Disparities in Pediatric Parotid Cancer Treatment and Presentation

Introduction: Salivary gland malignancies are uncommon in children, and few studies have been directed at understanding disparities related to these cancers. There is a need to understand factors that predict variations in treatment, presentation, and survival in children with parotid cancer.

Methods: A national database was used to analyze children with parotid malignancies between 2000-2019 in the Surveillance, Epidemiology, and End Results (SEER) Program. Race and ethnicity were classified as Non-Hispanic White, Non-Hispanic Black, Non-Hispanic Other, and Hispanic. Income was assessed at the county level. Outcomes included tumor size/stage at diagnosis, survival, and needing facial nerve sacrifice. Stratification by race and income was conducted to determine differences in outcomes. The Kaplan-Meier estimator was used to analyze survival. Multivariable logistic regression was conducted to identify predictors of outcomes.

Results: 174 patients were analyzed. Most patients (N=77, 44%) had mucoepidermoid tumors. Stratified by race/ethnicity (p=0.011), Non-Hispanic Black (Median 25 mm, IQR 15-32) and Hispanic (25mm, 20-36) had larger tumors than Non-Hispanic White patients (20 mm, 13-25). Hispanic patients had a higher rate of facial nerve sacrifice (35%) compared to White (15%) and Black (22%) patients. Survival did not differ across race/ethnicity or income. On multivariable analysis, Hispanic patients were more likely to experience facial nerve sacrifice (OR 2.60, 95%CI 1.01-6.85, p=0.049), and Black patients presented with larger (>75th %ile) tumors (3.02, 1.17-7.86, p=0.022) compared to White patients.

Conclusions: Variations in presentation and treatment exist across race/ethnicity in pediatric parotid cancers. Enumerating these disparities can improve access and outcomes for underserved populations.