Survival outcomes for HPV-positive oropharyngeal squamous cell carcinoma of the head and neck (SCCHN) have made significant gains in recent years, but new research in the February 2020 issue of JNCCN--Journal of the National Comprehensive Cancer Network finds some groups are being left behind. Researchers from Massachusetts General Hospital--along with Yale University School of Medicine, UT Southwestern Medical Center, and UNC Chapel Hill School of Medicine--conducted the largest population-based analysis to date on the socioeconomic factors that affect outcomes in this cancer type, and found significant racial and socioeconomic disparities.
When we examined outcomes by race and insurance status, adjusting for all clinical factors, those patients who were non-white or uninsured or poorly insured had much reduced cancer-specific survival compared to their white and well-insured peers. 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. 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."
Luke R. G. Pike, MD, DPhil, Department of Radiation Oncology, Massachusetts General Hospital
The researchers used a custom SEER Database to identify 4,735 adult patients who were diagnosed with primary nonmetastatic SCCHN with a known HPV status in 2013 or 2014. The data showed that among those patients with HPV-positive oropharyngeal cancer, there was a 5.6% rate of cancer-specific death at 20 months for white individuals, compared to an 11.2% rate for non-whites. Separately, the rate of cancer-specific death for persons with health insurance was 6.2%, versus 14.8% for the uninsured. Those outcome disparities were not seen for non-oropharyngeal cancers, or prognostically less favorable HPV-negative SCCHN.
"The study by Pike, et al. highlights the socioeconomic differences between patients with HPV-positive and HPV-negative SCCHN and identifies striking racial disparities among individuals with HPV-positive oropharyngeal SCCHN, whereby non-white and uninsured patients with HPV-positive cancers had worse cancer-specific mortality," commented Francis Worden, MD, University of Michigan Rogel Cancer Center, and Member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Head and Neck Cancers--who was not involved in this research. "While the exact reasons for these findings are speculative given the retrospective nature of this work, their data bring to light the importance for early diagnosis and treatment of all patients with HPV-positive oropharyngeal cancers and the importance of identifying and eliminating barriers to care.
HPV-positive cancers are highly curable, but data does show that patients who present with higher stage disease (due primarily to delays in diagnosis and thus delays in treatment) have lower overall survival rates. Additionally, lower income, non-white populations may be less likely to obtain care at larger, more experienced cancer centers that treat higher volumes of head and neck cancers. Published data suggest that patient care at such centers of excellence leads to improved outcomes due to expertise in administering complex treatment plans and the high level of support that is provided during medical care."
Pike, L., et al. (2020) Outcomes of HPV-Associated Squamous Cell Carcinoma of the Head and Neck: Impact of Race and Socioeconomic Status. JNCCN. doi.org/10.6004/jnccn.2019.7356.