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Patient Demographics Influence Treatment and Survival in Laryngeal Cancer: Presented at AHNS

By Arushi Sinha

SAN FRANCISCO -- July 24, 2008 -- Early detection of laryngeal carcinoma appears to result in better outcomes, and patients with access to health insurance appear to be diagnosed earlier than patients without insurance, researchers indicated here at the American Head and Neck Society (AHNS) 7th International Conference on Head and Neck Cancer.

The study was a retrospective cohort analysis using statewide data from the South Carolina Central Cancer Registry and Office of Research Statistics medical claims records. The main outcomes of interest were stage at diagnosis, main treatment modality, and survival.

Lawrence Yen, MD, Chairman, Department of Otolaryngology -- Head and Neck Surgery, Buddhist Tzuchi General Hospital, Taipei, Taiwan, presented the study findings in a poster session on July 22.

While there is much speculation about the role of patient characteristics -- including race -- on cancer outcomes, there are fewer systematic studies on the mechanisms by which this may occur, Dr. Yen said. "We asked the question: Are there racial differences in diagnosis?" he explained.

The study analysed the stage of diagnosis, treatment protocols, and survival outcomes of 548 patients with newly diagnosed laryngeal cancer. Patients were racially diverse: 68.8% were white and 31.2% African Americans.

African Americans were 17% less likely than whites to have their cancer diagnosed at an early stage and were 14% more likely to undergo surgical treatment, although these findings were not statistically significant.

By contrast, the structural components of patient healthcare -- such as access to insurance and distance from a major medical facility -- did prove to be significantly different according to the patient's race. Those who had either public insurance (odds ratio [OR] = 2.18) or private insurance (OR = 2.86) were more likely to have an early diagnosis of laryngeal carcinoma compared with those who had no insurance. And those who were married (OR = 1.53) were diagnosed earlier than those who were not married.

Patients who lived in a rural community (OR = 1.59) or had local tumour spread (OR = 1.95) were more likely to receive surgical treatment and possible loss of laryngeal function.

Both surgery (hazard ratio [HR] = 0.15) and radiotherapy (HR = 0.17) techniques significantly improved patient survival.

"Race seems like a factor only because African Americans have more late-stage disease at presentation or because they live in rural areas and are therefore more likely to receive surgical therapy," explained Dr. Yen.

The authors stated that health policy needs to focus on a more equitable allocation of healthcare resources.

"The outcomes don't have much to do with race. It turns out to be common sense, really," said Dr. Yen. For their innovative research, the presentation received an award of distinction from the conference committee.

[Presentation title: Racial Difference in the Diagnosis, Treatment and Survival of Laryngeal Cancer Patients. Abstract P600]

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