Abstract B085: Disparities and factors associated with 30-day mortality following surgical treatment for squamous cell head and neck cancer with or without adjuvant therapy
Authors: Bukatko Aleksandr R. , Patel Parth , Kakarla Vindhya , Simpson Matthew C. , Boakye Eric A. , Stamatakis Katherine A. , Osazuwa-Peters Nosayaba 
Published: August 2020

Introduction: Factors such as anatomic complexity and extensive surgical procedures increase the risk of serious, sometimes fatal complications post-surgical treatment for head and neck cancer squamous cell carcinoma (HNSCC). Thirty-day (30-day) mortality is a common quality metric that evaluates short-term survival; however, no study has described disparities associated with 30-day mortality following surgery in HNSCC United States population. The aim of this study was to identify disparities and factors (clinical and nonclinical) associated with 30-day postoperative mortality in patients with HNSCC treated with and without adjuvant therapy.

Methods: In this retrospective study, we utilized a patient cohort of 102,877 confirmed HNSCC cases from the National Cancer Database (2004-2013) who were treated surgically with curative intent for the primary head and neck cancer. The effects of adjuvant therapy and other clinical and nonclinical factors on 30-day postoperative mortality were estimated via multivariate logistic regression with adjustment for time-varying nature of adjuvant therapy. Outcome was defined as any-cause-death within 30 days after definitive surgery of primary cancer. We controlled for several clinical and nonclinical covariates, including age, race, sex, health insurance status, primary tumor site, stage of presentation, and Charlson-Deyo comorbidity score.

Results: There were 859 patients who died within 30 days of definitive surgery for cancer, yielding a 30-day mortality rate of 0.83%. Treatment differences were associated with mortality, and patients who received adjuvant therapy had were significantly more likely to die within 30 days compared with those treated with surgery alone (aOR: 3.51; 95% CI 1.85, 6.66). Increasing number of comorbidities was also associated with greater odds of 30-day mortality (Charlson-Deyo comorbidity scores of 1: aOR: 1.45; 95% CI 1.23, 1.71, and Charlson-Deyo comorbidity scores of 2+ aOR: 2.52; 95% CI 2.05, 3.09). There were also sociodemographic disparities associated with 30-day mortality. Odds of 30-day mortality were significantly increased among patients with Medicaid insurance (aOR: 1.99; 95% CI 1.48, 2.68), as well as those who lived in neighborhoods with little education (≥ 29% missing high school diploma: aOR: 1.43; 95% CI 1.08, 1.88).

Conclusions: Disparities impact short-term mortality in the head and neck cancer population. Patients that were significantly more likely to die within 30 days of surgical treatment were those treated with adjuvant therapy, those with greater burden of comorbidities, those with little education, and those covered by Medicaid. To our knowledge, this is the largest study to document short term (30-day) mortality disparities among patients with head and neck cancer post-surgery in the United States. To improve short-term survival among head and neck cancer patients, it is important to account for these disparities found in this study.

Citation Format: Aleksandr R. Bukatko, Parth Patel, Vindhya Kakarla, Matthew C. Simpson, Eric A. Boakye, Katherine A. Stamatakis, Nosayaba Osazuwa-Peters. Disparities and factors associated with 30-day mortality following surgical treatment for squamous cell head and neck cancer with or without adjuvant therapy [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B085.