Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: B356
Session Name: Poster Session
Persistent Gap in Black vs. White Head and Neck Cancer Survival, 2000-2020
Nana-Hawwa Abdul-Rahman, MS1; Wesley Cai, MD2; Rida Ashraf2; Teja Pulavarthi, MPH1; Katie M Carlson, MPH2; Sandra Stinnett, MD2; Marci L Nilsen, PhD, RN2; Nosayaba Osazuwa-Peters, BDS, PhD, MPH3; Jose P Zevallos, MD, MPH2; Angela Mazul, PhD, MPH2; 1University of Pittsburgh School of Medicine, Pittsburgh, PA; 2Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA; 3Duke University School of Medicine Department of Head and Neck Surgery & Communication SciencesBackground: Black patients with head and neck cancer (HNC) have a mortality hazard ratio of 1.5 compared to White patients, and the Black vs. White survival difference in HNC is the third worst of all cancers. However, trends in disparities over time are largely unexplored.
Methods: We identified patients with HNC from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 – 2020. Cancer mortality rate (CMR) was defined as the number of HNC-related deaths within a racial group divided by the total population of the given race per 100,000 persons. Age-adjusted CMR and 95% confidence intervals (95% Cl) were calculated for each HNC site (oral cavity, hypopharynx, larynx, and oropharynx). CMRs reflect changes in both incidence and survival. Five-year overall survival (OS) and hazard ratios (HR) with their 95% Cl were reported from 2000 to 2016 to allow for complete five-year survival.
Results: Despite a stable population among non-Hispanic White patients with oral cavity cancer and a similar CMR to non-Hispanic Black patients in 2000, as shown in figure 1C, an increasing trend in CMR was observed in White populations from 2000 (CMR= 0.43, 95% Cl: 0.38 to 0.48) to 2020 (CMR= 2.68, 95% Cl: 2.58 to 2.78). The 5-year survival increased from 2000 to 2016 for both races; however, it remained lower in Black patients at 35% (95% Cl: 29 to 40%) in 2000 and 52% (95% Cl: 46 to 58%) in 2016. CMR for hypopharynx cancer remained relatively stable across racial populations between 2000 and 2020 (Figure 1D). Black patients experienced a stable 5-year OS (24%, 95% Cl: 17 to 32% in 2000, and 27%, 95% Cl: 18 to 36% in 2016), whereas White patients had an increase in 5-year OS (29%, 95% Cl: 25 to 33% in 2000, and 36%, 95% Cl: 31 to 40% in 2016). For larynx cancer, CMR increased over time for both races (Figure 1B), with Black populations experiencing a higher increase in CMR from 1.0 (95% CI: 0.839 to 1.274) to 3.15 (95% CI: 2.87 to 3.45). In oropharynx cancer, both the 5-year OS and CMR remained relatively stable over time (Figure 1A). However, Black patients experienced a higher 5-year survival trend from 35% (95% CI: 30 to 40%) in 2000 to 51% (95% CI: 46 to 55%) in 2016. With White patients as the reference group, the hazard ratio remained relatively stable across the four HNC sites from 2000 to 2016.
Conclusion: This 20-year cancer mortality study showed either widening or persistent Black vs. White mortality gaps in some HNC subsites, especially oral cavity and larynx. It is important that ongoing research address personal and societal factors underlying this persistent disparity. This includes improving access to care, reducing smoking rates, and ensuring timely diagnoses.
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