Oropharynx cancer in the US: Racial disparities in stage at presentation.

Abstract

e13766 Background: Global occurrence of oropharynx cancer (OPC) varies greatly. While rare in the US, the diverse nature of the US clinical environment – where patients face intersectional disparities in access across the cancer continuum – requires a greater understanding of existing disparities in OPC. As such, this study explored the difference in stage at presentation of OPC, focusing on AA patient subpopulations. Methods: Patients with OPC were identified from the National Cancer Database (2004 to 2021), allowing for disaggregation by race/ethnicity and analysis of Asian American (AA) and other subgroups. Multivariable ordinal logistic regression models (adjusting for demographic and socioeconomic factors) defined adjusted odds ratios (aORs, higher aOR represents greater risk of advanced OPC). Results: Among the 30635 patients, the majority were white (25979, 84.8%) and Black (3738, 12.2%). Among the majority populations, white patients were more likely to be insured (χ2 P < .0001) and live outside of low-income zip codes (χ2 P < .0001), but Black patients were more likely to be uninsured (χ2 P < .0001) and live in lower-income zip codes (χ2 P < .0001). The population was heterogeneous in income and insurance status. Among patients without insurance, 55.9% presented with distant metastatic disease (37.0% for private insurance, 52.6% for Medicaid, and 35.9% for Medicare), while 50.5% of patients in the lowest income zip codes presented with distant metastatic disease, versus 42.3% for the highest income zip codes (P < .01 for all). Prior to disaggregation, distant metastatic disease comprised 37.8% of cases in white patients (ref), 51.2% in Black patients (aOR 1.50, P < .0001), 41.7% in Native American patients (aOR 1.49, P > .05), 41.4% in AA patients (aOR 1.62, P = .0009), and 33.3% in Native Hawaiian and other Pacific Islander patients (aOR 0.71, P > .05). After disaggregation, rates of distant metastatic disease at presentation were greatest (≥50%) among Laotian (100%), Kampuchean (100%), Japanese (51.7%, aOR 1.60, P > .05), Black (51.2%, aOR 1.50, P < .0001), and Hmong (50%) patients. Rates of presentation with distant metastatic disease were lower than whites in Korean (37.5%, aOR 1.35, P > .05), Vietnamese (36.7%, aOR 0.90, P > .05), Native Hawaiian (36.4%, aOR 2.83, P > .05), and other Pacific Islander (11.1%, aOR 0.49, P < .0001) patients. Notably, Asian Indian & Pakistani patients were at increased risk of distant metastatic disease at presentation (45.9%, aOR 2.06, P = .03). Conclusions: While the vast majority of OPC patients in the US were not from minoritized groups, distant metastatic disease at presentation was most common in AA subgroup (Laotian, Kampuchean, Japanese, and Hmong) and Black patients, even when adjusted for social determinants of health. This follows previously established trends of disparities in head and neck cancer, and support engagement with minority populations to increase awareness of OPC.