Findings from a retrospective cohort study suggest that a better understanding of socioeconomic differences and cancer treatment disparities among patients with head and neck cancer may help to improve clinical outcomes (JAMA Netw Open. 2020;3[1]:e1919697).

“Patients with head and neck cancer receive care at academic comprehensive cancer programs (ACCPs), integrated network cancer programs (INCPs), comprehensive community cancer programs (CCCPs), and community cancer programs (CCPs),” explained Ryan M. Carey, MD, Department of Otorhinolaryngology–Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and colleagues, who hypothesized that treatment facility type may be tied to overall survival (OS).

Thus, Dr Carey et al sought to evaluate whether such a link exists in 525,740 patients (mean age, 63.3 years) diagnosed with head and neck cancer between January 1, 2004, and December 31, 2016.

The primary outcome measure of the study was OS after diagnosis and treatment of head and neck cancer, and the secondary outcome measure was the likelihood of receiving treatment at ACCPs and INCPs vs CCCPs and CCPs.

Data were gathered from the National Cancer Database and analyzed between May 1, 2019, and November 30, 2019. For analysis, Dr Carey and co-investigators used multivariable Cox proportional hazards regression and univariable and multivariable logistic regression models.

Ultimately, 36,595 (7.0%); 174,658 (33.2%); 232,867 (44.3%); and 57,857 (11.0%) patients received treatment at CCPs, CCCPs, ACCPs; and INCPs, respectively.

Patients with aerodigestive cancers had a median survival of 69.2 months (95% CI, 68.6-69.8), whereas patients with salivary gland cancers had a median of 107.2 months (95% CI, 103.9-110.2) and those with skin cancers had a median of 113.2 months (95% CI, 111.4-114.6).

According to the results, treatment at ACCPs (hazard ratio [HR], 0.89; 95% CI, 0.88-0.91), INCPs (HR, 0.94; 95% CI, 0.92-0.96), and CCCPs (HR, 0.94; 95% CI, 0.92-0.95) were tied to improved OS compared with CCPs.

Patients were more likely to receive treatment at ACCPs and INCPs if they had government insurance (odds ratio [OR], 1.35; 95% CI, 1.29-1.41), no insurance (OR, 1.12; 95% CI, 1.09-1.16), or Medicaid (OR, 1.17; 95% CI, 1.14-1.20) versus private insurance. However, patients with Medicare were less likely to be treated at ACCPs and INCPs (OR, 0.95; 95% CI, 0.94-0.97).

Notably, patients who were black (OR, 1.55; 95% CI, 1.52-1.59) or Asian (OR, 1.56; 95% CI, 1.49-1.63) were more likely to receive care at ACCPs and INCPs than white patients. Furthermore, patients from high-income areas were more likely to receive treatment at ACCPs and INCPs than those from lower-income areas (OR, 1.25; 95% CI, 1.22-1.28).

“These findings suggest that treatment at ACCPs and INCPs was associated with a better overall survival rate in patients with head and neck cancer. Key social determinants of health such as race/ethnicity, socioeconomic status, and type of insurance were associated with receiving treatment at ACCPs and INCPs,” Dr Carey and colleagues concluded.—Hina Porcelli