Cancer More Likely To Recur In Blacks Treated For Head And Neck Cancer
GAINESVILLE, Fla. — Black people treated for head and neck cancer have double the risk of cancer recurring elsewhere in the body and thus are far more likely to die within five years than white patients who received essentially the same treatment for the same type of malignancies, University of Florida researchers have found.
The discovery adds to a growing body of scientific discoveries that link race with outcomes for various cancers and draws attention to the need for better identification of patients most at risk and for customized therapies, said Dr. William M. Mendenhall, a professor of radiation oncology at UF’s College of Medicine and a member of the UF Shands Cancer Center. UF researchers reported their findings in the Dec. 1 issue of Cancer, the journal of the American Cancer Society.
In the United States, about 37,000 people are diagnosed as having head and neck cancer each year, a figure that represents about 3 percent of all cancer cases. The cancer is most common in people who use tobacco or are heavy drinkers, but it can occur in individuals who have no such risk factors.
“The cure rates are fairly high if you catch it early, so early diagnosis is important,” Mendenhall said. “Another issue is quality of life because of the location of the cancer itself and the treatment of the cancer. If you don’t control this type of cancer it is typically associated with significant detrimental effects on quality of life: It affects your ability to eat, to communicate, to go out in public. It’s not a real common cancer, but it has a major impact on the people who wind up getting it.”
Initially, Mendenhall said he didn’t expect to see any differences in long-term survival in black versus white patients, because the nearly 700 patients whose medical records UF scientists studied all had tumors that were of similar size and aggressiveness. In addition, all patients received identical treatment: twice-daily radiation therapy for six-and-a-half weeks at Shands at UF medical center, and surgery when needed. About 8 percent were black.
Researchers tracked patients for up to seven years and found that cancer was indeed more likely to resurface in black people, and it usually did so in distant parts of the body, such as the lung, bone or liver.
“I really didn’t think that if you looked at patients with similar stage tumors who were treated the same way that there would be a difference in outcome,” Mendenhall said. “But all received the exact same treatment and we accounted for confounding variables, like perhaps minority patients might be of lower socioeconomic status and therefore have less access to health care or be less likely to complete treatment or even get the treatment considered to be optimal. I fully expected to see no difference in outcomes. Lo and behold, when we looked there turned out to be a difference. It’s not really clear exactly why.
“The reason it’s important is it tells us we need to do something to modify treatment for those patients to try to reduce their risk of having distant metastasis,” he added. “Because if you develop a distant metastasis, the odds are almost 100 percent you’re going to die from the cancer. So it’s important to try to reduce that risk.”
Other studies have shown that adding chemotherapy to the treatment regimen may help reduce the risk of distant metastases, but additional research will have to be conducted to confirm its effectiveness in blacks, Mendenhall said.
Researchers also will aim to carefully look at the site and extent of the initial tumor to see whether those factors are linked with the ability to successfully treat cancer recurrence, he said.
“The recurrences we’re seeing in blacks versus whites tend to be distant recurrences,” Mendenhall said. “So the chances of salvaging them from distant metastases is very, very low. Really what we would want to do is modify treatments on the front end rather than keep a closer eye on them afterward.”
UF scientists conceded that a drawback of the study was their inability to access reliable information related to study participants’ lifestyles, including tobacco and alcohol use. Similarly, they did not account for potentially important differences in patients’ health before treatment was begun.
Even so, “our data underscore practical implications that are worth consideration,” the authors wrote in the journal.
Mendenhall emphasized the study calls attention to the importance of evaluating ethnic and racial influences on disease and prognosis, and he recalled the recent defeat of Proposition 54 in California, which sought to remove references to race in medical records and on a variety of state forms.
“From the medical standpoint, it’s important not to eliminate that information because there may be groups of people, sometimes ethnic groups or racial groups, where the outcome of treatment might be different for that group of patients,” he said. “If you can’t take a look at outcomes and account for race, which you could not do if it was removed from medical records, you wouldn’t know that and you’d lose the opportunity to optimize treatment for these patients.”
Government funding for follow-up studies is crucial to better define and to determine the causes of differences in survival after treatment for head and neck cancer, said Dr. Randal S. Weber, chairman of the department of head and neck surgery at the University of Texas M.D. Anderson Cancer Center.
“This study points out the importance of considering racial differences when evaluating the effectiveness of cancer treatment,” Weber said. “We have known for some time that African-American males with other types of cancers do not do as well as Caucasian males with similar types and stage of cancer. Many factors, such as more advanced cancer stage at presentation and diminished cancer immunity in these patients, may be responsible and will require further study. Dr. Mendenhall’s study may help identify patients at higher risk for cancer spread who may benefit from more intensive therapy.”