Disparities in sinonasal squamous cell carcinoma short- and long-term outcomes: Analysis from the national cancer database

Laryngoscope. 2018 Mar;128(3):560-567. doi: 10.1002/lary.26804. Epub 2017 Aug 16.

Abstract

Objectives/hypothesis: To examine sociodemographic, hospital-specific, and disease-related characteristics in relation to outcomes in sinonasal squamous cell carcinoma (SCC).

Study design: The National Cancer Database was queried for location codes corresponding to the nasal cavity and paranasal sinuses and histology codes representing SCC malignancy. Multivariate analyses were performed against short- and long-term outcomes (overall survival, days to discharge, 30-day readmission, and 30- and 90-day mortality).

Results: The database included 5,584 sinonasal SCC patients with an overall median survival of 53.5 months (95% confidence interval [CI]: 49.7-57.8). On multivariate analysis, uninsured, Medicaid, and Medicare were independently associated with worse overall survival compared to private insurance (hazard ratio [HR]: 1.49, 95% CI: 1.22-1.82, P < .001; HR: 1.57, 95% CI: 1.34-1.85, P < .001; and HR: 1.14, 95% CI: 1.01-1.29, P = .03, respectively). Both Medicaid and Medicare were also associated with increased 30-day mortality (HR: 1.36, 95% CI: 1.76-143.29, P = .02; HR: 8.27, 95% CI: 1.66-70.88, P = .02, respectively), and Medicaid patients spent more time in the hospital following surgery (difference in days to discharge: HR: 2.09, 95% CI: 0.57-3.61, P < .01). Compared to white race, other race was associated with improved overall survival (HR: 0.79, 95% CI: 0.63-0.99, P = .04) but increased 30-day readmissions (HR: 3.85, 95% CI: 1.58-8.38, P < .01). Hispanic ethnicity was associated with increased 30-day readmissions (HR: 2.35, 95% CI: 1.08-4.75, P = .02]. The highest income bracket (≥$63,000) was associated with fewer hospital readmissions (HR: 0.33, 95% CI: 0.13-0.79, P = .01).

Conclusions: Sociodemographic and economic differences in outcomes of patients with sinonasal SCC cancer exist. An understanding of these differences may help minimize disparities in oncologic treatment.

Level of evidence: 2c. Laryngoscope, 128:560-567, 2018.

Keywords: National Cancer Database; Sinonasal cancer; disparities; overall survival; race; readmission; squamous cell carcinoma.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / mortality*
  • Databases, Factual
  • Female
  • Health Status Disparities*
  • Humans
  • Income / statistics & numerical data
  • Insurance, Health / statistics & numerical data
  • Male
  • Medicaid / statistics & numerical data
  • Medicare / statistics & numerical data
  • Middle Aged
  • Multivariate Analysis
  • Paranasal Sinus Neoplasms / mortality*
  • Patient Readmission / statistics & numerical data
  • Proportional Hazards Models
  • Racial Groups / statistics & numerical data
  • Treatment Outcome
  • United States