Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
MO_34_2793 - Disparities in Follow-Up Care After Definitive Treatment for Head and Neck Cancer in an Ethnically Diverse Population
Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3
Disparities in Follow-Up Care After Definitive Treatment for Head and Neck Cancer in an Ethnically Diverse Population
H. Perlow1, S. J. Ramey2, V. Cassidy1, D. Kwon3, E. Nicolli4, R. Yechieli5, and S. Samuels5; 1University of Miami Miller School of Medicine, Miami, FL, 2University of Miami; Jackson Health System, Miami, FL, 3Department of Statistics, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, 4Department of Otolaryngology, University of Miami / Sylvester Comprehensive Cancer Center, Miami, FL, 5Department of Radiation Oncology, University of Miami / Sylvester Comprehensive Cancer Center, Miami, FL
Purpose/Objective(s): National guidelines dictate consensus follow-up (F/U) recommendations after the definitive treatment of head and neck cancer. NCCN recommendations include, but are not limited to, a history and physical within 3 months of treatment conclusion, repeat baseline imaging of the primary, and a TSH test every 6-12 months. Utilization of follow up care has not been previously studied in head and neck cancer; therefore, potential F/U disparities are unknown. This study addresses whether treatment location, Spanish language preference, or Hispanic ethnicity have an impact on utilization of F/U care in a ethnically diverse population.
Materials/Methods: This retrospective study included patients with a biopsy proven diagnosis of non-metastatic oropharyngeal or laryngeal cancer treated with radiotherapy (RT) between January 1, 2014 and June 30, 2016 at a safety-net hospital (SNH) or adjacent private academic hospital (PAH). Variables analyzed included treatment location, language preference, race, ethnicity, socioeconomic status, cancer type, comorbidity, stage, and treatment modality. Components of F/U care analyzed were documentation of any radiation oncologist (RO) visit, ENT visit, imaging of the primary site, or TSH test after the completion of curative radiotherapy. Univariable (UVA) and multivariable (MVA) analyses were conducted to estimate odds ratios, corresponding 95% confidence intervals, and p-values using a logistic regression model.
Results: 234 patients were eligible for inclusion in this study. 182 patients were treated at the PAH, and 52 patients were treated at the SNH. 41.9% of patients identified as Hispanic, 12.0% as non-Hispanic black, and 43.6% as non-Hispanic white (NHW). 85.4% of patients attended a follow up ENT appointment, 90.9% attended a follow up RO appointment, 84.2% of patients received post treatment imaging of the primary site, and 56.8% of patients received a TSH test after treatment. On MVA, PAH treatment vs. SNH treatment (OR 3.32, p = 0.01) and surgery + concurrent chemoradiation (CRT) vs. RT alone (OR 15.38, p = 0.04) were associated with increased likelihood of ENT F/U; oropharyngeal cancer vs. laryngeal cancer (OR 0.34, p = 0.04) was associated with decreased likelihood of ENT F/U. PAH treatment (OR 5.47, p = 0.01) was associated with increased likelihood of RO follow up. Oropharyngeal cancer (OR 4.96, p = 0.01) was associated with increased likelihood of follow up imaging; Hispanic vs. NHW ethnicity (OR 0.27, p = 0.05) was associated with decreased likelihood of follow up imaging. PAH treatment (OR 4.28, p < 0.01) and CRT (OR 5.19, p = 0.01), surgery + RT (OR 3.83, p = 0.05), and surgery plus CRT (OR 4.75, p = 0.02) vs. RT alone were all associated with increased likelihood of TSH testing.
Conclusion: F/U services are not equally utilized when comparing a private and safety-net hospital. Hispanic ethnicity, cancer type, and treatment modality also have an impact on F/U services. Quality metrics may be necessary to target and reduce these disparities.
Author Disclosure: H. Perlow: None. S.J. Ramey: Travel Expenses; Intellisphere. V. Cassidy: None. D. Kwon: None. R. Yechieli: None.