2018 ASCO Annual Meeting!
Session: Head and Neck Cancer
Type: Oral Abstract Session
Time: Sunday June 3, 8:00 AM to 11:00 AM
Are women with head and neck cancer undertreated?
Head and Neck Cancer
2018 ASCO Annual Meeting
J Clin Oncol 36, 2018 (suppl; abstr LBA6002)
Author(s): Annie Park, Amy Albaster, Hanjie Shen, Loren K. Mell, Jed Abraham Katzel; Kaiser Permanente, Santa Clara, CA; Kaiser Permanente Division of Research, Oakland, CA; UCSD, La Jolla, CA; University of California San Diego Moores Cancer Center, La Jolla, CA
Background: Generalized competing event (GCE) models have been used to stratify patients with cancer according to their relative hazard for cancer death versus death from other causes. We evaluated outcomes for head and neck cancer (HNC) patients treated at Kaiser Permanente Northern California (KPNC) based on demographic data and comorbidities using a GCE model. Methods: We identified 884 HNC patients diagnosed 2000-2015 from the KPNC cancer registry, age 18-85 and stage II-IVB by AJCC 7th edition. Using the GCE proportional relative hazards model, controlling for age, sex, tumor site, and Charlson comorbidity index (CCI), we identified associations between these factors and the relative hazard for HNC-specific mortality (ω+ ratio, ‘gcerisk’ package in R). Death, disenrollment, and end of study (12/31/2016) were used as censoring events. Logistic regression models estimated the odds of receiving intensive treatment (platinum based regimen), adjusting for the same covariates plus stage, smoking, and alcohol abuse history. Results: With a median follow-up of 2.9 years, 271 patients died of cancer, and 93 of non-cancer causes. Compared to male, females were less likely to receive intensive chemotherapy (35% vs. 46%, p = 0.006) and radiation (60% vs. 70%, p = 0.008). On GCE analysis, female patients had an increased relative hazard ratio (RHR) for death from HNC vs. other causes (adjusted RHR 1.92; 95% CI 1.07-3.43), indicating they may be relatively undertreated. Conclusions: Female patients in our cohort may be undertreated in clinical practice, potentially missing the opportunity to aggressively treat their HNC. This study supports the use of a GCE methodology to objectively identify patients more likely to benefit from treatment intensification. These findings may help guide future research in health disparities.
|Covariate||Adjusted RHR (ω+ ratio) for cancer vs. non-cancer |
mortality (95% CI)
chemotherapy OR (95% CI)
OR (95% CI)
OR (95% CI)
|Female||1.92 (1.07-3.43)||0.68 (0.48, 0.98)||0.79 (0.56, 1.11)||1.04 (0.72, 1.53)|
|CCI > = 1||0.75 (0.46-1.24)||0.78 (0.68-0.89)||0.96 (0.86-1.07)||1.02 (0.91-1.15)|
|Age (per 10 years)||0.78 (0.62-0.99)||0.88 (0.75-1.02)||0.90 (0.77-1.05)||0.70 (0.59-0.82)|
1. Multicenter phase II trial of palbociclib, a selective cyclin dependent kinase (CDK) 4/6 inhibitor, and cetuximab in platinum-resistant HPV unrelated (-) recurrent/metastatic head and neck squamous cell carcinoma (RM HNSCC).