New study reveals racial disparities in voice box-preserving cancer treatment
A new epidemiological study led by UC Davis researchers reveals significant racial disparities in the use of non-surgical larynx-preservation therapy for locally advanced laryngeal cancer.
A review of medical records between 1991 and 2008 from across the country reveals that over 80 percent of white patients received radiation treatment combined with chemotherapy that preserves the larynx, or voice box. Only 74.5 percent of African American patients received this same treatment, with the remainder undergoing surgery that removed the larynx altogether, a procedure that has a dramatic effect on quality of life.
Just published online in the American Medical Association's Archives of Otolaryngology - Head and Neck Surgery, the paper analyzes treatment trends among 5,385 white, black, Latino and Asian patients with stage III and IV laryngeal cancers. Records were culled from the National Cancer Institute's (NCI) Surveillance Epidemiology and End Results program, which collects information on cancer incidence, prevalence and survival from specific geographic areas representing 28 percent of the U.S. population.
"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," says lead author Allen Chen, an assistant professor in the UC Davis Department of Radiation Oncology.
Non-surgical therapy using radiation therapy with concurrent chemotherapy confers a high rate of voice conservation without adversely affecting survival for selected patients diagnosed with locally advanced cancers of the larynx.
Before larynx-preserving treatment gained widespread acceptance in recent decades, the standard of care for essentially all patients with locally advanced laryngeal cancer was initial surgical removal of the larynx, called a total laryngectomy. These patients suffer from more respiratory complications, pain and depression than patients with an intact larynx. They often develop chronic shoulder pain and sleep disturbances, and they experience worse social functioning and isolation as a result of speech impairment and body disfigurement.
While researchers observed a marked disparity between the study's white and black populations, differences were less pronounced for the Latino and Asian groups, with 78 percent of Latinos and 75.6 percent of Asians receiving larynx-preserving treatment. The observed gap between whites and blacks may also be narrowing, as the use of larynx-preservation is increasing among black patients over time.
"Further studies are needed to elicit the root causes of the current treatment disparities between whites and blacks, but it seems likely that critical factors include income, education and insurance differences, along with a lack of access to appropriate radiation facilities," says Chen, who also serves as the UC Davis Department of Radiation Oncology's residency training program director.
Chen points out that the best treatment facilities can be found at the nation's 41 NCI-designated comprehensive cancer centers, as these institutions feature not only the latest technologies but also in-depth counseling and therapy both for medical decision-making and post-treatment management.
"Larynx preservation requires close coordination of care involving multiple specialists, including radiation oncologists, medical oncologists, otolaryngologists, speech pathologists, swallowing therapists, dentists and nutritionists, among many others," he said. "Having all of these services available in centers such as the UC Davis Comprehensive Cancer Center makes treatment a lot more feasible for patients."
Other authors were Wei-Hsien Hou and Megan E. Daly of the UC Davis Department of Radiation; Nancy Y. Lee of the Department of Radiation Oncology at the Memorial Sloan-Kettering Cancer Center, New York; and D. Gregory Farwell and Quang Luu of the UC Davis Department of Otolaryngology, Head and Neck Surgery.
UC Davis Comprehensive Cancer Center is the only National Cancer Institute-designated center serving the Central Valley and inland Northern California, a region of more than 6 million people. Its specialists provide compassionate, comprehensive care for more than 9,000 adults and children every year, and access to more than 150 clinical trials at any given time. Its innovative research program engages more than 280 scientists at UC Davis, Lawrence Livermore National Laboratory and Jackson Laboratory (JAX West), whose scientific partnerships advance discovery of new tools to diagnose and treat cancer. Through the Cancer Care Network, UC Davis collaborates with a number of hospitals and clinical centers throughout the Central Valley and Northern California regions to offer the latest cancer care. Its community-based outreach and education programs address disparities in cancer outcomes across diverse populations. For more information, visit cancer.ucdavis.edu.