PMID- 31090932
STAT- Publisher
LR  - 20190515
IS  - 1097-0142 (Electronic)
IS  - 0008-543X (Linking)
DP  - 2019 May 15
TI  - Undertreatment of women with locoregionally advanced head and neck cancer.
LID - 10.1002/cncr.32187 [doi]
AB  - BACKGROUND: It is difficult to predict whether a patient with head and neck
      cancer (HNC) is more likely to die of the cancer or another comorbidity.
      Competing event models can help to identify individual patients or groups of
      patients who may be undertreated or overtreated in clinical practice. METHODS:
      Patients with HNC (n = 884), aged 18 to 85 years and diagnosed from 2000 to 2015 
      with stage II to IVB disease according to the seventh edition of the American
      Joint Committee on Cancer system, were identified. With a generalized competing
      event (GCE) model that controlled for age, sex, tumor site, surgical treatment,
      and Charlson Comorbidity Index (CCI), the association between these factors and
      the relative hazard for cancer mortality was determined. Logistic regression
      models were used to estimate the odds of receiving platinum-based
      chemoradiotherapy or a less intensive therapy, with adjustments made for age,
      sex, tumor site, CCI, stage, smoking, and alcohol abuse history. RESULTS:
      Compared with men, women had an increased relative hazard ratio for death from
      HNC versus other causes, which was reported as an adjusted omega(+) ratio
      comparing women with men (omega(+) ratio, 1.95; 95% CI, 1.09-3.49), even though
      they were less likely to receive intensive chemoradiotherapy than men (adjusted
      odds ratio, 0.69; 95% CI, 0.48-0.99). CONCLUSIONS: These findings indicate that
      women in this cohort may be undertreated in clinical practice and potentially
      miss the opportunity for their HNC to be aggressively treated. This study
      supports the use of GCE models to identify patients who are potentially
      undertreated and may also help to guide future research in health disparities.
CI  - (c) 2019 American Cancer Society.
FAU - Park, Annie
AU  - Park A
AD  - Department of Internal Medicine, Scripps Mercy, San Diego, California.
FAU - Alabaster, Amy
AU  - Alabaster A
AD  - Division of Research, Kaiser Permanente, Oakland, California.
FAU - Shen, Hanjie
AU  - Shen H
AD  - Center for Precision Radiation Medicine, La Jolla, California.
FAU - Mell, Loren K
AU  - Mell LK
AD  - Center for Precision Radiation Medicine, La Jolla, California.
AD  - Department of Radiation Medicine and Applied Sciences, University of California
      San Diego, San Diego, California.
FAU - Katzel, Jed A
AU  - Katzel JA
AD  - Department of Oncology, Kaiser Permanente, Santa Clara, California.
LA  - eng
GR  - Kaiser Foundation Hospitals
PT  - Journal Article
DEP - 20190515
PL  - United States
TA  - Cancer
JT  - Cancer
JID - 0374236
OT  - chemotherapy
OT  - head and neck cancer
OT  - health care disparities
OT  - morbidity
EDAT- 2019/05/16 06:00
MHDA- 2019/05/16 06:00
CRDT- 2019/05/16 06:00
PHST- 2018/12/28 00:00 [received]
PHST- 2019/04/02 00:00 [revised]
PHST- 2019/04/04 00:00 [accepted]
PHST- 2019/05/16 06:00 [entrez]
PHST- 2019/05/16 06:00 [pubmed]
PHST- 2019/05/16 06:00 [medline]
AID - 10.1002/cncr.32187 [doi]
PST - aheadofprint
SO  - Cancer. 2019 May 15. doi: 10.1002/cncr.32187.