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American Head & Neck Society
Translational Research Meeting

April 21-22, 2015

AHNS Annual Meeting
April 22-23, 2015 during the
Combined Otolaryngology Spring Meetings


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Sociodemographic Disparities In Choice Of Therapy And Survival In Advanced Stage Laryngeal Cancer

Presentation: S001
Topic: Decisions in Advanced Head and Neck Cancer
Type: COSM
Date: Wednesday, April 22, 2015
Session: 9:00 AM - 9:45 AM Scientific Session #1
Authors: Alok T Saini, MD, Eric Genden, MD, MBA, Uchechukwu Megwalu, MD, MPH
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Institution(s): Mount Sinai Hospital
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Importance: Identifying sociodemographic factors impacting choice of therapy and survival will reveal potential opportunities for intervention aimed at reducing health disparities.

 

Objective: To determine if sociodemographic factors affect choice of treatment and survival in patients with advanced stage laryngeal cancer in the U.S. using a large population-based cancer database.

 

Design/Setting/Participants: Population-based, non-concurrent cohort study of 5,381 patients with a diagnosis of stage III or stage IV laryngeal squamous cell carcinoma between 1992 and 2009. Data was extracted from the Surveillance, Epidemiology, and End Results (SEER) Database.

 

Interventions: N/A

 

Main Outcome(s) and Measures: Choice of therapy (surgical vs. non-surgical) and disease specific survival (DSS)

 

Results: On multivariable analysis, age ≥60 years (Odds Ratio [OR]=0.78; 95% CI, 0.70-0.88), stage III disease (OR=0.43; 95% CI, 0.39-0.49) and more recent year of diagnosis (OR=0.89; 95% CI, 0.87-0.90) decreased the odds of receiving surgical therapy, while residing in a county with low median household income (OR=1.36; 95% CI, 1.17-1.57) and glottic subsite (OR=1.59; 95% CI, 1.39-1.81) increased the odds of receiving surgical therapy. Age ≥60 years (Hazard Ratio [HR]=1.45; 95% CI, 1.33-1.59), black race (HR=1.14; 95% CI, 1.02-1.27), and nonsurgical therapy (HR=1.39; 95% CI, 1.26-1.52) negatively impacted DSS while female sex (HR=0.81; 95% CI, 0.72-0.90), married status (HR=0.69; 95% CI, 0.63-0.75), stage III disease (HR=0.60; 95% CI, 0.54-0.66), and glottic subsite (HR=0.81; 95% CI, 0.72-0.90) positively impacted DSS. When stratifying by treatment type, black race was a poor prognostic factor with surgical therapy (HR=1.21; 95% CI, 1.03-1.41) but not with nonsurgical therapy (HR=1.09; 95% CI, 0.94-1.27).

 

Conclusions and Relevance: For patients with advanced laryngeal cancer, younger age, stage IV disease, glottic cancer, and residing in a low income county increase the likelihood of receiving surgical therapy. Female sex, married status, stage III disease, and glottic subsite provides a survival benefit regardless of treatment choice. Black race appears to be a negative prognostic factor for patients treated with surgical therapy, but not with non-surgical therapy. This highlights the impact of sociodemographic factors on treatment strategies and outcomes, and highlights areas for further research on health disparities.

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