Matched and other demographic and exposure characteristics of minority American cases and non-Hispanic white American controls with head and neck cancer

It is unknown whether population-level racial or ethnic disparities in mortality from squamous cell carcinoma of the head and neck (SCCHN) also occur in the setting of standardized multidisciplinary-team directed care. Therefore, we conducted a matched-pair study that controlled for several potentially confounding prognostic variables to assess whether a difference in survival exists for African American or Hispanic American compared with non-Hispanic white American SCCHN patients receiving similar care. Matched pairs were 81 African American case and 81 non-Hispanic white control patients and 100 Hispanic American cases and 100 matched non-Hispanic white controls selected from 1,833 patients of a prospective epidemiologic study of incident SCCHN within a single, large multidisciplinary cancer center. Matching variables included age (±10 years), sex, smoking status (never versus ever), site, tumor stage (T1-2 versus T3-4), nodal status (negative versus positive), and treatment. Cases and controls were not significantly different in proportions of comorbidity score, alcohol use, subsite distribution, overall stage, or tumor grade. Matched-pair and log-rank analyses showed no significant differences between cases and controls in recurrence-free, disease-specific, or overall survival. Site-specific analyses suggested that more aggressive oropharyngeal cancers occurred more frequently in minority than in non-Hispanic white patients. We conclude that minority and non-Hispanic white SCCHN patients receiving similar multidisciplinary-team directed care at a tertiary cancer center have similar survival results overall. These results encourage reducing health disparities in SCCHN through public-health efforts to improve access to multidisciplinary oncologic care (and to preventive measures) and through individual clinician efforts to make the best multidisciplinary cancer treatment choices available for their minority patients. The subgroup finding suggests a biologically based racial/ethnic disparity among oropharyngeal patients and that prevention and treatment strategies should be tailored to different populations of these patients. Head and neck cancers arise in the oral cavity, oropharynx, hypopharynx, and larynx and are overwhelmingly squamous cell carcinomas. In several independent analyses of National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) data, the incidence of these cancers is higher in African Americans than in their white counterparts (1–4). SEER data from the past 30 years also indicate that 5-year relative survival rates for minority patients fall in the bottom of the overall ranges for cancers of the oral cavity and pharynx (range, 5262%) and larynx (range, 62-71%; ref. 1). Indeed, laryngeal cancer mortality in African American men is more than double that in white men and ranks second only to prostate cancer mortality in magnitude of disparity (1, 2). This pattern of results is echoed in several other populationand hospital-based studies (5–16). Although survival disparities between African American and non-minority patients receive substantial attention, studies of survival among Hispanic American head and neck cancer patients are scarce (17, 18). Authors' Affiliations: Departments of Head and Neck Surgery, Epidemiology, and Health Disparities Research, The University of Texas M.D. Anderson Cancer Center; Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas; Tulane University School of Medicine, New Orleans, Louisiana; and Department of Otolaryngology, University of Illinois in Chicago School of Medicine, Chicago, Illinois Received 7/3/09; revised 7/19/09; accepted 7/21/09; published OnlineFirst 9/8/09. Grant support: NIH R03 grant CA 128110-01A1 (Principal Investigator: E.M. Sturgis), The University of Texas M.D. Anderson Cancer Center Institutional Research Grants (Principal Investigator: E.M. Sturgis), Career Development Award (E.M. Sturgis) NIH Specialized Program of Research Excellence grant (Principal Investigator: Waun Ki Hong), M.D. Anderson Cancer Center Start-up Funds (E.M. Sturgis); NIH K-12 grant 88084 (E.M. Sturgis; Principal Investigator: R.C. Bast); NIH R01 grant ES-11740 (Q. Wei); Centers for Disease Control K01 grant DP001120 (L.R. Reitzel); and NIH P-30 grant CA 16672 (to M.D. Anderson Cancer Center). Note: L.M. Chen is currently affiliated with the Department of Otolaryngology, The New York Eye and Ear Infirmary, New York City, New York. Requests for reprints: Erich M. Sturgis, Department of Head and Neck Surgery, Unit 1445, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030. Phone: 713-792-5432; Fax: 713-794-4662; E-mail: esturgis@mdanderson.org. ©2009 American Association for Cancer Research. doi:10.1158/1940-6207.CAPR-09-0154 782 Cancer Prev Res 2009;2(9) September 2009 www.aacrjournals. org Cancer Research. on June 19, 2017. © 2009 American Association for cancerpreventionresearch.aacrjournals. org Downloaded from Published OnlineFirst September 8, 2009; DOI: 10.1158/1940-6207.CAPR-09-0154