African American and poor patients have a dramatically worse prognosis for head and neck cancer

An examination of 20,915 patients

Manuel A. Molina, Michael C. Cheung, Eduardo A. Perez, Margaret M. Byrne, Dido Franceschi, Frederick L. Moffat, Alan S. Livingstone, W. Jarrard Goodwin, Juan C. Gutierrez, Leonidas Koniaris

Research output: Contribution to journalArticle

115 Citations (Scopus)

Abstract

BACKGROUND. 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). METHODS. 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. RESULTS. 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. CONCLUSIONS. 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.

Original languageEnglish (US)
Pages (from-to)2797-2806
Number of pages10
JournalCancer
Volume113
Issue number10
DOIs
StatePublished - Nov 15 2008
Externally publishedYes

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Head and Neck Neoplasms
African Americans
Social Class
Survival
Poverty Areas
Neoplasms
Poverty
Larynx
Hispanic Americans
Information Systems
Alcohol Drinking
Mouth
Early Diagnosis
Neck
Multivariate Analysis
Smoking
Head
Demography
Carcinoma
Delivery of Health Care

Keywords

  • Ethnicity
  • Head and neck
  • Race
  • Socioeconomic status
  • Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

African American and poor patients have a dramatically worse prognosis for head and neck cancer : An examination of 20,915 patients. / Molina, Manuel A.; Cheung, Michael C.; Perez, Eduardo A.; Byrne, Margaret M.; Franceschi, Dido; Moffat, Frederick L.; Livingstone, Alan S.; Goodwin, W. Jarrard; Gutierrez, Juan C.; Koniaris, Leonidas.

In: Cancer, Vol. 113, No. 10, 15.11.2008, p. 2797-2806.

Research output: Contribution to journalArticle

Molina, MA, Cheung, MC, Perez, EA, Byrne, MM, Franceschi, D, Moffat, FL, Livingstone, AS, Goodwin, WJ, Gutierrez, JC & Koniaris, L 2008, 'African American and poor patients have a dramatically worse prognosis for head and neck cancer: An examination of 20,915 patients', Cancer, vol. 113, no. 10, pp. 2797-2806. https://doi.org/10.1002/cncr.23889
Molina, Manuel A. ; Cheung, Michael C. ; Perez, Eduardo A. ; Byrne, Margaret M. ; Franceschi, Dido ; Moffat, Frederick L. ; Livingstone, Alan S. ; Goodwin, W. Jarrard ; Gutierrez, Juan C. ; Koniaris, Leonidas. / African American and poor patients have a dramatically worse prognosis for head and neck cancer : An examination of 20,915 patients. In: Cancer. 2008 ; Vol. 113, No. 10. pp. 2797-2806.
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abstract = "BACKGROUND. 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). METHODS. 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. RESULTS. 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. CONCLUSIONS. 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.",
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T1 - African American and poor patients have a dramatically worse prognosis for head and neck cancer

T2 - An examination of 20,915 patients

AU - Molina, Manuel A.

AU - Cheung, Michael C.

AU - Perez, Eduardo A.

AU - Byrne, Margaret M.

AU - Franceschi, Dido

AU - Moffat, Frederick L.

AU - Livingstone, Alan S.

AU - Goodwin, W. Jarrard

AU - Gutierrez, Juan C.

AU - Koniaris, Leonidas

PY - 2008/11/15

Y1 - 2008/11/15

N2 - BACKGROUND. 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). METHODS. 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. RESULTS. 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. CONCLUSIONS. 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.

AB - BACKGROUND. 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). METHODS. 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. RESULTS. 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. CONCLUSIONS. 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.

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