Smoking status after a cancer diagnosis and long-term survival among newly diagnosed head and neck cancer patients
Seung Hee Choi
Michigan State University College of Nursing, USA
: J Clin Exp Oncol
Cancer disparities are endemic in the United States healthcare system and in many other industrialized nations, albeit previous studies have limitations of retrospective nature, inability to control for confounding variables, and failure to explore root causes of the disparities. To examine disparities as predictors of survival, longitudinal data were collected from newly diagnosed head and neck cancer patients (N=634). The independent variables were median household income, education, race, age, sex, and marital status. The outcome variables were overall, cancer-specific, and disease-free survival censored at 5 years. Kaplan-Meier curves and univariate and multivariate Cox proportional hazards models were performed to examine demographic disparities in relation to survival. Five-year overall, cancer-specific, and disease-free survival were 65.9% (418/634), 76.8% (487/634), and 67.4% (427/634), respectively. Lower income (HR, 1.4; 95% CI, 1.0â1.9), high school education or less (HR, 1.4; 95% CI, 1.0â1.8), and older age in decades (HR, 1.4; 95% CI, 1.2â1.6) were significant independent predictors of poor overall survival. A high school education or less (HR, 1.5; 95% CI, 1.0â2.0 for cancer-specific survival; HR, 1.5; 95% CI, 1.1â2.0 for disease-free survival) and advanced age (HR, 1.3; 95% CI, 1.1â1.6 for cancer-specific survival; HR, 1.3; 95% CI, 1.1â1.5 for disease-free survival) decreased both cancer-specific and disease-free survival rates. Low income, low education, and advanced age significantly predicted poor survival even though there was fairly equal access to care. Recommendations from the Institute of Medicineâs Report to reduce disparities need to be implemented in treating head and neck cancer patients.