Advanced Stage of Head and Neck Cancer at a Tertiary-care County Hospital

Background: Public hospitals provide health care for uninsured and medically underserved patients in large metropolitan areas. Outcomes for head and neck cancer patients within this population are perceived as being worse than outcomes for the general population, perhaps because of advanced stage at presentation.

Objective: This study assesses the initial cancer stage in patients with head and neck carcinoma presenting to an urban tertiary-care county hospital compared with data for the general population.

Study Design: Prospective study of 209 consecutive patients newly diagnosed with head and neck cancer by the Division of Otolaryngology/Head and Neck Surgery from October 2003 to April 2005.

Methods: Clinical and pathologic data were obtained as patients presented and underwent treatment. Demographic data were obtained retrospectively. Staging analysis was performed on 186 patients with squamous cell carcinoma. Normative data were obtained from the National Cancer Database.

Results: The mean age was 55, with a 4:1 male to female ratio. Over 95% of patients reported being unemployed. The racial composition was white 27%, African American 52%, Hispanic 11%, Asian 7%, and 3% "other." Staging revealed that 68% of patients were stage IV, and 85% would be considered "advanced" disease (stage III/IV). This is significantly worse than what national data demonstrates, where only 39% are stage IV, and 55% have advanced stage of disease at presentation.

Conclusion: Although the perceived poor outcome of uninsured and underserved cancer patients is multifactorial, advanced stage at presentation is a critical factor. These statistics demonstrate the need for increased patient education and screening for this underserved population as an initial step to improve outcome.