Persistent disparities in head and neck cancer survival in the United States

PURPOSE: Head and neck cancer (HNC) is a heterogenous disease with substantial mortality. This study assesses the long-term epidemiologic landscape, demographic disparities, and survival outcomes of HNC. METHODS: Adult patients with primary HNC were identified in the Surveillance, Epidemiology, and End Results (SEER) database by International Classification of Diseases for Oncology (ICD-O) codes. The primary outcomes of this study were overall survival (OS) and cancer-specific survival (CSS). Secondary outcomes included primary tumor site distributions and rates of surgery by race and ethnicity. Multivariable Cox regression modeling was utilized to determine predictors of all-cause and HNC-specific mortality. RESULTS: In this cohort of 117,893 head and neck cancer patients, significant racial and ethnic disparities were observed in tumor site, treatment, and outcomes. Black patients were less likely to receive surgery even when accounting for tumor subsite and stage (OR 0.672, 95% CI 0.641-0.705). Five-year overall survival (OS) and cause-specific survival (CSS) were lower in all minority groups (p < 0.001), with Black patients showing the lowest OS (31.3%) and CSS (58.8%). Multivariable analysis confirmed race/ethnicity, low income (HR 1.043, 95% CI 1.018-1.068), and unmarried status (HR 1.327, 95% CI 1.305-1.350) as independent predictors of increased all-cause and HNC-specific mortality. CONCLUSION: In this most comprehensive and up-to-date analysis of HNC, we demonstrate profound racial and ethnic disparities in tumor sites, treatments, and survival. This study provides critical evidence to guide health policy, resource allocation, and clinical practice aimed at closing longstanding equity gaps in head and neck cancer care.