Do Race, Ethnicity, and Socioeconomic Status Impact Cancer Follow-Up Care?

How well do head and neck cancer patients who received curative treatment adhere to National Comprehensive Cancer Network (NCCN) follow-up guidelines, and do race, ethnicity, socioeconomic status, and treatment setting impact the use of follow-up care?

Bottom Line: Safety-net hospital treatment, socioeconomic status, Hispanic ethnicity, and NHB race were associated with decreased follow-up service utilization.

Background: NCCN follow-up guidelines on head and neck cancer include, but are not limited to, a history and physical within three months of treatment conclusion and repeat baseline imaging of the primary site within six months. Previously reported barriers to adequate follow-up in other primary cancers include African-American race, Spanish language preference, and safety-net hospital treatment. 

Study design: Retrospective case review of 234 patients with biopsy-proven, nonmetastatic oropharyngeal or laryngeal cancer treated with radiotherapy between January 1, 2014, and June 30, 2016, at a safety-net hospital (52) or adjacent private academic hospital (182).

Setting: Jackson Memorial Hospital, Miami; and University of Miami Sylvester Comprehensive Cancer Center.

Synopsis: Overall, 43.6% of patients were non-Hispanic white (NHW), 41.9% were Hispanic, and 12.0% were non-Hispanic black (NHB). Overall, 88.8% of patients received primary site post-treatment imaging within six months. NHB race, Hispanic ethnicity, and other race versus NHW ethnicity had an association with decreased likelihood of post-treatment imaging. Private academic hospital treatment versus safety-net hospital treatment was correlated with increased radiation oncologist (RO) follow-up within three months. Private academic hospital versus safety-net hospital treatment, highest socioeconomic status versus the lowest, and treatment with surgery + CRT versus RT alone were associated with increased otolaryngology follow-up within three months. Private academic hospital versus safety-net hospital treatment was correlated with increased follow-up likelihood with a surgeon or RO within three months.

Citation: Perlow HK, Ramey SJ, Cassidy V, et al. Disparities in adherence to head and neck cancer follow-up guidelines. Laryngoscope. 2019;129:2303–2308.