Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN): Analysis of disparities in care.

Abstract

5533 Background: We sought to examine differences in treatment by various populations in LORHAN, a national registry of head and neck carcinoma (HNC) patients (pts). Methods: Pts included in the analysis had de novo, stage III/IV, non-metastatic HNC, received radiotherapy (RT) and/or drug therapy, were ≥18 years of age and had provided written informed consent. Univariate analyses (UA) and multivariable logistic regression (LR) were used to assess relationship of pre-specified independent variables to selected treatment related dichotomous measures. Results: UA results are in table below. LR showed the following factors were significantly associated with use of RT alone: community setting (odds ratio [OR] 0.45; 95% CI, 0.30-0.67); age (OR 1.03; 95% CI, 1.01 - 1.05); black race (OR 1.9; 95% CI 1.1-3.0); Hispanic ethnicity (OR 3.5; 95% CI, 1.5-7.6). Factors significantly associated with use of surgery were: community setting (OR 0.54; 95% CI, 0.42-0.69) and age (OR 0.9877; 95% CI, 0.9766 - 0.9989). Conclusions: This analysis suggests setting, age and race may influence treatment received for HNC. Further investigation required to confirm findings here. Treatment comparison: Primary RT versus concurrent chemoradiation (CRT). Variable Intergroup comparisons All N=1,359 Primary CRT n=1,194 Primary RT n=165 P value No. % No. % No. % Setting Academic 864 64 738 62 126 76 0.0003 Community 495 36 456 38 39 24 Age (years) Mean 58 58 61 0.007 Ethnicity White (non-Hispanic origin) 1,108 82 986 83 122 74 0.009 Black (non-Hispanic origin) 163 12 133 11 30 18 Hispanic 39 3 30 3 9 6 Asian 22 2 19 2 3 2 Other 27 2 26 2 1 <1 Insurance status Does not have insurance 72 5 70 6 2 1 0.003 Has insurance 648 48 580 49 68 41 Unknown 639 47 544 46 95 58 Type of insurance Private 401 30 361 30 40 24 0.02 Medicaid 75 6 68 6 7 4 Medicare 141 10 125 11 16 10 Military/VA 29 2 24 2 5 3 No insurance 72 5 70 6 2 1 Unknown 641 47 546 46 95 58 Household income NS Highest education level NS Treatment comparison: Surgery vs. no surgery before RT or CRT. Variable Intergroup comparisons All N=1,826 No surgery n=1,359 surgery n=467 P value No. % No. % No. % Setting Academic 1,220 67 864 64 356 76 <0.0001 Community 606 33 495 36 111 24 Age (years) Mean 58 58 57 0.006 Other variables (as noted above) NS Abbreviation: NS, not significant.