ASCO Annual Meeting

ASCO Annual Meeting

Issue: July 25, 2018
Perspective from Jorge Nieva, MD
Perspective from Joshua Jones, MD, MA
June 02, 2018
5 min read
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Women less likely than men to receive intensive treatment for head, neck cancers

Issue: July 25, 2018
Perspective from Jorge Nieva, MD
Perspective from Joshua Jones, MD, MA
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CHICAGO — Women appeared less likely than men to receive intensive treatment for head and neck cancer, according to study results presented at ASCO Annual Meeting.

When researchers controlled for factors such as age and serious medical conditions, their analysis showed the ratio of cancer mortality to noncancer mortality was twice as high among women than men.

The findings suggest women with head and neck cancer may be undertreated. However, due to confounding factors, additional prospective study is needed to confirm this possibility.

Head and neck cancers are more than twice as common among men than women.

Patients who have good performance status may receive more intense treatments, such as platinum-based chemotherapy with radiation therapy. Less intensive treatments — such as cetuximab (Erbitux, Eli Lilly) with radiation, or radiation alone — may be offered to patients who cannot tolerate intensive chemotherapy. Others receive no cancer treatment.

Jed A. Katzel, MD, medical oncologist at Kaiser Permanente in Santa Clara, Calif., and colleagues used registry data to evaluate outcomes of 884 patients (661 men) diagnosed with stage II to stage IVB head and neck cancer between 2000 and 2015. All patients underwent treatment at Kaiser Permanente Northern California.

“Our goal was ... to determine which patients were most likely to benefit from aggressive therapy, while minimizing toxicity for those likely to die from competing events,” Katzel said during a press conference.

Investigators used logistic regression models to estimate the odds that patients received intensive cancer treatment. They adjusted for factors such as sex, age, tumor stage, Charlson Comorbidity Index, and history of alcohol or smoking use.

Results showed men were considerably more likely than women to receive intensive chemotherapy (46% vs. 35%) or radiation (70% vs. 60%). Rates of surgery appeared similar between groups.

“This may be a reflection of differences in primary tumor location in our cohort, with relatively more oral cavity cancers in women compared with men, and relatively fewer oropharynx cancers in women,” Katzel said.

Researchers used a generalized competing event model to compare a patient’s risk for dying of cancer with the risk for dying of other causes. This mathematical tool controlled for differences in sex, age, tumor site and Charlson score, but it did not control for HPV status.

After median follow-up of 2.9 years, 364 patients had died; of these, 271 died of cancer and 93 died of other causes.

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The generalized competing event model analysis yielded + scores — calculated by dividing the HR for cancer mortality by the HR for noncancer mortality — that showed both women (average + = 7) and men (average + = 3.8) were more likely to die of cancer than other causes.

“For women, the ratio of head and neck cancer death to noncancer death was approximately double the ratio for men, despite controlling for other factors like age and other comorbidities,” Katzel said.

Researchers are evaluating whether differences in the rate of HPV-related head and neck cancers between women and men may play a role in the observed mortality disparities.

HPV-related cancers — which are more responsive to treatment — occur most frequently in the oropharynx. However, in this analysis, fewer women than men had oropharyngeal cancers (38% vs. 55%).

Katzel acknowledged other confounders, including a small number of noncancer deaths (n = 19) among women, and the fact women may have been healthier than men in the cohort.

“Further investigation is needed to determine if there is an actual difference in treatment and outcomes for women compared with men,” Katzel said. “To this end, we have planned a chart-by-chart review, as well as prospective analysis that will be performed in the currently enrolling NRG-HN004 clinical trial.” – by Mark Leiser

For more information:

Park A, et al. Abstract LBA6002. Presented at: ASCO Annual Meeting; June 1-5, 2018; Chicago.

Disclosures: The researchers report funding from Kaiser Permanente Northern California Graduate Medical Education Department. Park reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.