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Head and Neck Surgery

Disparities in Head and Neck Cancer: Not Just About Access

Tuesday, October 3, 2023
9:45 AM - 9:51 AM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Russell A. Whitehead, BS

    M3
    Rush Medical College
    Chicago, Illinois, United States

  • Evan A. Patel, MS

    Medical Student
    Rush University Medical Center
    Chicago, IL, United States

    • Senior Author(s)

  • MB

    Mihir K. Bhayani, MD

    Associate Professor
    Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, USA

  • Jeffrey C. Liu, MD

    Associate Professor
    Temple University Hospital
    Philadelphia, PA, United States

Disclosure(s):
Russell A. Whitehead, BS: No relevant relationships to disclose.
Evan A. Patel, MS: No relevant relationships to disclose.
Jeffrey C. Liu, MD: No relevant relationships to disclose.
Introduction: A growing body of literature identifies stark racial disparities in head and neck cancer (HNC) in the United States, primarily between non-Hispanic white (NHW) and non-Hispanic black (NHB) populations. The etiology of this disparity is often attributed to inequitable access to healthcare and socioeconomic status (SES). However, other contributors have been reported. We set out to perform a systematic review to better understand the landscape of HNC racial disparity.

Methods: A systematic review was conducted in Covidence following PRISMA Guidelines. A search of PubMed, SCOPUS, and CINAHL for literature published through November 30, 2022 evaluating racial disparities in HNC identified 2309 publications. Full texts were screened by 2 authors independently, and inconsistencies were resolved by consensus. 340 publications were ultimately selected for analysis. Racial groups examined included NHB and NHW Americans, Hispanic/Latin Americans, Native Americans, and Asian/Pacific Islanders.

Results: Of the 340 articles, 192 focused on the theme of access and SES, including limited access to high quality hospitals, poor insurance coverage, and inadequate transportation. Additional themes contributing to racial disparities were identified in 148 articles. Disparities in HNC incidence due to race-informed differential silencing of tumor suppressor genes, incongruities in surgical recommendations, likelihood of refusal of recommended surgery, and likelihood of receiving any cancer-directed treatment were other identified themes. Higher rates of substance use and lower rates of HPV-associated malignancies were also identified as contributing to disparate HNC outcomes.

Conclusions: Differential access to care plays a significant role in racial disparities in HNC. However, additional themes driving racial disparities include biologic differences, recommendation for surgery, provider/patient bias, and lifestyle differences. Future studies should investigate how to provide equitable access to care, but also address these other sources of outcome disparities in HNC unrelated to access and SES.