Open AccessSurvival Differences in American Indians with Head and Neck Cancer
Author(s) -
Dwojak Sunshine M.,
Sequist Thomas,
Deschler Daniel G.,
Emerick Kevin S.
Publication year - 2011
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599811415823a157
Subject(s) - medicine , hazard ratio , head and neck cancer , cancer , stage (stratigraphy) , proportional hazards model , hypopharyngeal cancer , head and neck squamous cell carcinoma , oncology , odds ratio , multivariate analysis , univariate analysis , confidence interval , paleontology , biology
Objective American Indians and Alaska Natives (AI/AN) experience poor overall survival. The specific aim of this study was to analyze disparities in survival between AI/AN and white patients with squamous cell carcinoma of the head and neck. Method We identified all incident cases of oropharyngeal, oral cavity, and hypopharyngeal/laryngeal squamous cell carcinoma among AI/AN and white patients from 1996 to 2007 using the SEER database. Univariate, multivariate, and sequential Cox proportional hazard models were fit to analyze racial differences in sex, age, stage, treatment patterns, and overall survival. Results For cancer of the oropharynx, AI/AN experienced decreased overall survival after adjusting for age, sex, stage, and type of treatment (hazard ratio (HR) = 1.4, P =. 008). For cancer of the oral cavity, AI/AN experienced decreased survival after adjusting for patient age and sex (HR =1.3, P =. 05). This difference was eliminated after adjusting for type of treatment (HR=1.2, P =. 17). AI/AN were significantly less likely to receive surgery (odds ratio=0.57, P =. 02). For hypopharyngeal/laryngeal cancer, AI/AN experienced decreased survival after adjusting for patient age and sex (HR = 1.6, P =. 04). Adjusting for stage at diagnosis eliminated the disparity (HR =1.4, P =. 12). Conclusion Significant disparities in survival exist among AI/AN patients with head and neck cancer. These disparities are variably related to stage at presentation and differential treatment patterns. Future research is needed to understand how to implement programs to reduce these differences in care and outcomes.