Gender and racial disparities in survival from head and neck cancer: A competing events analysis of Kaiser Permanente patients.

Abstract

e18048 Background: Outcomes for patients with head and neck cancer (HNC) are affected by tumor specific features, as well as demographic characteristics and health-related comorbidities. We previously found that women have a higher risk of HNC death compared with risk of death from other causes using a General Competing Event (GCE) model. With a larger, more recent and well-annotated cohort of patients with HNC from Kaiser Permanente Northern California, we applied the GCE model to investigate sex and racial disparities in all-cause, HNC-specific, and non-HNC mortality. Methods: We identified patients with mucosal HNC treated in the curative setting between 2013-2017 on sociodemographic and clinical factors. Using GCE models adjusted for age, smoking status, Charlson comorbidity index, primary tumor site, and tumor stage, we examined if gender and race/ethnicity were associated with a higher relative hazard of HNC-specific mortality over non-HNC mortality (relative hazard ratio (RHR), ‘gcerisk’ package in R). Follow-up was measured from HNC diagnosis date to death or end of study (12/31/2022) whichever occurred earliest. Results: In our cohort of 1616 patients (mean age at diagnosis: 64.2 years), 25.7% were female. The majority were White (70.5%), followed by Asian (12.3%), Hispanic (8.0%), Black (4.8%), and other/unknown (4.3%). Women were less likely to smoke and had more oral cavity cancer and less p16+ oropharyngeal cancer than men. Patients of non-white (vs. white) race were younger, lived in more deprived neighborhoods, had less smoking and alcohol use, had more nasopharyngeal carcinoma and less p16+ oropharyngeal cancer. Over a median follow-up of 6.5 years, 274 patients died of HNC, and 279 patients died of other causes. Greater HNC-specific mortality was associated with female gender (RHR ratio 1.63; 95% confidence interval [CI] 1.10-2.41) and non-White race (RHR ratio 1.40; 95% CI 0.95-2.08). Conclusions: We observed worse HNC-specific mortality among female and nonwhite patients, which may be related to underlying disease biology and socioeconomic factors. This highlights the importance of examining both HNC-specific and non-HNC mortality to identify cancer health disparities. Mortality outcomes associated with gender and race among 1616 patients with head and neck cancer (HNC) treated in the curative setting. Variable All-Cause Mortality HR a (95% CI) Cancer Specific Mortality HR a (95% CI) Non-Cancer Mortality HR a (95% CI) Cancer Specific vs. Non-Cancer Mortality RHR* a (95% CI) Female vs. Male 1.07 (0.88, 1.29) 1.37 (1.04, 1.79) 0.84 (0.63, 1.12) 1.63 ( 1.10, 2.41 ) Non-White vs. White 0.94 (0.77, 1.14) 1.11 (0.85, 1.46) 0.79 (0.60, 1.05) 1.40 (0.95, 2.08) HR = Hazard ratio. *RHR = Relative hazard ratio for HNC-specific mortality vs. non-HNC mortality. a Adjusted for age, smoking status, Charlson comorbidity index, primary tumor site, tumor stage.