Abstract
Purpose
To determine if sociodemographic factors are associated with treatment choice and survival in patients with advanced stage laryngeal cancer in the U.S.
Design/setting/subjects/methods
Population-based, non-concurrent cohort study of 5381 patients diagnosed with stage III or IV laryngeal squamous cell carcinoma from 1992–2009. Data was extracted from the Surveillance, Epidemiology, and End Results (SEER) database.
Main outcome(s) and measures
Choice of therapy (surgical vs. non-surgical) and disease-specific survival (DSS).
Results
Age ≥ 60 years (odds ratio [OR] = 0.78; 95% CI, 0.70–0.88) and more recent year of diagnosis (OR = 0.89; 95% CI, 0.87–0.90) decreased the odds of receiving surgical therapy, while residing in a county with low median household income (OR = 1.36; 95% CI, 1.17–1.57) increased the odds of receiving surgical therapy. Age ≥ 60 years (hazard ratio [HR] = 1.45; 95% CI, 1.33–1.59) and Black race (HR = 1.14; 95% CI, 1.02–1.27) were negatively associated with DSS, while female sex (HR = 0.81; 95% CI, 0.72–0.90) and married status (HR = 0.69; 95% CI, 0.63–0.75) were positively associated with DSS.
Conclusions and relevance
For patients with advanced laryngeal cancer, younger age and residing in a low-income county increase the likelihood of receiving surgical therapy. Female sex and married status provide a survival benefit, while Black race appears to be a negative prognostic factor. This highlights the impact of sociodemographic factors on treatment strategies and outcomes and highlights areas for further research on health disparities.
1
Introduction
Approximately 12,000 cases of laryngeal cancer are diagnosed annually, accounting for an estimated 3000 deaths each year in the U.S. . Historically, advanced stage laryngeal cancer was treated with total laryngectomy (TL) with post-operative radiation. However, in 1991, the results of the Department of Veterans Affairs (VA) Laryngeal Cancer Study shifted the treatment paradigm toward organ conservation therapy with chemotherapy and radiation . This shift in paradigm was solidified by the Radiation Therapy Oncology Group (RTOG) 91-11 study, which showed that concurrent chemoradiation improved tumor control compared with induction chemotherapy followed by radiation .
Since the publication of these studies, chemoradiation has become increasingly popular as a treatment modality for the treatment of advanced laryngeal cancer . However, it is unclear whether sociodemographic factors affect the choice of therapy. A recent study using the Surveillance, Epidemiology, and End Results (SEER) database reported pronounced racial disparities in the use of laryngeal preservation therapy for laryngeal cancer . Moreover, sociodemographic factors have been associated with survival in a number of cancers, including laryngeal cancer . The purpose of our study was to investigate the impact of demographic and socioeconomic factors on choice of therapy and survival in patients with advanced staged laryngeal cancer using a large population-based cancer registry.
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