title: Impact of race/ethnicity on laryngeal cancer in patients treated at a Veterans Affairs Medical Center.
abstract: OBJECTIVE
  Black patients generally present with advanced head and neck cancer resulting in decreased survival. The objective of this study was to determine whether equal access to laryngeal cancer care in a tertiary care Veterans Affairs (VA) Medical Center would result in similar survival for white and black patients.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Patient and tumor characteristics, compliance with National Comprehensive Cancer Network (NCCN) guidelines, and survival outcomes were collected for 205 male patients with squamous cell carcinoma of the larynx treated between 2000 and 2012 at the Michael E. DeBakey Veterans Affairs Medical Center.
  
  
  RESULTS
  Black patients constituted 33% of the entire cohort, were older (mean age, 65.1 vs. 62.1 years), and consumed less tobacco (46.6 vs. 65.8 mean pack-years) than white patients. Disease stage and compliance with NCCN guidelines were not affected by race. Mean follow up time was 3.6 years. A higher recurrence rate was noted among white patients (24% vs. 15%, P < .05). Neither disease-free survival (DFS) nor overall survival (OS) was significantly different between black and white patients (DFS 69% vs. 68%, P = .7; OS 68% vs. 77%, P = .1).
  
  
  CONCLUSIONS
  Utilization of a multidisciplinary approach to laryngeal cancer care at the VA medical center allows for high compliance with NCCN guidelines and excellent oncologic outcomes. Ethnicity did not impact stage at presentation, treatment selection, or treatment intensity in this patient cohort. Our data suggest that cancer care at a VA medical center results in clinical outcomes that do not significantly vary based on patient race.
authors.affiliation: Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Vlad C
authors.initials: VC
authors.lastname: Sandulache
authors.forename: Mark W
authors.initials: MW
authors.lastname: Kubik
authors.forename: Heath D
authors.initials: HD
authors.lastname: Skinner
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Malsky
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Gelbard
authors.forename: Jose P
authors.initials: JP
authors.lastname: Zevallos
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000208:ethnology* / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005006:Ethnicity; D006787:Hospitals, Veterans; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D007825:Laryngectomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000208:ethnology / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D044469:Racial Groups; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Race; larynx; outcomes; survival; veteran