Survival from head and neck cancers based on socioeconomic status in Asians.

Abstract

5596 Background: Lower socioeconomic status (SES) has been linked with higher incidence and lower survival in head and neck cancer (HNC) patients. However, there is little data on outcomes in Asians/Pacific Islanders (APIs) with HNC. The purposes of this study are to examine the effect of SES on overall survival (OS) in APIs with HNC and to compare their survival to that of other ethnicities using population-based registry data. Methods: 53,544 eligible HNC patients (of whom 4,711 were APIs) were identified from the California Cancer Registry from 1988 to 2007. Block-group SES, based on a composite of Census 1990 and 2000 data, was calculated for each patient based on address at diagnosis. SES was categorized into 2 groups for comparison (low SES = quintiles 1-3; high SES = quintiles 4-5). For each HNC site, descriptive data, treatment, and outcomes were recorded. OS was computed by the Kaplan- Meier method. Adjusted hazard ratios (HR) were estimated using Cox proportional hazards regression models. Results: In all patients combined, lower SES was significantly associated with poorer OS for all HNC sites. APIs had significantly better OS compared to Caucasians for OC, adjusted hazard ratio (HR) 0.83 (95% CI 0.76–0.90); LX/HP, HR 0.74 (95% CI 0.68–0.81); and NP, HR 0.82 (95% CI 0.74–0.90). OS benefit was preserved in both lower SES and higher SES strata (Table). After adjustment for other parameters, lower SES was significantly associated with poorer survival among APIs with OC, OPC, and LX/HP analyzed together. Conclusions: Neighborhood SES significantly influences survival in APIs with HNC, consistent with previous studies of other racial/ethnic groups. Unexpectedly, the higher median OS for APIs compared to Caucasians persisted for most HNC sites across levels of SES. This racial difference in HNC survival requires further elucidation for future individualized care. Median survival (months) by tumor site and SES for all, Caucasians, and API patients with HNC Tumor site All patients Caucasians API High SES Low SES High SES Low SES High SES Low SES Oral cavity (OC) 62.4 38.1 61.7 40.9 91.0 40.9 Oropharynx (OP) 85.4 36.7 86.2 43.7 101.7 38.8 Larynx/ hypopharynx (LX/HP) 74.6 49.3 73.9 50.8 119.1 59.3 Nasopharynx (NP) 100.9 61.3 64.1 35.4 148.4 83.1 No significant financial relationships to disclose.