Racial disparities in the choice of definitive treatment for squamous cell carcinoma of the oral cavity

Head Neck. 2018 Nov;40(11):2372-2382. doi: 10.1002/hed.25341. Epub 2018 Jun 26.

Abstract

Background: Definitive surgery is recommended for oral cavity squamous cell carcinoma (SCC). The purpose of this study was to present our assessment of the disparities in treatment selection for oral cavity SCC.

Methods: Non-Hispanic white and non-Hispanic black patients with oral cavity SCC were identified in the National Cancer Database (NCDB). Regression models were used to estimate relative risk (RR) of receiving surgery and absolute difference between non-Hispanic white and non-Hispanic black patients.

Results: There were 82.3% of non-Hispanic white patients who received surgery, compared to 64.2% of non-Hispanic black patients (P < .001). The non-Hispanic black patients were less likely to receive surgery than non-Hispanic white patients (RR 0.87) with an absolute difference of 10.9%. The non-Hispanic black patients were significantly more likely to not be offered surgery (RR 1.42) and to refuse recommended surgery (RR 1.38) but not have a contraindication to surgery (RR 1.17).

Conclusion: The non-Hispanic black patients are less likely to receive or be recommended surgery for oral cavity SCC and are more likely to refuse surgery. Further study is needed to identify strategies to close this disparity.

Keywords: oral cavity carcinoma; racial disparity; reason for no surgery; surgery; treatment selection.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Black or African American / statistics & numerical data
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / ethnology*
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / surgery*
  • Chemoradiotherapy / statistics & numerical data
  • Databases, Factual
  • Disease-Free Survival
  • Female
  • Healthcare Disparities / ethnology*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Mouth Neoplasms / diagnosis
  • Mouth Neoplasms / ethnology*
  • Mouth Neoplasms / mortality
  • Mouth Neoplasms / surgery*
  • Patient Preference / ethnology*
  • Patient Preference / statistics & numerical data
  • Retrospective Studies
  • Risk Assessment
  • Statistics, Nonparametric
  • Surgical Procedures, Operative / statistics & numerical data
  • Survival Analysis
  • United States