3117 - Racial and Socioeconomic Disparities in the Receipt of Guideline-Concordant Radiation Therapy for Head and Neck Squamous Cell Carcinoma

05:00pm - 06:00pm PT

Hall F

Screen: 28

POSTER

Presenter(s)

David Nganga, MD - University of North Carolina Hospitals, Chapel Hill, NC

D. Nganga¹, X. Tan², M. Peterson³, T. Hackman⁴, S. Sheth⁵, A. Olshan³, and X. S. Chen⁵; ¹Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, ²Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC, ³University of North Carolina, Chapel Hill, NC, ⁴Department of Otolaryngology, University of North Carolina School of Medicine, Chapel Hill, NC, ⁵University of North Carolina at Chapel Hill, Chapel Hill, NC

Purpose/Objective(s):

Black patients and those from disadvantaged socioeconomic background experience worse outcomes after treatment for head and neck squamous cell carcinoma (HNSCC). We hypothesize that deviation of treatment received from established guidelines may partly explain this disparity. The aim of this study is to test whether race and primary cancer type are associated with the receipt of guideline-concordant care in a state-wide, population-based cohort of HNSCC patients.

Materials/Methods:

The Carolina Head and Neck Cancer Epidemiology Study (CHANCE) was a population-based study that prospectively identified patients with a new diagnosis of HNSCC in the larynx, pharynx and oral cavity between 2002 and 2006. Treatment data, including the receipt of radiation (RT), surgery and chemotherapy, were retrospectively collected from the original medical record. The main outcomes of this study included the receipt of guideline-concordant therapy as recommended by the National Comprehensive Cancer Network Guidelines, including treatment modality, delay in initiating postoperative radiation (PORT), and RT dose and treatment breaks. A chi-square test was performed to determine the impact of individual factors including primary site, race, age, and sex.

Results:

1388 patients were included in the study: 497 (35.8%) with primary tumor in the oropharynx, 480 (34.6%) larynx and 411(29.6%) oral cavity. 1009 (72.6%) patients were white, 351 (25.3%) black, and 28 (2%) other race, with 84% insured. 563 (40%) patients had early-stage disease (T1-2, N0) while 843 (60%) patients had locally advanced disease. Chemoradiation was the most common modality of treatment (24.6%), while 17% of the patients received RT alone. Patients received a median dose of 69 Gy (IQR 64–70 Gy) with a median of 35 fractions.

Patients with oral cavity cancers (34.8%) were more likely to undergo treatment with guideline incongruent modalities compared to patients with oropharynx (19.1%) or larynx cancers (14%) (p < 0.001).

282 patients received PORT at a median interval of 37 days (IQR 25-51 days) from surgery. Of these, 44.3% did not receive PORT within 42 days from surgery. Oral cavity primary (p = 0.046) was significantly associated with delayed initiation of PORT. Black patients were less likely to receive timely PORT than patients who were white (51.8% vs 41.1%, p = 0.10).

Patients with oral cavity primaries (22.9%) were less likely to have received guideline-concordant RT dose and were more likely to experience longer breaks during treatment compared to oropharynx (12.9%) and larynx (10%) cancers (p<0.001).

Conclusion:

Patients of Black and other races are less likely to receive guideline concordant treatment for HNSCC. Receipt of non-recommended treatment modalities and delay in the initiation of PORT are among the main reasons of deviation from guideline-concordant care. Further research is needed to identify the underlying causes of this disparity and improve the care quality in an equitable manner for HNSCC patients.