Disparity by sex may exist for head and neck cancer treatment, outcomes in USA
medwireNews: Women with head and neck cancer may be undertreated relative to their male counterparts, suggests research presented at the ASCO Annual Meeting 2018.
Using data for 223 women and 661 men with stage II–IVB disease who received treatment at Kaiser Permanente Northern California in Santa Clara, USA, the investigators found that the rates of intensive chemotherapy and radiotherapy were significantly lower among the female than male patients, at 35% versus 46% and 60% versus 70%, respectively.
Furthermore, a mathematical tool – termed the generalized competing event (GCE) model – that adjusts for factors such as age, sex, and comorbidities, showed that both women and men were more likely to die from head and neck cancer than from other causes. But women had a relative hazard ratio for head and neck cancer-specific mortality that was 1.92 higher than that for men.
Taken together, these findings suggest that “[f]emale patients in our cohort may be undertreated in clinical practice, potentially missing the opportunity to aggressively treat their [head and neck cancer],” say the researchers.
However, study author Jed Katzel, from Kaiser Permanente Northern California, told the press in Chicago, Illinois, USA, that although the GCE model adjusts for various parameters, potential confounders remain. For instance, a smaller proportion of women than men had oropharyngeal cancers (38 vs 55%) – these are often associated with human papillomavirus (HPV) positivity, which in turn is generally associated with better prognosis and outcomes.
He added: “Besides undertreatment, there are a number of factors that could contribute to the differences in outcomes between women and men with head and neck cancer, and it’s clear we need further investigation.”
As the next step Katzel and authors plan to undertake a chart review to further analyze these differences.
Speaking to medwireNews, ASCO Expert Joshua Jones (Hospital of the University of Pennsylvania, Philadelphia, USA) explained that the goal of the study was not to assess for disparities in care, instead the GCE model was employed to identify patients most likely to benefit from intensive treatments. This finding – of the significant differences in the treatments received by men compared with women – was “unexpected,” which is part of the reason why this study is so interesting, he said.
Jones noted that the reasons for the differences are not yet clear, but he speculated that it could be related to HPV status or perhaps to patient preferences that were not captured in the analysis. These are very intensive treatments, which may not be for everyone, Jones commented.
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