Head and neck cancer worse in blacks

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African Americans and economically disadvantaged patients face a worse prognosis than other patients with head and neck cancer, according to a report in the journal Cancer.

“The head and neck cancer manuscript is the first in a series of manuscripts we have written to examine disparities in cancer,” Dr. Michael Cheung told Reuters Health. “We have observed disparities in a number of different cancers,” including those of the esophagus and the reproductive organs.

Cheung and colleagues at the University of Miami Miller School of Medicine, sought to determine the impact of race and socioeconomic status on outcomes for almost 21,000 patients with cancers of the head and neck diagnosed between 1998 and 2002. 

Typical survival times were significantly higher for whites (40 months) than for African Americans (21 months), for Hispanics (47 months) than for non-Hispanics (37 months), and for women (41 months) than for men (36 months), the authors report.

Patients living in communities with poverty rates above 15 percent were diagnosed with head and neck cancer at a significantly earlier age, and survival times were decreased across all age groups in such communities.

Consistent with previous research, alcohol and tobacco use also adversely affected survival in patients with head and neck cancer, the report indicates.

Other predictors of survival included the location and stage of the tumor as well as the surgical, medical, and radiology treatments used.

The inequalities seen in the study are “not explained completely by demographics, (other medical) conditions, or undertreatment because poor outcomes continued to be observed after (accounting) for these factors,” the researchers note.

Doctors first “need to be aware of such disparities,” Cheung said. They “need to know that certain groups may present at a younger age and may have more aggressive cancer at that age. A delay in diagnosis may turn a potentially treatable cancer into a cancer that is unresectable.”

He continued, doctors “need to be vigilant in early cancer detection by following the recommended cancer screening guidelines and be pro-active in patient education on risk reduction, such as smoking cessation and alcohol consumption.”

Giving patients information can make a difference. Doctors “also need to be certain that our patients understand their diagnosis and understand where they need to go and who they must see in order for them to receive multimodal care (i.e., surgical oncologist, medical oncologist, radiation oncologist, etc.),” Cheung concluded.

SOURCE: Cancer, November 15, 2008.

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