Gaps in cure rate appear linked to race and insurance status for common HPV-related cancer
New study in JNCCN points to need for greater efforts to reduce racial disparities in cancer survival and increase access to appropriate health care
PLYMOUTH MEETING, PA [February 6, 2020] — Survival outcomes for HPV-positive oropharyngeal squamous cell carcinoma of the head and neck (SCCHN) have made significant gains in recent years, but new research in the February 2020 issue of JNCCN–Journal of the National Comprehensive Cancer Network finds some groups are being left behind. Researchers from Massachusetts General Hospital–along with Yale University School of Medicine, UT Southwestern Medical Center, and UNC Chapel Hill School of Medicine–conducted the largest population-based analysis to date on the socioeconomic factors that affect outcomes in this cancer type, and found significant racial and socioeconomic disparities.
“When we examined outcomes by race and insurance status, adjusting for all clinical factors, those patients who were non-white or uninsured or poorly insured had much reduced cancer-specific survival compared to their white and well-insured peers,” said Luke R. G. Pike, MD, DPhil, Department of Radiation Oncology, Massachusetts General Hospital. “It’s unsettling that black and Hispanic men and women with HPV-positive oropharyngeal carcinoma–a disease we now recognize to be curable in many patients with even very advanced disease–appear to do disproportionately poorly as compared to their white peers. We also speculate that patients with insufficient insurance were unable to access high-quality radiotherapy, surgery, and chemotherapy, which is crucial to the successful treatment of locally advanced HPV-positive oropharyngeal cancer. We must strive to ensure that all men and women, no matter their insurance status or race, can get access to high-quality treatment for head and neck cancers.”
The researchers used a custom SEER Database to identify 4,735 adult patients who were diagnosed with primary nonmetastatic SCCHN with a known HPV status in 2013 or 2014. The data showed that among those patients with HPV-positive oropharyngeal cancer, there was a 5.6% rate of cancer-specific death at 20 months for white individuals, compared to an 11.2% rate for non-whites. Separately, the rate of cancer-specific death for persons with health insurance was 6.2%, versus 14.8% for the uninsured. Those outcome disparities were not seen for non-oropharyngeal cancers, or prognostically less favorable HPV-negative SCCHN.
“The study by Pike, et al. highlights the socioeconomic differences between patients with HPV-positive and HPV-negative SCCHN and identifies striking racial disparities among individuals with HPV-positive oropharyngeal SCCHN, whereby non-white and uninsured patients with HPV-positive cancers had worse cancer-specific mortality,” commented Francis Worden, MD, University of Michigan Rogel Cancer Center, and Member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Head and Neck Cancers–who was not involved in this research. “While the exact reasons for these findings are speculative given the retrospective nature of this work, their data bring to light the importance for early diagnosis and treatment of all patients with HPV-positive oropharyngeal cancers and the importance of identifying and eliminating barriers to care. HPV-positive cancers are highly curable, but data does show that patients who present with higher stage disease (due primarily to delays in diagnosis and thus delays in treatment) have lower overall survival rates. Additionally, lower income, non-white populations may be less likely to obtain care at larger, more experienced cancer centers that treat higher volumes of head and neck cancers. Published data suggest that patient care at such centers of excellence leads to improved outcomes due to expertise in administering complex treatment plans and the high level of support that is provided during medical care.”
To read the entire study, visit JNCCN.org. Complimentary access to “Outcomes of HPV-Associated Squamous Cell Carcinoma of the Head and Neck: Impact of Race and Socioeconomic Status” is available until May 10, 2020.
About JNCCN–Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN–Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world.
The NCCN Member Institutions are: Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, Columbus, OH; O’Neal Comprehensive Cancer Center at UAB, Birmingham, AL; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.
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