Format

Send to

Choose Destination
Oral Oncol. 2019 Jul;94:32-40. doi: 10.1016/j.oraloncology.2019.05.009. Epub 2019 May 14.

Gender disparities in head and neck cancer chemotherapy clinical trials participation and treatment.

Author information

1
Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, United States.
2
Department of Internal Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States.
3
Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States.
4
Yale Cancer Center, New Haven, CT, United States; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, United States.
5
Yale Cancer Center, New Haven, CT, United States; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States.
6
Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, United States; Yale Cancer Center, New Haven, CT, United States. Electronic address: benjamin.judson@yale.edu.

Abstract

OBJECTIVES:

To characterize the representation of women in clinical trials directing the National Comprehensive Cancer Network (NCCN) guidelines for chemotherapy use in head and neck squamous cell carcinoma (HNSCC), as well as the relationship between gender and chemotherapy administration in the definitive treatment of HNSCC in the United States.

METHODS:

A review of all HNSCC chemotherapy clinical trials cited by the 2018 NCCN guidelines was performed. Sex-based proportions were compared with the corresponding proportions in the general U.S. population of patients with HNSCC between 1985 and 2015, derived from the Surveillance, Epidemiology, and End Results (SEER) program. A second analysis using the National Cancer Database (NCDB), identified 63,544 adult patients diagnosed with stages III-IVB HNSCC between 2004 and 2014 and treated with definitive radiotherapy or chemoradiotherapy. Univariable and multivariable logistic regression analyses were used to identify predictors of chemotherapy administration.

RESULTS:

While women comprised 26.2% of U.S. patients with HNSCC between 1985 and 2015, they comprised only 17.0% of patients analyzed in U.S. NCCN-cited chemotherapy clinical trials between 1985 and 2017. On multivariable analysis, women had decreased odds of receiving chemotherapy (Odds Ratio [OR]: 0.875; 95% Confidence Interval [CI]: 0.821-0.931; p < 0.001).

CONCLUSION:

Women are underrepresented in HNSCC chemotherapy clinical trials cited by the national guidelines. Additionally, women are less likely than men to receive definitive chemoradiotherapy as oppose to definitive radiotherapy. Reasons for these disparities warrant further investigation as well as re-evaluation of eligibility criteria and enrollment strategies, in order to improve relevance of clinical trials to women with HNSCC.

KEYWORDS:

Chemotherapy; Clinical trials; Disparities; Head and neck cancer; NCCN guidelines; Radiotherapy

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center