1. Goodwin, Peter M.

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CHICAGO-Women and men were treated differently for the same tumor stages of head and neck cancer (HNC) and had different outcomes in a study with patients surveyed over a 15-year period in Santa Clara, Calif. The findings-using the generalized competing event (GCE) assessment model that balanced the risk of cancer death against non-cancer death-has prompted a call to reassess the influence of gender on treatment decision-making.

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Study author Jed A. Katzel MD, a medical oncologist with Kaiser Permanente in Santa Clara, reported the new data from GCE modeling at the 2018 ASCO Annual Meeting (Abstract LBA6002).


Risk Doubled

"Women were nearly twice as likely to die from head and neck cancer than from other causes," Katzel said. "This GCE analysis allowed us to compare the hazard ratio for cancer death over non-cancer death. This led us to hypothesize that women could be undertreated. But we acknowledge that it's going to take further evaluation to fully answer the question."


Commenting on the findings ASCO Expert Joshua A. Jones, MD, MA, a radiation oncologist at the Perelman School of Medicine at University of Pennsylvania in Philadelphia said: "We don't know why women are getting less treatment and having worse outcomes and we need to find out. Though these findings are specific to California, the disparities we see are startling and worth considering in treatment discussions in everyday practice."


The researchers analyzed data from 884 patients ages 18-85 years diagnosed with HNC who had tumors ranging from stage II to stage IVB. Logistic regression models were used to estimate the odds of receiving intensive (platinum-based) treatment. After a median follow-up of 2.9 years, 271 patients had died of cancer and 93 from non-cancer causes.


Key Finding

"We took into account a number of different demographic factors-like age, smoking history, alcohol abuse, co-morbidity-as well as tumor location-and we found that for different treatment types women were less likely than men to receive intensive chemotherapy and radiation therapy-a difference that was statistically significant," said Katzel.


Thirty-five percent of females received intensive chemotherapy compared with 46 percent of male patients. Women were also less likely to be treated with radiation (60% compared with 70%).


GCE analysis found that for female patients the increased relative hazard ratio for death from HNC as compared with other causes was 1.92.


Katzel said the study database gave the researchers access to a large amount of demographic data that made it possible to make statistically significant assessments of the differences between women and men.


Treatment Choices

"We'll need further analysis to fully understand why some patients may elect to have or decline aggressive and potentially burdensome treatments," he said.


While the data required confirmation, Katzel said clinicians should consider using the GCE model for assessing outcomes in other clinical situations. "One clinical implication is showing the utility of this GCE model [that] can identify populations that are potentially overtreated or undertreated in clinical practice."


Oropharynx Cancer

The study found differences in terms of tumor location between men and women that could also had implications. "There was a difference in the primary tumor location and in particular oropharynx cancer. The rate in women was only 38 percent while the rate in men was 55 percent. And this was statistically significant."


He said this was important because HPV-related HNC most commonly occurred in the oropharynx. "And we know that HPV-related head and neck cancer has a better response to therapy and better overall survival."


The study concluded that, since female patients in this California cohort may have been undertreated in clinical practice, there had potentially been missed opportunities to aggressively treat them which could have improved outcomes. The researchers stated: "This study supports the use of a GCE methodology to objectively identify patients more likely to benefit from treatment intensification. These findings may help guide future research in health disparities."


Peter M. Goodwin is a contributing writer.


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