PMID- 33799314
OWN - NLM
STAT- MEDLINE
DCOM- 20220308
LR  - 20221207
IS  - 1097-0142 (Electronic)
IS  - 0008-543X (Linking)
VI  - 127
IP  - 15
DP  - 2021 Aug 1
TI  - Association of race and health care system with disease stage and survival in 
      veterans with larynx cancer.
PG  - 2705-2713
LID - 10.1002/cncr.33557 [doi]
AB  - BACKGROUND: Black patients with laryngeal squamous cell carcinoma (LSCC) 
      historically have inferior outcomes in comparison with White patients. The 
      authors investigated these racial disparities within the Veterans Health 
      Administration (VHA), an equal-access system, and within the Surveillance, 
      Epidemiology, and End Results (SEER) program, which is representative of the US 
      hybrid-payer system. METHODS: Patients with invasive (T1 or greater) LSCC were 
      included from SEER (2004-2015) and the VHA (2000-2017). The primary outcomes of 
      overall survival (OS) and larynx cancer-specific survival (LCS) were evaluated in 
      Cox and Fine-Gray models. RESULTS: In the SEER cohort (7122 patients: 82.6% White 
      and 17.4% Black), Black patients were more likely to present with advanced 
      disease and had inferior OS (hazard ratio [HR], 1.37; 95% CI, 1.26-1.50; P < 
      .0001) in a multivariable analysis. Black LCS was worse in a univariable analysis 
      (HR, 1.42; 95% CI, 1.27-1.58; P < .0001), but this effect was attenuated by 83% 
      when the authors controlled for the TNM category and was found to be 
      insignificant in a multivariable analysis (HR, 1.05; 95% CI, 0.93-1.18; P = .42). 
      In the VHA cohort (9248 patients: 79.7% White and 20.3% Black), the 2 racial 
      cohorts presented with similar tumor characteristics and similar OS (HR, 0.95; 
      95% CI, 0.89-1.02; P = .14). Black LCS was similar in univariable (HR, 1.10; 95% 
      CI, 1.00-1.22; P = .05) and multivariable analyses (HR, 1.02; 95% CI, 0.92-1.14; 
      P = .67). CONCLUSIONS: Black patients with LSCC had a tumor burden at diagnosis 
      and survival outcomes comparable to those of White patients within the VHA; this 
      was counter to what was observed in the SEER analysis and prior national trends. 
      This study's findings point toward the notable role of health care access in 
      contributing to racial health disparities in the realm of larynx cancer.
CI  - (c) 2021 American Cancer Society.
FAU - Voora, Rohith S
AU  - Voora RS
AUID- ORCID: 0000-0001-9242-844X
AD  - School of Medicine, University of California San Diego, San Diego, California.
AD  - Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, 
      University of California San Diego, San Diego, California.
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California.
FAU - Kotha, Nikhil V
AU  - Kotha NV
AD  - School of Medicine, University of California San Diego, San Diego, California.
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California.
AD  - Department of Radiation Medicine and Applied Sciences, University of California 
      San Diego School of Medicine, La Jolla, California.
FAU - Kumar, Abhishek
AU  - Kumar A
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California.
AD  - Department of Radiation Medicine and Applied Sciences, University of California 
      San Diego School of Medicine, La Jolla, California.
FAU - Qiao, Edmund M
AU  - Qiao EM
AD  - School of Medicine, University of California San Diego, San Diego, California.
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California.
AD  - Department of Radiation Medicine and Applied Sciences, University of California 
      San Diego School of Medicine, La Jolla, California.
FAU - Qian, Alexander S
AU  - Qian AS
AD  - School of Medicine, University of California San Diego, San Diego, California.
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California.
AD  - Department of Radiation Medicine and Applied Sciences, University of California 
      San Diego School of Medicine, La Jolla, California.
FAU - Panuganti, Bharat A
AU  - Panuganti BA
AUID- ORCID: 0000-0003-1149-9532
AD  - Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, 
      University of California San Diego, San Diego, California.
AD  - Moores Cancer Center, La Jolla, California.
FAU - Banegas, Matthew P
AU  - Banegas MP
AUID- ORCID: 0000-0002-6158-7162
AD  - Kaiser Permanente Center for Health Research, Portland, Oregon.
FAU - Weissbrod, Philip A
AU  - Weissbrod PA
AD  - Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, 
      University of California San Diego, San Diego, California.
AD  - Moores Cancer Center, La Jolla, California.
FAU - Stewart, Tyler F
AU  - Stewart TF
AD  - Moores Cancer Center, La Jolla, California.
AD  - Division of Hematology-Oncology, University of California San Diego, San Diego, 
      California.
AD  - Division of Blood and Marrow Transplantation, University of California San Diego, 
      San Diego, California.
FAU - Rose, Brent S
AU  - Rose BS
AUID- ORCID: 0000-0002-3197-9552
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California.
AD  - Department of Radiation Medicine and Applied Sciences, University of California 
      San Diego School of Medicine, La Jolla, California.
AD  - Moores Cancer Center, La Jolla, California.
FAU - Orosco, Ryan K
AU  - Orosco RK
AUID- ORCID: 0000-0002-7885-4327
AD  - Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, 
      University of California San Diego, San Diego, California.
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California.
AD  - Moores Cancer Center, La Jolla, California.
LA  - eng
GR  - University of California San Diego School of Medicine/
GR  - Altman Clinical Translational Research Institute/
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210402
PL  - United States
TA  - Cancer
JT  - Cancer
JID - 0374236
SB  - IM
CIN - Cancer. 2021 Aug 1;127(15):2612-2613. PMID: 33799316
MH  - Black People
MH  - Health Services Accessibility
MH  - Humans
MH  - *Laryngeal Neoplasms/therapy
MH  - Proportional Hazards Models
MH  - SEER Program
MH  - United States/epidemiology
MH  - *Veterans
OTO - NOTNLM
OT  - Surveillance, Epidemiology, and End Results (SEER)
OT  - Veterans Health Administration (VHA)
OT  - health care disparities
OT  - health services accessibility
OT  - laryngeal cancer
OT  - veterans' health
EDAT- 2021/04/03 06:00
MHDA- 2022/03/09 06:00
CRDT- 2021/04/02 20:38
PHST- 2020/12/31 00:00 [received]
PHST- 2021/02/01 00:00 [accepted]
PHST- 2021/04/03 06:00 [pubmed]
PHST- 2022/03/09 06:00 [medline]
PHST- 2021/04/02 20:38 [entrez]
AID - 10.1002/cncr.33557 [doi]
PST - ppublish
SO  - Cancer. 2021 Aug 1;127(15):2705-2713. doi: 10.1002/cncr.33557. Epub 2021 Apr 2.