Race Shown to Predict Survival Disparities in Head and Neck Cancer Clinical Trials

Jeffrey Liu, MD, FACS, surgeon in the Division of Head and Neck Surgery and an associate professor in the Department of Surgical Oncology.
First author of the study, Jeffrey Liu, MD, FACS, an associate professor in the Division of Head and Neck Surgery at Fox Chase and the Lewis Katz School of Medicine at Temple University.

PHILADELPHIA (December 7, 2022)—Racial disparities in head and neck cancer (HNC) survival are well documented, with Black patients experiencing twice the mortality rate of whites. Previous research has shown that demographic factors like socioeconomic status and access to healthcare play a role. A study published today by researchers at Fox Chase Cancer Center suggests that independent of these factors, race itself may predict disparate outcomes between patients.

“What is unique about our study is it strongly supports the conclusion that Black patients seem to respond to therapy differently than white patients,” said Jeffrey Liu, MD, FACS, an associate professor in the Division of Head and Neck Surgery at Fox Chase and at the Lewis Katz School of Medicine at Temple University, the first author of the study.

The researchers used data from Radiation Therapy Oncology Group (RTOG) clinical trial patients to investigate differences between Black and white HNC patient survival outcomes. Coauthors included collaborator Camille Ragin, PhD, MPH, a professor in the Cancer Prevention and Control research program and Associate Director of Diversity, Equity, and Inclusion, and Brian Egleston, MPP, PhD, an associate research professor in the Biostatistics and Bioinformatics Facility.

The authors chose RTOG patients as their study subjects for two reasons. First, clinical trial patients are by design as similar as possible in terms of age, health status, cancer stage, and other potentially confounding attributes. Second, once patients are enrolled into a trial, the care they receive is largely the same—something that is not true for the general population. Access and quality of cancer care varies geographically, but in national clinical trials treatment is essentially the same for all patients.

Drawing on these RTOG data, Liu and his team matched 468 Black HNC patients with white patients in the same study arm, so both groups of patients received the same treatment. The researchers hypothesized that with factors like socioeconomic status controlled for, Black and white patients would have equally successful treatment outcomes. However, they found that in 60% of the matched pairs, white patients had better survival outcomes than Black patients.

“Using self-reported race, we see a difference in how these groups respond to the same treatment,” said Liu.

He acknowledged that race is a social construct, not a biological one, and is thus an imperfect variable for grouping patients. However, until precision medicine advances to the point where clinicians can use a patient’s genetic profile to predict response to therapy, self-reported race will continue to be used, albeit with caution.

“The bottom line is that people are different. When you put together groups of patients, however imperfect the grouping, some people may be less responsive to therapy than others,” said Liu. “Our next steps are to try to understand why this is the case.”

The study, “Racial Survival Disparities in Head and Neck Cancer Clinical Trials,” was published in Journal of the National Cancer Institute.

Fox Chase Cancer Center (Fox Chase), which includes the Institute for Cancer Research and the American Oncologic Hospital and is a part of Temple Health, is one of the leading comprehensive cancer centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase is also one of just 10 members of the Alliance of Dedicated Cancer Centers. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence six consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. It is the policy of Fox Chase Cancer Center that there shall be no exclusion from, or participation in, and no one denied the benefits of, the delivery of quality medical care on the basis of race, ethnicity, religion, sexual orientation, gender, gender identity/expression, disability, age, ancestry, color, national origin, physical ability, level of education, or source of payment.

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