Exploring Florida's Racial Disparities in Oral and Pharyngeal Cancer Treatment

Objective: Our previous research found that Blacks/African-Americans in Florida with oral and pharyngeal cancer (OPC) consistently were more likely than whites to receive only radiation therapy and less likely to receive cancer-directed surgery, across tumor stages and anatomic sites. This study explored potential explanatory factors for that disparity.

Methods: Data from Florida Cancer Data System included 30,059 OPC cases diagnosed in 1999-2002. Potential explanatory factors for racial disparities in cancer-directed surgery included in multiple logistic regression modeling were: type of health care facility; type of health insurance; region of state; stage at diagnosis; primary tumor site; sex; and age at diagnosis. Distances from patients' residences to treatment facility were calculated by using GIS mapping.

Results: Compared to whites with OPC, Blacks/African-Americans were more likely to be uninsured or covered by Medicaid; less likely to have Medicare or private insurance coverage; and more likely to be treated in a major medical center. After adjusting for stage at diagnosis, tumor site, type of facility, region, insurance status, and age, Blacks/African-Americans were still significantly less likely than whites to have cancer-directed surgery (OR=0.63; 95% CI: 0.58, 0.70). Racial disparities persisted even within individual health care facilities. The mean distance between home and the cancer treatment facility was significantly less for Blacks/African-Americans (mean=12.2 miles, s.e.=1.72) than for whites (mean=16.9 miles, s.e.=0.61; p=.009).

Conclusions: In Florida, Blacks/African-Americans with OPC are less likely than whites to receive cancer-directed surgery. That disparity is not explained by type of facility, distance to facility, site or stage of tumor, type of insurance, region, or age at diagnosis. Future studies will examine co-morbidities and other patient factors as possible explanations.

Supported by: Tuskegee University, National Center for Bioethics in Research & Health Care, Oral, Head & Neck Cancer Bioethics Pilot Research Program; and NIH grant R01DE16226.