Abstract 4190: Impact of comorbidities and nonclinical factors associated with sinonasal cancer all-cause mortality in the United States
Authors: Premal B. Desai, Aleksandr R. Bukatko, Matthew C. Simpson, Eric Adjei Boakye, Jason W. Greenberg, Greg M. Ward, Ronald J. Walker, Jastin L. Antisdel, Nosayaba Osazuwa-Peters
Journal: Cancer Research (2019)

Abstract Introduction: The anatomical complexity of the sinonasal region contributes to the poor prognosis and relative rarity of sinonasal cancer. While several studies have focused on the major clinical factors associated with survival, the burden of comorbidities and its impact on all-cause mortality of sinonasal cancer is unknown. Objective: This study aimed at describing the impact of comorbidities and nonclinical factors on all-cause mortality of sinonasal cancer in the United States. Methods: In this retrospective cohort study (n=10769), adult cases of sinonasal cancer (International Classification of Diseases for Oncology, third edition typology codes: C30.0, C30.1, C31.0-C31.3, C31.8, C31.9) diagnosed from 2004 through 2013. The outcome of interest was all-cause mortality. Independent variables included treatment type, time to treatment, staging, comorbidity scoring, histology, HPV test status, age, gender, race, facility type, distance to facility, insurance, local income, and urban level. Survival analysis was conducted via multivariable extended Cox regression with Heaviside adjustment for time-varying component of treatment variables. Results: In this cohort, 79% were whites, 60% males, and mean age of diagnosis was 63.5 years. Approximately 1-in-5 patients (18.6%) had a major comorbidity (Charlson-Deyo score ≥ 1) at the time of sinonasal cancer diagnosis. In the final model, after controlling for clinical factors including stage of presentation, treatment modality, HPV status, and histological subtypes, increasing Charlson-Deyo comorbid score was associated with a corresponding increase in hazard of mortality [(aHR score of 1 = 1.25; 95% CI 1.16, 1.35), (aHR score of 2+ = 1.62; 95% CI 1.42, 1.84). There were significant effects of race and socioeconomic status on all-cause mortality. Males (aHR = 1.11; 95% CI 1.05, 1.18); blacks (aHR = 1.12, 95% CI 1.02, 1.24); those uninsured (aHR = 1.40; 95% CI 1.21, 1.62) or covered by Medicaid (aHR = 1.48; 95% CI 1.31, 1.66); and patients living in zip-codes with lower median income quartile (aHR &amp;lt;$30,000 = 1.17; 95% CI 1.06, 1.29) all had greater hazard of all-cause mortality. Additionally, treatment at community cancer programs was associated with increased hazard of mortality (aHR = 1.14, 95% CI 1.01, 1.28) compared with being treated at an academic/research program. Conclusions: Besides clinical factors such as stage of presentation, severe comorbid disease is most associated with all-cause mortality among patients with sinonasal cancer. Additionally, other nonclinical factors associated with sinonasal cancer all-cause mortality included race, insurance status, income, histological subtypes of the cancers, and comorbidity scores. Understanding the impact of these factors on mortality could help clinicians in disease prognostication and management of patients with sinonasal cancer. Note: This abstract was not presented at the meeting. Citation Format: Premal B. Desai, Aleksandr R. Bukatko, Matthew C. Simpson, Eric Adjei Boakye, Jason W. Greenberg, Greg M. Ward, Ronald J. Walker, Jastin L. Antisdel, Nosayaba Osazuwa-Peters. Impact of comorbidities and nonclinical factors associated with sinonasal cancer all-cause mortality in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4190.