Survival differences among American Indians/Alaska Natives with head and neck squamous cell carcinoma

BACKGROUND: American Indians/Alaska Natives experience poor overall survival. Data are limited on American Indians/Alaska Natives with head and neck squamous cell carcinoma (HNSCC). METHODS: We identified all cases of HNSCC among American Indians/Alaska Natives, and white patients from 1996 to 2007 using the Surveillance, Epidemiology, and End Results (SEER) database. Univariate, multivariate, and Cox models were fit to analyze racial differences in sex, age, stage, treatment, and survival. RESULTS: American Indians/Alaska Natives experienced decreased survival for oropharyngeal cancer (hazard ratio [HR] = 1.4; p = .008). After adjusting for demographic factors, survival was decreased for oral cavity cancer (HR = 1.3; p = .05) and hypopharyngeal/laryngeal cancer (HR = 1.6; p = .04). These disparities were eliminated after adjusting for treatment for oral cavity cancer (HR = 1.2; p = .17) and stage for hypopharyngeal/laryngeal cancer (HR = 1.4; p = .12). American Indians/Alaska Natives received less surgery for oral cavity cancer (78% vs 85%; p = .02). CONCLUSION: Disparities in survival exist among American Indians/Alaska Natives patients with HNSCC. They are related to stage and differential treatment patterns.