Receipt of immunotherapy for head and neck cancer varies by race, cancer type
Key takeaways:
- White patients had increased odds of receiving immunotherapy vs. other races.
- Patients with advanced vs. localized disease more frequently received immunotherapy.
White patients and those with nonoropharyngeal cancer and advanced disease appeared more likely to receive immunotherapy for head and neck cancer squamous cell carcinoma, according to study results.
The findings, published in JAMA Otolaryngology — Head and Neck Surgery, indicated equitable access may reduce cancer-associated health disparities, researchers concluded.
Rationale and methodology
“The U.S. FDA approved [immunotherapy] for select cases of head and neck squamous cell carcinoma in 2016. However, it is unclear whether there are clinical or sociodemographic differences among patients receiving immunotherapy as part of their care,” Shreya P. Ramkumar, BS, medical student at Saint Louis University School of Medicine, and colleagues wrote. “Given the known disparities in head and neck cancer care, we hypothesized that there are differences in receipt of immunotherapy among patients with head and neck squamous cell carcinoma based on clinical and nonclinical characteristics.”
Immunotherapy has been around for a while, and immune checkpoint inhibitors for more than a decade, but it wasn’t until 2016 that the FDA approved the first immune checkpoint inhibitors for head and neck cancers, Nosayaba Osazuwa-Peters, PhD, BDS, MPH, CHES, member of Duke Cancer Institute and assistant professor in head and neck surgery at Duke University School of Medicine, told Healio.
“There has been evidence of the effectiveness of immunotherapy in head and neck cancer, however, immunotherapy is not clinically indicated across all cases of head and neck cancer, and among patients with recurrent or metastatic disease who may benefit, this treatment is only effective for a fraction of patients,” he said. “Additionally, head and neck care is highly disparate, and given the high cost of immunotherapies, it is important to examine whether there were differences in receipt of immunotherapy among this population of patients.”
Investigators conducted a retrospective cohort study to characterize clinical and nonclinical factors associated with receipt of immunotherapy among 4,860 patients aged 65 years and older (mean age, 74.4 ± 7.1 years; 73.9% men; 87% white) with head and neck squamous cell carcinoma.
“Knowing that access to cancer care in the U.S. is usually driven by health insurance status, we limited this initial study to individuals aged 65 years or older, who would all typically qualify for Medicare insurance,” Osazuwa-Peters said.
Researchers pooled electronic health record data from 37 U.S.-based centers that used the Navigating Cancer digital health product between January 2017 and April 2022. They used multivariable logistic regression to characterize clinical (tumor stage and anatomical subsite) and nonclinical (age, smoking history, race and ethnicity, sex and marital status) factors associated with receipt of immunotherapy.
Findings
Overall, 11.4% of patients received immunotherapy.
Results of the final model adjusted for covariates showed that white patients with head and neck squamous cell carcinoma had 80% increased odds for receiving immunotherapy (adjusted OR = 1.8; 95% CI, 1.3-2.48) compared with patients of other races.
“An important finding in this study from a health equity lens was that patients with head and neck cancer who are white appeared significantly more likely to receive immunotherapy treatment compared with patients who were racial minorities,” Osazuwa-Peters said.
Results additionally showed that patients with nonoropharyngeal disease appeared significantly more likely to receive immunotherapy compared with those with oropharyngeal cancer (adjusted OR = 1.29; 95% CI, 1.05-1.59), as did those with advanced-stage vs. local disease (adjusted OR = 2.39; 95% CI, 1.71-3.34).
Of note, researchers observed no statistically significant differences in the odds for receiving immunotherapy based on age, sex or smoking history.
Study limitations included a lack of data on patients’ comorbidity burden, a small data sample size and not analyzing variability in health insurance status, which may be independently associated with access to immunotherapy, mediate the association between race and receipt of immunotherapy, or both.
Implications
“An important implication of our study is health equity — high-quality cancer care is equitable cancer care,” Osazuwa-Peters told Healio. “If patients could benefit from a breakthrough cancer treatment, such as immunotherapy, it is critical that there is more equitable access to this treatment option across patient populations.”
Equitable access becomes even more critical given how expensive immunotherapy treatment is, he continued.
“We are currently working on several studies that will utilize larger national data to further validate these initial results, examine social determinants of health and health outcomes associated with immunotherapy use in head and neck cancer, and further deepen our knowledge of the epidemiology of immunotherapy use in [these] patients,” Osazuwa-Peters said.
For more information:
Nosayaba Osazuwa-Peters, PhD, BDS, MPH, CHES, can be reached at nosa.peters@duke.edu.
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Ramkumar SP, et al. JAMA Otolaryngol Head Neck Surg. 2023;doi:10.1001/jamaoto.2023.2420.