Women Less Likely to Receive Aggressive Head and Neck Cancer Treatment

In head and neck cancer treatment, women appeared to be less likely to receive chemotherapy and radiation compared with men, according to an analysis of cancer registry data from a California hospital system presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting.

When determining treatment, a patient’s activity level and other medical problems are taken in to consideration. For example, patients who appear to have higher measures of overall well-being may be offered more intensive treatment including platinum-based chemotherapy with radiation therapy, whereas patients who cannot tolerate intensive chemotherapy may be offered less intensive treatments, such as the targeted therapy Erbitux (cetuximab) with radiation, radiation alone, or even no cancer treatment at all.

“The treatment of head and neck cancer often requires intensive treatment that can have lasting side effects,” said senior author Jed A. Katzel, M.D., medical oncologist at Kaiser Permanente. “Our goal was to review data from a large group of patients from Northern California to determine which patients are most likely to benefit from aggressive therapy, while minimizing toxicity for those likely to die from competing events.”

In the study, the researchers evaluated health outcomes in 223 female patients and 661 male patients who were diagnosed with stage 2 to 4B head and neck cancer between 2000 and 2015 at Kaiser Permanente Northern California.

They used logistic regression models to determine the odds of receiving intensive cancer treatment and a mathematical tool called the generalized competing event (GCE) model, which compared the risk of dying from cancer to the risk of dying from other causes.

“The GCE model is a mathematical model that can be used to calculate an omega-plus score for a patient,” said Katzel. “The omega-plus score is the hazard for cancer mortality over the hazard for non-cancer mortality. It essentially describes the degree to which cancer is the patients problem.”

Women exhibited lower odds of receiving intensive chemotherapy (35 percent vs. 46 percent) and radiation (60 percent vs. 70 percent) compared with men. However, rates for surgery appeared to be similar among both groups. Katzel attributed these findings to a potential reflection in the different primary tumor locations within the cohort, as there were relatively more oral cavity cancers and fewer oropharyngeal cancers among women.

After a median follow-up of 2.9 years, 271 patients died of cancer, including 93 of non-cancer causes. Both men and women were more likely to die from cancer than from other causes.

However, the ratio of cancer deaths compared with non-cancer deaths was almost two times higher in women compared with men, indicating that women may be relatively undertreated. Katzel noted that confounding factors to explain this could include a lower percentage of oropharyngeal head and neck cancer in women (38 percent vs. 55 percent); the smaller number of non-cancer deaths in women (19 women); and that the women in this cohort may have been healthier than the men.

Katzel added additional trials are necessary to “determine if there is an actual difference in treatment and outcomes for women compared with men.”

“To this end, we have planned a chart-by-chart review and prospective trials using GCE in the NRG-HN004 clinical trial,” he added.

ASCO expert Joshua A. Jones, M.D., MA, agreed that further research is warranted considering these findings were not only striking, but a surprise.

“It is really important that we continue this research, that we continue to figure out what those differences are, why they are happening so that we can make sure that as we are talking with patients with head and neck cancer that we are providing the right treatment for the right patient at the right time,” Jones added. “And (it is important) that everyone has the appropriate access to outstanding clinical care for head and neck cancer.”