title: Racial parities in outcomes after radiotherapy for head and neck cancer.
abstract: BACKGROUND
  Although black patients experience worse outcomes after treatment for squamous cell carcinoma of the head and neck (HNSCC), these conclusions were based on populations in which blacks comprised a minority of patients. The objective of the current study was to determine the impact of race on outcomes in patients with HNSCC who received radiotherapy at an institution in which blacks comprised the majority of patients.
  
  
  METHODS
  In this retrospective cohort study, the authors reviewed 366 black patients and 236 white patients who had nonmetastatic HNSCC for which they received radiotherapy between 1990 and 2012. The primary study outcome measures were locoregional control, freedom from distant metastasis, progression-free survival, and overall survival.
  
  
  RESULTS
  The median follow-up was 18.3 months for all patients. The 2-year locoregional control rate was 71.9% for black patients compared with 64.2% for white patients (hazard ratio, 0.72; P=.03). There was no difference between blacks and whites regarding 2-year freedom from distant metastasis, progression-free survival, or overall survival. Among the patients who had stage III through IVB disease, blacks and whites had similar outcomes. On multivariate analysis, race was not statistically significant for locoregional control, freedom from distant metastasis, progression-free survival, or overall survival. Despite these similar outcomes, black patients had worse socioeconomic factors and increased comorbidities but had similar treatment compliance compared with white patients.
  
  
  CONCLUSIONS
  With more adverse prognostic factors, black patients experienced oncologic outcomes similar to the outcomes of white patients after receiving radiotherapy for HNSCC. The current data suggest that centers that treat large percentages of minority patients who receive radiotherapy for HNSCCs may overcome existing health care disparities through improved treatment compliance.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Gene-Fu F
authors.initials: GF
authors.lastname: Liu
authors.forename: Mark C
authors.initials: MC
authors.lastname: Ranck
authors.forename: Abhishek A
authors.initials: AA
authors.lastname: Solanki
authors.forename: Hongyuan
authors.initials: H
authors.lastname: Cao
authors.forename: Antonia
authors.initials: A
authors.lastname: Kolokythas
authors.forename: Barry L
authors.initials: BL
authors.lastname: Wenig
authors.forename: Lucy
authors.initials: L
authors.lastname: Chen
authors.forename: Stephanie
authors.initials: S
authors.lastname: Ard
authors.forename: Ralph R
authors.initials: RR
authors.lastname: Weichselbaum
authors.forename: Howard
authors.initials: H
authors.lastname: Halpern
authors.forename: Michael T
authors.initials: MT
authors.lastname: Spiotto
mesh_terms: D001741:Black or African American; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003872:Dermatitis / Q000209:etiology; D018572:Disease-Free Survival; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011878:Radiotherapy / Q000009:adverse effects; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome; D044465:White People
keywords: head and neck neoplasms; minority groups; minority health; outcomes assessment; radiotherapy