Affiliation:
1. Department of Otolaryngology–Head and Neck Surgery MedStar Georgetown University Hospital Washington District of Columbia USA
2. Department of Otolaryngology–Head and Neck Surgery District of Columbia Veteran's Affairs Medical Center Washington District of Columbia USA
3. Department of Otolaryngology–Head and Neck Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA
4. Department of Otolaryngology‐Head and Neck Surgery Georgetown University School of Medicine Washington District of Columbia USA
5. Howard University College of Medicine Washington District of Columbia USA
Abstract
AbstractObjectiveThere is limited data on the impact of clinical‐demographic factors on survival outcomes among veterans with head and neck squamous cell carcinoma (HNSCC). This study was undertaken to evaluate the impact of race and other factors on overall survival (OS) in a population of veterans with HNSCC treated with curative intent.MethodsDemographic and clinical data were collected on veterans with HNSCC treated with curative intent at our institution between 1999 and 2021. The primary outcome was 3‐year OS. Secondary outcomes included treatment delay intervals, including time to treatment initiation (TTI), total package time, and duration of chemoradiation (DCRT).ResultsOf 260 veterans with HNSCC, black veterans had significantly lower 3‐year OS (49.4%) compared to white veterans (65%, P = .019). Black veterans were also more likely to experience delays in treatment initiation (median TTI 46 vs 41 days; P = .047). Black patients were more likely to receive radiation alone (25.8% [black] vs 8.4% [white]; P < .001) and less likely to receive adjuvant therapy if treated surgically (11.1% [black] vs 22.4% [white]; P = .004), despite any statistically significant difference in stage of their tumor at presentation (Stage I: 21.2% [black] vs 19.6% [white]; P = .372); (Stage IV: 44.4% [black] vs 48.6% [white]; P = .487). Other factors associated with worse 3‐year OS included older age (P = .023), lower body mass index (P = .026), neurocognitive disorder/dementia (P = .037), mental health disorders (P = .020), hypopharyngeal primary (P = .001), higher stage disease (P = .002), treatment type (P = .001), need for prophylactic gastrostomy tube (P = .048) or tracheotomy (P = .005), recurrent disease (P = .036), persistent disease (P < .001), distant metastases (P = .002), longer TTI (P = .0362), and longer DCRT (P = .004).DiscussionBlack race appears to be an independent predictor of 3‐year OS in veterans with HNSCC. Further studies are warranted to determine the factors responsible for disparities in survival.Implications for PracticeThis study evaluated the ways in which race affects survival for US veterans with head and neck cancer. The authors found that black veterans had an increased risk of death compared to white patients, and also experienced delays when receiving treatment.Level of EvidenceLevel IV.