Survival outcomes for oropharyngeal squamous cell carcinoma of the head and neck (SCCHN) positive for the human papillomavirus (HPV) have made significant gains in recent years, but some groups are being left behind, reports a multi-institution team of researchers who say they have conducted the largest population-based analysis to date of the socioeconomic factors that affect outcomes.
“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, of the Department of Radiation Oncology at 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,” said Pike.
“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,” said Pike. “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 study used a custom SEER Database to identify 4,735 adult patients diagnosed with primary nonmetastatic SCCHN with a known HPV status in 2013 or 2014. There was a 5.6% rate of cancer-specific death at 20 months for white individuals, compared to 11.2% for non-whites. Separately, the rate of cancer-specific death for patients with health insurance was 6.2%, versus 14.8% for the uninsured. These outcome disparities were not seen for non-oropharyngeal cancers or prognostically less favorable HPV-negative SCCHN, the researchers said.
“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,” said Francis Worden, MD, of the University of Michigan Rogel Cancer Center, who was not involved in the study.
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,” said Worden, who also is a member of the NCCN Clinical Practice Guidelines in Oncology Panel for Head and Neck Cancers.
“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,” said Worden.
“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,” said Worden.
The study, “Outcomes of HPV-Associated Squamous Cell Carcinoma of the Head and Neck: Impact of Race and Socioeconomic Status,” was published by JNCCN—Journal of the National Comprehensive Cancer Network.
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