Racial/Ethnic Differences in Head and Neck Cancer Survival Rates

Background: Head and neck cancer (HNC) is the eighth most common cancer in the male population in the U.S. It is more common in men than women, and it usually affects adults ages 40 to 60. The main risk factors are tobacco and alcohol consumption and HPV infection. It is also known that race/ethnicity, social determinants of health (SDOH), and oral health influence the prevalence of HNC. Regarding its prognosis, the most important factors related to survival are the tumor site, the clinical stage at diagnosis, and proper treatment given timely. Despite all the advances in treatment for head and neck cancer in the last 30 years, survival rates have not increased at the same pace, nor are they the same in different populations. Recently, researchers have investigated how the risk factors of HNC can also affect survival. Some studies have looked for the association between race/ethnicity, SDOH, and other patient- and tumor-related factors and the occurrence of HNC but have also used those factors as predictors of patients' lives after the HNC diagnosis, producing a much more complex understanding of survival outcomes and maybe justifying why advances in treatment have not been enough to improve survival across all population. The aim of this study is to investigate the racial/ethnic differences in head and neck cancer survival rates observed in the US in recent years, and its possible association with patient and tumor characteristics, and SDOH. Methods: This is a retrospective study based on patients registered from 2007 to 2014 in the 18-cancer registry dataset of the SEER Public-Use Data from the Surveillance, Epidemiology, and End Results (SEER) Program. Selection criteria included patients aged 18 or older, with a diagnosis of invasive squamous cell carcinoma localized at the oral cavity, oropharynx, hypopharynx, or larynx. In addition to the individual (including clinical data) and county-level data obtain from SEER, other county-level attributes were obtained from: the National Center for Education Statistics, the U.S. Census Bureau’s – American Community Survey, and the Community Health Rankings. Statistical analysis was performed on the Statistical Package SPSS version 23. Data distribution was described in tables regarding the main variables. The association of these variables with race/ethnicity was evaluated by the chi-square test. For the cancer-specific survival analysis, the Kaplan-Meier method (and the log-rank test) as well as the Cox proportional hazards model were used. For all statistical tests, the significance was 2-sided and achieved when p-values ≤ 0.05. Results: The final sample size included 59,853 head and neck cancer patients. The majority of the patients were White (76.4%), followed by Blacks (11.2%), Hispanics (7.7%), Asian or Pacific Islanders (4.2%), and American Indians/Alaska Natives (0.5%). The tumors were localized predominantly at the oropharynx (41.6%) as is usually the case with patients at an advanced clinical stage (62.9%). The most common treatment performed was radiotherapy…