Association of race and health care system with disease stage and survival in veterans with larynx cancer. Issue 15 (2nd April 2021)

• Record Type: Journal Article
• Authors: Voora, Rohith S.; Kotha, Nikhil V.; Kumar, Abhishek; Qiao, Edmund M.; Qian, Alexander S.; Panuganti, Bharat A.; Banegas, Matthew P.; Weissbrod, Philip A.; Stewart, Tyler F.; Rose, Brent S.; Orosco, Ryan K.
• Is Part Of: Cancer. Volume 127:Issue 15(2021)
• Page Start: 2705
• Page End: 2713
• Publication Date: 2021-04-02
• Subjects: health care disparities -- health services accessibility -- laryngeal cancer -- Surveillance, Epidemiology, and End Results (SEER) -- veterans' health -- Veterans Health Administration (VHA) -- veterans' health -- Veterans Health Administration (VHA); Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.33557
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : Background: Black patients with laryngeal squamous cell carcinoma (LSCC) historically have inferior outcomes in comparison with White patients. The authors investigated these racial disparities within the Veterans Health Administration (VHA), an equal‐access system, and within the Surveillance, Epidemiology, and End Results (SEER) program, which is representative of the US hybrid‐payer system. Methods: Patients with invasive (T1 or greater) LSCC were included from SEER (2004‐2015) and the VHA (2000‐2017). The primary outcomes of overall survival (OS) and larynx cancer–specific survival (LCS) were evaluated in Cox and Fine‐Gray models. Results: In the SEER cohort (7122 patients: 82.6% White and 17.4% Black), Black patients were more likely to present with advanced disease and had inferior OS (hazard ratio [HR], 1.37; 95% CI, 1.26‐1.50; P < .0001) in a multivariable analysis. Black LCS was worse in a univariable analysis (HR, 1.42; 95% CI, 1.27‐1.58; P < .0001), but this effect was attenuated by 83% when the authors controlled for the TNM category and was found to be insignificant in a multivariable analysis (HR, 1.05; 95% CI, 0.93‐1.18; P = .42). In the VHA cohort (9248 patients: 79.7% White and 20.3% Black), the 2 racial cohorts presented with similar tumor characteristics and similar OS (HR, 0.95; 95% CI, 0.89‐1.02; P = .14). Black LCS was similar in univariable (HR, 1.10; 95% CI, 1.00‐1.22; P = .05) and multivariable analyses (HR, 1.02; 95% CI, 0.92‐1.14; P = .67). Conclusions: Black patients with LSCC had a tumor burden at diagnosis and survival outcomes comparable to those of White patients within the VHA; this was counter to what was observed in the SEER analysis and prior national trends. This study's findings point toward the notable role of health care access in contributing to racial health disparities in the realm of larynx cancer. Abstract : Within the "equal‐access" veterans' health system, Black and White patients with larynx cancer have similar disease burdens at diagnosis and similar larynx cancer survival outcomes. These observations, in contrast to Surveillance, Epidemiology, and End Results data, suggest that health care access may be a significant mediator of race‐based larynx cancer survival disparities.