Marc A Emerson1, Douglas R Farquhar2, Nicholas R Lenze2, Siddharth Sheth1,3, Angela L Mazul4, Adam M Zanation2, Trevor G Hackman2, Mark C Weissler2, Jose P Zevallos4, Wendell G Yarbrough1,2,5, Paul Brennan6, Behnoush Abedi-Ardekani6, Andrew F Olshan1. 1. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 2. Department of Otolaryngology - Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 3. Division of Medical Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 4. Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA. 5. Department of Pathology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 6. International Agency for Research on Cancer, WHO, Lyon, France.
Abstract
BACKGROUND: Little is known about how factors combine to influence progression of squamous cell carcinoma of the head and neck (HNSCC). We aimed to evaluate multidimensional influences of factors associated with HNSCC stage by race. METHODS: Using retrospective data, patients with similar socioeconomic status (SES), access to care (travel time/distance), and behavioral risk factors (tobacco/alcohol use and dental care) were grouped by latent class analysis. Relative frequency differences (RFD) were calculated to evaluate latent classes by stage, race, and p16 status. RESULTS: We identified three latent classes. Advanced T-stage was higher for black (RFD = +20.2%; 95% CI: -4.6 to 44.9) than white patients (RFD = +10.7%; 95% CI: 2.1-19.3) in the low-SES/high-access/high-behavioral risk class and higher for both black (RFD = +29.6%; 95% CI: 4.7-54.5) and white patients (RFD = +23.9%; 95% CI: 15.2-32.6) in the low-SES/low-access/high-behavioral risk class. CONCLUSION: Results suggest that SES, access to care, and behavioral risk factors combine to underly the association with advanced T-stage. Additionally, differences by race warrant further investigation.
BACKGROUND: Little is known about how factors combine to influence progression of squamous cell carcinoma of the head and neck (HNSCC). We aimed to evaluate multidimensional influences of factors associated with HNSCC stage by race. METHODS: Using retrospective data, patients with similar socioeconomic status (SES), access to care (travel time/distance), and behavioral risk factors (tobacco/alcohol use and dental care) were grouped by latent class analysis. Relative frequency differences (RFD) were calculated to evaluate latent classes by stage, race, and p16 status. RESULTS: We identified three latent classes. Advanced T-stage was higher for black (RFD = +20.2%; 95% CI: -4.6 to 44.9) than white patients (RFD = +10.7%; 95% CI: 2.1-19.3) in the low-SES/high-access/high-behavioral risk class and higher for both black (RFD = +29.6%; 95% CI: 4.7-54.5) and white patients (RFD = +23.9%; 95% CI: 15.2-32.6) in the low-SES/low-access/high-behavioral risk class. CONCLUSION: Results suggest that SES, access to care, and behavioral risk factors combine to underly the association with advanced T-stage. Additionally, differences by race warrant further investigation.
Keywords:
HPV-related cancer; distance to care; head and neck cancer; late stage; latent class analysis; neoplasm stage; racial disparities; socioeconomic status
Authors: Douglas R Farquhar; Maheer M Masood; Nicholas R Lenze; Philip McDaniel; Angela Mazul; Siddharth Sheth; Adam M Zanation; Trevor G Hackman; Mark Weissler; Jose P Zevallos; Andrew F Olshan Journal: Oral Oncol Date: 2019-01-02 Impact factor: 5.337
Authors: Douglas R Farquhar; Kimon Divaris; Angela L Mazul; Mark C Weissler; Jose P Zevallos; Andrew F Olshan Journal: Oral Oncol Date: 2017-10 Impact factor: 5.337