Survival Differences in American Indians with Head and Neck Cancer

Abstract

Objective: American Indians and Alaska Natives (AI/AN) experience poor overall survival. The specific aim of this study was to analyze disparities in survival between AI/AN and white patients with squamous cell carcinoma of the head and neck.

Method: We identified all incident cases of oropharyngeal, oral cavity, and hypopharyngeal/laryngeal squamous cell carcinoma among AI/AN and white patients from 1996 to 2007 using the SEER database. Univariate, multivariate, and sequential Cox proportional hazard models were fit to analyze racial differences in sex, age, stage, treatment patterns, and overall survival.

Results: For cancer of the oropharynx, AI/AN experienced decreased overall survival after adjusting for age, sex, stage, and type of treatment (hazard ratio (HR) = 1.4, P = .008). For cancer of the oral cavity, AI/AN experienced decreased survival after adjusting for patient age and sex (HR =1.3, P = .05). This difference was eliminated after adjusting for type of treatment (HR=1.2, P = .17). AI/AN were significantly less likely to receive surgery (odds ratio=0.57, P = .02). For hypopharyngeal/laryngeal cancer, AI/AN experienced decreased survival after adjusting for patient age and sex (HR = 1.6, P = .04). Adjusting for stage at diagnosis eliminated the disparity (HR =1.4, P = .12).

Conclusion: Significant disparities in survival exist among AI/AN patients with head and neck cancer. These disparities are variably related to stage at presentation and differential treatment patterns. Future research is needed to understand how to implement programs to reduce these differences in care and outcomes.