Researchers found that Black non-Hispanic patients with head and neck cancer present with later stage at diagnosis and receive less treatment following their diagnosis compared to patients in all other racial and ethnic groups.
Black non-Hispanic patients have a worse head and neck cancer (HNC) prognosis than patients in all other racial and ethnic groups, including Hispanic patients, according to a study published in the Journal of the National Comprehensive Cancer Network.1
The research showed that Black non-Hispanic patients present with later stage at diagnosis and receive less treatment following their diagnosis. Given these findings, researchers recommended that efforts be made to address modifiable factors that lead to these higher cancer stages, including improving access to nonemergent health care, enhancing prevention and screening programs (including tobacco cessation), and increasing navigational support.
“Just a reminder that we are talking about a curable disease, a disease that, if treated properly, can be eradicated with a high degree of certainty,” Sana Karam, MD, PhD, an associate professor in the Department of Radiation Oncology at the University of Colorado Cancer Center, said in a press release.2 “I hope that more targeted interventions can be developed as a result of our findings. The problem lies not so much in biological differences, but access. If Black patients get the treatment, they do just as well."
In this study, researchers used the SEER-Medicare database to identify patients with HNC diagnosed in 2006 through 2015 to evaluate cancer-specific survival (CSS) between different racial and ethnic cohorts as the main outcome. Additionally, patient demographics, tumor
factors, socioeconomic status, and treatments were also evaluated with regard to the primary outcomes between racial and ethnic groups.
Black non-Hispanic patients were found to have significantly worse CSS than all other racial and ethnic groups, including Hispanic patients, in unadjusted univariate analysis (Black non-Hispanic patients: HR, 1.48; 95% CI, 1.33-1.65; Hispanic patients: HR, 1.12; 95% CI, 0.99-1.28). However, when data were stratified for multivariate analysis using forward Cox regression, it was revealed that socioeconomic status, cancer stage, and receipt of treatment were predictive factors for the survival differences.
Specifically, Black non-Hispanic patients with HNC were found to be most likely to present at a later stage (OR, 1.62; 95% CI, 1.38-1.90) and to receive less treatment (OR, 0.67; 95% CI, 0.55-0.81). Further, it was discovered that unmarried status, high poverty areas, increased emergency department visits, and receipt of healthcare at non-National Cancer Institute (NCI)/nonteaching hospitals also significantly impacted stage and treatment.
“Although it is impossible to assess what treatment options were offered or declined, it has previously been described that Black patients are less likely than others to undergo surgery for HNC. There are many data showing mistrust of the medical community among Black patients, in addition to the role of implicit bias and structural racism in the community, all of which can be associated with delayed or forgone medical care or refusal of ideal medical care,” the authors noted. “It is imperative for healthcare workers to educate themselves on racism and cultural differences and to form trusting relationships with their patients to provide optimal cancer care.”
Importantly, the researchers highlighted some solutions that may improve outcomes for this patient population, including diversifying the healthcare workforce to allow for better racial, ethnic and cultural understanding, increasing use of patient navigation programs, and challenging health care systems to focus on racial and ethnic inequalities through various initiatives.
“Once patients are diagnosed, efforts to increase trust, decrease bias and racism, and provide access to multidisciplinary/tertiary cancer care should be prioritized to bridge the treatment gap for Black [non-Hispanic] individuals,” the authors concluded.
1. McDermott JD, Eguchi M, Morgan R, et al. Elderly Black Non-Hispanic Patients With Head and Neck Squamous Cell Cancer Have the Worst Survival Outcomes. J Natl Compr Canc Netw 2020. doi: 10.6004/jnccn.2020.7607
2. Black Lives Also Matter in Cancer Care [news release]. University of Colorado Cancer Center. Published October 1, 2020. Accessed October 14, 2020. https://www.newswise.com/articles/black-lives-also-matter-in-cancer-care?sc=dwhr&xy=10019792