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Race, Insurance Status Linked to Lower Cancer Survival

Reduced survival seen in HPV-associated head and neck cancer for nonwhite, uninsured patients

MONDAY, March 16, 2020 (HealthDay News) -- Nonwhite, uninsured patients with clinically favorable human papillomavirus (HPV)-associated squamous cell carcinoma of the head and neck (SCCHN) have higher mortality than their white peers, according to a study published in the February issue of the Journal of the National Comprehensive Cancer Network.

Luke R.G. Pike, M.D., from Massachusetts General Hospital in Boston, and colleagues used a custom Surveillance, Epidemiology, and End Results database to analyze 4,735 patients with nonmetastatic SCCHN and known HPV status who were diagnosed between 2013 and 2014. The authors performed a multivariable logistic regression analysis to identify associations between patient characteristics and HPV status and cancer-specific mortality (CSM).

The researchers found that oropharyngeal primary, male sex, and higher education were positively associated with HPV-positive SCCHN, while uninsured status, single marital status, and nonwhite race were negatively associated with HPV-positive SCCHN. Among patients with HPV-positive SCCHN, white race was associated with lower CSM (adjusted hazard ratio [aHR], 0.55), while uninsured status was associated with higher CSM (aHR, 3.12). The investigators did not observe these associations for HPV-negative or nonoropharynx SCCHN.

"It's unsettling that black and Hispanic men and women with HPV-positive oropharyngeal carcinoma -- a disease we now recognize to be curable in many patients with even very advanced disease -- appear to do disproportionately poorly as compared to their white peers," Pike said in a statement. "We also speculate that patients with insufficient insurance were unable to access high-quality radiotherapy, surgery, and chemotherapy, which is crucial to the successful treatment of locally advanced HPV-positive oropharyngeal cancer. We must strive to ensure that all men and women, no matter their insurance status or race, can get access to high-quality treatment for head and neck cancers."

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