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Head and Neck Surgery

(458) Socioeconomic Influences on Outcomes in Head and Neck Cutaneous SCC

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Mitchell T. Victor, BA

    Medical Student
    Department of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, La Jolla, CA. Northwestern University, Feinberg School of Medicine, Chicago, IL.
    Chicago, Illinois, United States

  • WZ

    Wynne Zheng, MA

    Department of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, USA

    • Co-Author(s)

  • WZ

    Wynne Zheng, MA

    Department of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, USA

  • SP

    Soo Park, MD

    Assistant Professor
    Moores Cancer Center, La Jolla, California, USA

    • Senior Author(s)

  • TG

    Theresa Guo, MD

    Assistant Professor
    Department of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, USA

Disclosure(s):
Mitchell T. Victor, BA: No relevant relationships to disclose.
Wynne Zheng, MA: No relevant relationships to disclose.


Introduction: This study aims to identify socioeconomic factors influencing presentation and outcomes of cutaneous head and neck squamous cell carcinoma (cHNSCC).

Methods: A retrospective cohort study was performed of patients with cHNSCC treated between 2008-2022 at a single academic institution, approved by IRB protocol #804816. Demographic, socioeconomic data, and disease characteristics were obtained from medical record abstraction. Outcome measures included tumor stage, number of distinct primaries, recurrence, disease-specific death, and overall survival. Chi-squared and Mann-Whitney tests were implemented to evaluate clinicopathologic distributions across disease stages. Survival analyses were performed using Cox regression and Kaplan Meier analysis.

Results: 347 patients met inclusion criteria. Median age and length of follow-up were 70.3 and 4 years, respectively. Majority of patients were male (79.5%) and identified as non-Hispanic white (91.9%). Patients presenting with Stage III/IV disease were more likely to have Medicaid or be uninsured (p=0.014), live >30 miles from treating institution (p=0.009), live in a less urban area (p=0.014), have a history of homelessness (p=0.028), and have a diagnosis of dementia (p=0.041). Stage III/IV disease predicted both recurrence and disease-specific death (Log-Rank, p< 0.001). Insurance status (aHR: 2.09, 95%CI [1.19-3.65], p=0.010; 1.88 [1.13-3.13], p=0.015) and immune status (2.16 [1.34-3.50], p< 0.001; 2.05 [1.28-3.28], p=0.003) were both independent predictors of recurrence and overall survival, respectively. Immune status also predicted disease-specific death (4.34 [1.82-10.35], p< 0.001).

Conclusions: Socioeconomic barriers including insurance status contribute to higher cHNSCC disease stage and worse disease-related outcomes. Those with limited access to healthcare due to either socioeconomic status or location present with more advanced disease in cHNSCC, which can contribute to poorer outcomes. Identification of these barriers may allow for intervention by providers and policymakers to reduce these disparities.