Poor Survival for American Indians with Head and Neck Squamous Cell Carcinoma.
To examine patient characteristics, treatment modalities, and human papillomavirus (HPV) prevalence to identify potential mediators of disparities that may lead to differences in outcomes for American Indians with head and neck squamous cell carcinoma (HNSCC).



Historical cohort study.



Community cancer centers.



We reviewed all patients older than 18 years with a new diagnosis of HNSCC in South Dakota from 1999 to 2009. We assessed tissue samples from cases of oropharyngeal cancer for the presence of HPV DNA.



In total, 474 white patients were compared with 32 American Indians. American Indians experienced significantly worse survival compared with whites (hazard ratio [HR], 0.59; P = .05), even after controlling for other factors such as age, sex, distance, Charlson comorbidity index, alcohol abuse, smoking, insurance, and disease stage. American Indians had a greater risk of alcohol abuse (68% vs 42%; P = .008), current smoking (67% vs 49%; P = .03), living more than 1 hour from a cancer center (81% vs 30%; P < .001), lacking private insurance (24% vs 68%; P < .001), and late-stage disease presentation (stages III and IV) (74% vs 55%; P = .04). There were no detected differences in age, sex, medical comorbidities, tumor site, tumor grade, HPV status, time to treatment, or type of treatment received.



American Indians in South Dakota with HNSCC have poorer survival compared with white patients. Once presented to a cancer center, American Indians received nearly identical treatment to white patients. Disparities in outcomes arise primarily due to sociodemographic factors and later stage at presentation.
Department of Otolaryngology Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA sunshine_dwojak@meei.harvard.edu.
Sunshine M
SM
Dwojak
Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
Dianne M
DM
Finkelstein
Department of Otolaryngology Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA.
Kevin S
KS
Emerick
Sanford Cancer Research Center, Sioux Falls, South Dakota, USA.
John H
JH
Lee
Rapid City Regional Hospital, John T. Vucurevich Cancer Care Institute, Rapid City, South Dakota, USA.
Daniel G
DG
Petereit
Department of Otolaryngology Massachusetts Eye and Ear Infirmary, and Harvard Medical School, Boston, Massachusetts, USA.
Daniel G
DG
Deschler
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000473:pathology; D012307:Risk Factors; D012959:Socioeconomic Factors; D013023:South Dakota / Q000453:epidemiology; D016019:Survival Analysis
American Indians; disparities; head and neck cancer; human papillomavirus