Study suggests racial disparities may exist in larynx preservation therapy for cancer

CHICAGO – A study of laryngeal (voice box) cancers suggests that racial disparities may exist with black patients less likely to undergo larynx preservation than white patients, according to a report published by Archives of Otolaryngology – Head & Neck Surgery, a JAMA Network publication.

Annually about 12,000 cases of laryngeal cancer are diagnosed in the United States, and the standard of care historically has been total laryngectomy (removal of the voice box) followed by radiation for locally advanced cancer. However, studies have now resulted in widespread acceptance of larynx preservation using radiation with chemotherapy as the initial treatment, with total laryngectomy reserved for "salvage" therapy, according to the study background.

Wei-Hsien Hou, M.D., Ph.D., of the University of California Davis School of Medicine, Sacramento, and colleagues used the Surveillance Epidemiology and End Results (SEER) database to identify white, black, Hispanic and Asian patients with stage III and stage IV laryngeal cancers diagnosed during 1991 through 2008. A total of 3,862 patients met their selection criteria, including 2,808 white patients, 648 black patients, 287 Hispanic patients and 119 Asian patients.

The authors report that among white patients, 2,254 (80.3 percent) had larynx preservation and among black patients, 483 (74.5 percent) had larynx preservation.

"After controlling for potentially confounding variables including age, sex, year of diagnosis, stage and subsite, we demonstrated that blacks were less likely to undergo larynx preservation than whites. Following the trend within the general population, the use of larynx preservation has also increased among black patients over time, and our data suggest that the observed racial disparity may in fact be narrowing," the authors note.

On univariate analysis, blacks (odds ratio [OR] 0.72) were significantly less likely to undergo larynx preservation, and this racial disparity persisted on multivariate analysis for blacks (OR, 0.78) and was still observed among patients treated more recently between 2001 and 2008 (OR, 0.74), according to the study results.

Researchers note possible explanations for their results may include a lack of health literacy and social factors such as financial barriers and health insurance.

"In conclusion, although the use of nonsurgical larynx preservation therapy appears to be increasing among the general population, racial disparities continue to exist, most notably among black patients with stage IV disease," the authors conclude. "Acknowledging that socioeconomic and nonethnicity related variables have the potential to confound our observed findings, we believe that future research should focus on identifying and eliminating barriers to the use of larynx preservation for all medically suitable patients, with a particular focus on black patients with stage IV disease."

(Arch Otolaryngol Head Neck Surg. 2012:138[7]:644-649. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

To contact corresponding author Allen M. Chen, M.D., call Dorsey Griffith at 916-734-9118 or email dorsey.griffith@ucdmc.ucdavis.edu.