne, M. M., Franceschi, D., Moffat, F. L., Livingstone, A. S., Goodwin, W. J., Gutierrez, J. C. and Koniaris, L. G. (2008), African American and poor patients have a dramatically worse prognosis for head and neck cancer. Cancer, 113: 2797–2806. doi: 10.1002/cncr.23889
- Issue published online: 3 NOV 2008
- Article first published online: 6 OCT 2008
- Manuscript Accepted: 24 JUN 2008
- Manuscript Revised: 20 JUN 2008
- Manuscript Received: 21 APR 2008
- James and Ester King Tobacco Research Grant from the State of Florida
- head and neck;
- socioeconomic status;
Differences in cancer survival based on race, ethnicity, and socioeconomic status (SES) are a major issue. To identify points of intervention and improve survival, the authors sought to determine the impact of race, ethnicity, and socioeconomic status for patients with cancers of the head and neck (HN).
HN cancer patients diagnosed between 1998 and 2002 were examined using a linked Florida Cancer Data System and Florida Agency for Health Care Administration data set.
A total of 20,915 patients with HN cancers were identified, predominantly in the oral cavity and larynx. Overall, 72% of patients were male, 89.7% were white, 8.4% were African American (AA), and 10.6% were Hispanic. The median survival time (MST) was 37 months. MST varied significantly by race (white, 40 months vs AA, 21 months; P < .001), sex (men, 36 months vs women, 41 months; P = .001), and area poverty level (lowest, 27 months vs highest, 34 months; P < .0001). Only 32% of AA patients underwent surgery in comparison with 45% of white patients (P < .001). On multivariate analysis, independent predictors of poorer outcomes were race, poverty, age, sex, tumor site, stage, grade, treatment modality, and a history of smoking and alcohol consumption.
Carcinomas of the HN have an overall high mortality with a disproportionate impact on AA patients and the poor. Dramatic disparities by race and SES are not explained completely by demographics, comorbid conditions, or undertreatment. Earlier diagnosis and greater access to surgery and adjuvant therapies in these patients would likely yield significant improvement in outcomes. Cancer 2008. © 2008 American Cancer Society.