Racial Disparities in Acute Radiation-Related Toxicities among Patients Diagnosed with Head and Neck Cancer

Abstract

<h3>Purpose/Objective(s)</h3> It is of great importance to address implicit bias and structural racism in healthcare. To date, there is limited data available regarding racial differences in acute radiation-related toxicities for patients diagnosed with head and neck cancer (HNC). We hypothesize that race is significantly associated with increased rates of radiation-treatment related toxicity, which could result in escalated clinical interventions and decreased overall quality of life. <h3>Materials/Methods</h3> We retrospectively analyzed prospectively acquired data for 463 patients treated with radiation therapy (RT) ± systemic therapy in 2015-19. Racial demographics reported 64 African American patients, 19 Asian, 364 Caucasian, and 16 Other. This pilot analysis focuses on African American and Caucasian patients. Acute treatment-related toxicity and pain assessments were collected at point of care during on-treatment RT visits. We recorded 1 patient-reported outcome (LASA scale) & 8 toxicity parameters based on CTCAE grading: mucositis, aspiration, dehydration, dermatitis, fatigue, nausea, xerostomia, and anorexia. We also collected binary data ("yes" or "no") for 3 parameters: any documented hospitalization/ED visits, any nasogastric (NG) & any PEG tube placement within 3 months since RT start. Patients with NG or PEG placed prior to RT start were analyzed separately. To evaluate for racial disparities, we computed the mean of the maximum and average toxicity scores across racial subgroups and performed unpaired t-test analysis. For binary data, we computed the event rates for each racial subgroup and compared 2-population proportions using a pooled variance estimate. <h3>Results</h3> Overall, African American (AA) patients reported higher pain scores compared with Caucasian (C) patients (p = 0.004 – 0.007). Interestingly, mucositis and dermatitis scores were lower among AA patients than C (p = 0.0001 – 0.1). For PEG placement after RT start, we observed a higher rate in AA patients compared with C (p = 0.02). PEG placement prior to RT was also higher in AA compared to C (p < 0.05). We did not find evidence of racial differences for the other toxicity parameters reported. <h3>Conclusion</h3> Our data suggest that race is significantly associated with increased patient-reported pain scores and rates of PEG tube placement after RT start. The increased rate of PEG placement is concerning considering the potential risks of long-term dysphagia and late feeding tube dependency. Further investigation is warranted to understand the potential mechanisms behind disparities noted for HNC patients.