Sylvester Researchers Discover African Americans & Poor Have Worse Prognosis for Head & Neck Cancer
A team of Sylvester researchers has led a study which finds considerable disparities in survival for African Americans and poor patients with head and neck cancer. The study, led by Leonidas G. Koniaris, M.D., associate professor of surgery, cell biology and anatomy at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, indicates that earlier diagnosis and greater access to treatment could improve outcomes for these cancers among African Americans and the poor. The study is published online and in the November 15, 2008 issue of Cancer, a peer-reviewed journal of the American Cancer Society.
A number of studies have examined disparities in cancer survival among different groups to help identify interventions to improve patient outcomes. To investigate factors that impact survival from head and neck cancer, Koniaris teamed up with several colleagues, including W. Jarrard Goodwin, M.D., director of Sylvester, Dido Franceschi, M.D., associate professor and leader of the Stomach and Esophageal Cancer Site Disease Group at Sylvester, Frederick L. Moffat, M.D., professor of surgical oncology, Alan S. Livingstone, M.D., professor and chair of surgery, Margaret M. Byrne, Ph.D., research assistant professor of epidemiology and public health, and four surgical residents at the Miller School of Medicine.
The team of scientists reviewed all head and neck cancer cases in Florida between 1998 and 2002. By mining information from the Florida Cancer Data System and the Florida Agency for Health Care Administration dataset, they were able to accumulate data on diagnoses, comorbid conditions, and procedures performed during every hospitalization or outpatient visit among 20,915 head and neck cancer patients during that time.
The review found poorer outcomes were associated with race, poverty, age, gender, tumor site and stage, treatment type and a history of smoking and alcohol consumption.
Regarding race, the average survival time among Hispanics was 47 months, compared with 40 months among Caucasians and 21 months among African Americans. African American patients were diagnosed at a younger age and presented with more advanced disease compared with Caucasians. For all tumor stages, African American patients had a significantly shorter average survival time than Caucasians, regardless of poverty level. Treatments also differed between these two races: Caucasians were more likely than African Americans to have undergone surgery (45 percent vs. 32 percent), while African Americans were more likely than Caucasians to receive chemotherapy (26 percent vs. 19 percent) and radiation (66 percent vs. 56 percent). However, even among patients who received surgery, African Americans had a shorter survival time than Caucasians.
When assessing socioeconomic status, the investigators found that patients living in communities with poverty levels exceeding 15 percent were diagnosed with head and neck cancer at a significantly younger age, more frequently diagnosed with advanced disease, and had lower average survival across all age groups. Average survival time was significantly shorter in patients from the areas with the highest poverty rates irrespective of what type of therapy was received.
Koniaris and the other researchers conclude that racial disparities continue to exist in head and neck cancer survival. Socioeconomic inequities are also evident in head and neck cancer survival, even when the poor receive treatment for their disease. “Earlier diagnosis, particularly in those from low socio-economic status groups and amongst African American patients, is needed to improve outcomes,” says Koniaris.