Male Head and Neck Cancer Patients Who Live Alone Exhibit a Poor Outcome

Website: http://www.sic2004.org/

Newswise — Researchers have found that being without a significant other and making less than $25,000 per year affects survival and treatment outcome for men with advanced head and neck cancer. Marital/cohabitation status has no impact on female patients.

Men are nearly twice as likely as women to suffer from head and neck cancer, a disease that is often detected in late stages when prognosis is poor. Cohabitation status and low income have been found to be prognostic factors in other cancers and diseases. However, cohabitation status and gender are frequently examined as independent prognostic factors, rather than in interaction, despite evidence that the benefits of having a significant other may be different for men versus women. Identifying prognostic factors and their impact on various disease states can lead to improved treatment outcomes and survival.

Researchers analyzed demographic and treatment data from patient subgroups of three different head and neck clinical trials to test their hypothesis that non-cancer related factors influence local control and survival of patients treated for locally advanced head and neck cancer. The results of "Socio-Demographic Variables And Outcome In Radiation Therapy Oncology Group (RTOG) Head And Neck Trials: The Disadvantage Of Men Living Alone" will be presented by authors, Andre A. Konski, MD MBA, MA, Benjamin Movsas, MD, and Deborah Watkins-Bruner, PhD, of Fox Chase Cancer Center, Philadelphia, Tom Pajak, PhD, of the Radiation Therapy Oncology Group, Philadelphia, James Coyne, PhD, University of Pennsylvania, Philadelphia, Jonathan Harris, MS, of the Radiation Therapy Oncology Group, Philadelphia, Clement Gwede, MD, of H. Lee Moffitt Cancer Center, Tampa, Adam S. Garden, MD, U.T. M.D. Anderson Cancer Center, Houston, Sharon Spencer, MD, University of Alabama-Birmingham, and Christopher Jones, MD, Radiological Associates of Sacramento, at the 6th International Conference on Head and Neck Cancer (http://www.sic2004.org) being held August 7-11, 2004, at the Wardman Park Marriott, in Washington, D.C.

Methodology: This analysis included 1,822 patients (79 percent male) with locally advanced head and cancer treated in Radiation Therapy Oncology Group (RTOG) clinical trials 9003 (59 percent of total patients), 9111 (28 percent of total patients) and 9703 (13 percent of total patients) who provided follow-up information. Eligibility criteria for each clinical trial differed, but included patients with primary cancer of the oral cavity, oropharynx, hypopharynx, and larynx. Each patient was asked to complete the same socio-demographic data collection form.

Overall survival and local-regional control were both measured and compared to socio-demographic data. Local-regional control rates (LR) were estimated using the cumulative incidence method, which accounts for the competing risk of death without local-regional failure; univariate comparisons were performed with Gray's test. Overall survival (OS) rates were estimated using the Kaplan-Meier method; univariate comparisons were analyzed using the log-rank test. The multivariate Cox proportional hazards model was used to determine if any socio-demographic variables had prognostic impact on survival and local regional control after accounting for tumor related variables.

Results: The results indicate that socioeconomic status was associated with greater survival. Specifically, patients with income levels above $25,000 had improved survival compared to patients with income levels below $25,000.

Gender and cohabitation status affected all three outcome variables: survival, local regional control, and treatment delay, indicating that men who were not married or living with a partner had a consistent and striking disadvantage in outcome. The disadvantage of these unpartnered men was noted from the outset in terms of presenting with a more advanced stage cancer and lower KPS (Karnofsky Performance Score, a standard way of measuring the ability of cancer patients to perform ordinary tasks). However, additional deleterious effects on survival, local regional control, and treatment delay were observed even after controlling for the later stage at presentation and KPS. It is important to note that patients participating in a clinical trial receive standardized treatment and increased medical attention, which could possibly decrease the deleterious effects seen in these results. Thus, effects on survival and local regional control of unpartnered men under routine medical care could be more ominous than the results of this study.

Conclusions: This study indicates a clear and consistent disadvantage in overall treatment outcome for male head and neck cancer patients who are unmarried and do not have a live-in partner. In addition, it shows that head and neck cancer patients with higher income levels fare better. The researchers suggest that the latter may be due to better baseline health which allows patients to tolerate the rigors of head and neck cancer treatment or the ability to afford greater supportive care.

The results of this study provide information for the development of interventions in the treatment of patients with locally advanced head and neck cancer. The authors suggest that additional studies comparing marital status and gender interactions with outcomes is warranted in other disease sites.