Researchers reviewed the records of all patients (n = 1279) treated for SCCOP at M. D. Anderson between 1987 and 2004. Rates of local recurrence and overall survival were compared with multiple demographic factors. Researchers found that race was strongly associated with recurrence, whereas being uninsured was a significant predictor of worse survival.
Explore This IssueJune 2008
Overall, whites did best, Asians and Hispanics did next best, and blacks did worse, said study co-author Sue Yom, MD, now Assistant Professor of Radiation Oncology at the University of California at San Francisco School of Medicine.
The study was undertaken to see whether there were differences between various groups of patients receiving treatment at the center, she said. Care at M. D. Anderson is consistent and very standardized. But even with that level of standardized tertiary care, we found differences in survival between different patient groups, she said. The question was why.
Even as treatment for head and neck cancer has advanced to the point at which patients can be offered a good chance for long-term survival, it is important to know why some patients fail. SES and demographic factors, such as environment, patients’ ability to get themselves to treatment centers, family support, poverty, insurance status, or other factors, can all be reasons for failure.
In this study, it was not a problem with the actual care that was associated with failure. Patients were presenting with more aggressive forms of disease, and had more medical co-morbidities such as diabetes, hypertension or heart disease-factors that can affect how aggressive their cancer treatment can be. Also, many had poor lifestyle habits, such as smoking or alcohol use, and were not seeing primary care physicians who would take care of these issues, Dr. Yom said. This population probably could not afford regular physician visits that would help in managing post-treatment effects and maintaining surveillance for cancer recurrence.
I think we do have a moral obligation to think about whether all our patients have equity of care, Dr. Yom said. Although solutions are not yet at hand, the first step is to identify the problem, she said.
Data from the NCHC also show that visible minorities tend to fare worse, overall, when it comes to health status and outcomes. For instance, life expectancy for African-Americans, on average, is about five years shorter than that of Caucasian-Americans. African-Americans are also more likely to have diabetes, heart disease, and certain cancers than whites, although much of these discrepancies may be caused by genetics and lifestyle. However, minorities are also more likely to be uninsured or underinsured. The NCHC reports that in 2006, almost half of Hispanics did not always go for care when needed, compared with 43% of blacks and 41% of whites.
HNSCC and Race
Yet another study asserts that although race appears to be a predictor of poor survival, the real culprit is insurance status. This study, by Christine Gourin, MD, then at the Medical College of Georgia in Augusta, and colleagues was published in Laryngoscope in 2006. In this study, researchers investigated whether racial disparities exist between black and white patients with head and neck squamous cell carcinoma (HNSCC).