Jennifer A Marks1, Jeffrey M Switchenko2, Conor E Steuer3, Martha Ryan3, Mihir R Patel4, Mark W McDonald5, Kristin Higgins5, Johnathan J Beitler3,4,5, Dong M Shin3, Theresa W Gillespie6, Nabil F Saba3. 1. Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA. 2. Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA. 3. Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA. 4. Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA. 5. Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA. 6. Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Abstract
PURPOSE: Human papilloma virus (HPV) association remains one of the most important predictors of clinical outcome in oropharyngeal squamous cell carcinoma (OPSCC). We aimed to determine whether the relationship between HPV status and overall survival was influenced by socioeconomic factors. MATERIALS AND METHODS: Using the National Cancer Database, we examined the relationship between socioeconomic status and overall survival, controlling for demographics and socioeconomic variables (age at diagnosis, race, sex, clinical stage, facility type, facility location, insurance status, median-income quartiles, percent of no high-school education quartiles, rural-urban dwelling, Charlson-Deyo score, primary site, and treatment type). RESULTS: HPV-positive patients with private insurance have improved overall survival compared with HPV-positive patients who are uninsured (hazard ratio [HR], 0.51, 95% CI, 0.41 to 0.63, P < .001). HPV-negative patients with private insurance have improved overall survival compared with HPV-negative patients who were uninsured (HR, 0.62, 95% CI, 0.53 to 0.73, P < .001). HPV-positive patients living in the south had improved overall survival compared with HPV-positive patients living in the west (HR, 0.83, 95% CI, 0.72 to 0.96, P = .013). As assessed through interaction, relationships between survival and insurance (P = .004), rural-urban status (P = .009), and facility location (P = .021) statistically differed between HPV-positive and HPV-negative patients. CONCLUSION: HPV status impact on overall survival for patients with OPSCC is influenced by socioeconomic factors including insurance status and treatment facility. A deeper understanding of these interactions is needed to improve equity of care for patients with OPSCC.
PURPOSE: Human papilloma virus (HPV) association remains one of the most important predictors of clinical outcome in oropharyngeal squamous cell carcinoma (OPSCC). We aimed to determine whether the relationship between HPV status and overall survival was influenced by socioeconomic factors. MATERIALS AND METHODS: Using the National Cancer Database, we examined the relationship between socioeconomic status and overall survival, controlling for demographics and socioeconomic variables (age at diagnosis, race, sex, clinical stage, facility type, facility location, insurance status, median-income quartiles, percent of no high-school education quartiles, rural-urban dwelling, Charlson-Deyo score, primary site, and treatment type). RESULTS: HPV-positive patients with private insurance have improved overall survival compared with HPV-positive patients who are uninsured (hazard ratio [HR], 0.51, 95% CI, 0.41 to 0.63, P < .001). HPV-negative patients with private insurance have improved overall survival compared with HPV-negative patients who were uninsured (HR, 0.62, 95% CI, 0.53 to 0.73, P < .001). HPV-positive patients living in the south had improved overall survival compared with HPV-positive patients living in the west (HR, 0.83, 95% CI, 0.72 to 0.96, P = .013). As assessed through interaction, relationships between survival and insurance (P = .004), rural-urban status (P = .009), and facility location (P = .021) statistically differed between HPV-positive and HPV-negative patients. CONCLUSION: HPV status impact on overall survival for patients with OPSCC is influenced by socioeconomic factors including insurance status and treatment facility. A deeper understanding of these interactions is needed to improve equity of care for patients with OPSCC.
Authors: K Kian Ang; Jonathan Harris; Richard Wheeler; Randal Weber; David I Rosenthal; Phuc Felix Nguyen-Tân; William H Westra; Christine H Chung; Richard C Jordan; Charles Lu; Harold Kim; Rita Axelrod; C Craig Silverman; Kevin P Redmond; Maura L Gillison Journal: N Engl J Med Date: 2010-06-07 Impact factor: 91.245
Authors: Arya Amini; Jagar Jasem; Bernard L Jones; Tyler P Robin; Jessica D McDermott; Shilpa Bhatia; David Raben; Antonio Jimeno; Daniel W Bowles; Sana D Karam Journal: Oral Oncol Date: 2016-03-12 Impact factor: 5.337
Authors: David I Conway; Alex D McMahon; Katrina Smith; Roger Black; Gerry Robertson; John Devine; Patricia A McKinney Journal: Br J Oral Maxillofac Surg Date: 2009-05-28 Impact factor: 1.651
Authors: Manuel A Molina; Michael C Cheung; Eduardo A Perez; Margaret M Byrne; Dido Franceschi; Frederick L Moffat; Alan S Livingstone; W Jarrard Goodwin; Juan C Gutierrez; Leonidas G Koniaris Journal: Cancer Date: 2008-11-15 Impact factor: 6.860
Authors: Richard B Cannon; Hailey M Shepherd; Hilary McCrary; Patrick S Carpenter; Luke O Buchmann; Jason P Hunt; Jeffrey J Houlton; Marcus M Monroe Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-11-01 Impact factor: 6.223
Authors: J Ferlay; M Colombet; I Soerjomataram; C Mathers; D M Parkin; M Piñeros; A Znaor; F Bray Journal: Int J Cancer Date: 2018-12-06 Impact factor: 7.396
Authors: Smita Bhatia; Wendy Landier; Electra D Paskett; Katherine B Peters; Janette K Merrill; Jonathan Phillips; Raymond U Osarogiagbon Journal: J Natl Cancer Inst Date: 2022-07-11 Impact factor: 11.816