Head and Neck Surgery

Assessment of Social Vulnerability in Pediatric Head and Neck Cancer Care and Prognosis in the United States

Fei-Zhang DJ, Chelius DC, Patel UA, Smith SS, Sheyn AM, Rastatter JC. Assessment of Social Vulnerability in Pediatric Head and Neck Cancer Care and Prognosis in the United States. JAMA Netw Open. 2023;6(2):e230016. Published 2023 Feb 1. [Article Link]

How does social vulnerability affect children with head and neck cancer?

Currently, the literature demonstrates a paucity of data assessing the impact of social determinants of health (SDoH) on outcomes in pediatric head and neck cancer (HNC) patients.  This retrospective cohort study extracted data from the Surveillance, Epidemiology, and End Results Program database (SEER) and included pediatric HNC patients (19 years and younger) diagnosed from 1975 to 2017. The Centers for Disease Control and Prevention Social Vulnerability Index (CDC-SVI) was used to calculate social vulnerability, which features 15 social factors grouped into 4 SDoH-related themes: socioeconomic status (SES), minority and language status (ML), household composition (HH), and housing and transportation (HT). A total of 37,043 patients with 30 different HNCs had significant relative decreases in the surveillance period as large as 41.2% (non-Hodgkin lymphomas) and in the survival period as large as 61.4% (glioma not otherwise specified) as overall social vulnerability increased. For thyroid carcinoma patients in the lowest quintile of vulnerability index, surveillance period and months survival (mean) were 158 and 218 months vs. 98 and 122 months in the highest quintile, respectively. While demonstrating the extent to which SDoH can impact outcomes in the pediatric HNC population, Fei-Zhang et al. confirm the anecdotal understanding of the situation.  Physicians can use these findings to guide their clinical practice and prevent unwarranted adverse outcomes in at risk patient populations.

Luka Bahra’s Takeaway: This study illustrates how factors contributing to healthcare disparities are often multifaceted and complex.Future studies should focus on reducing such disparity by implementing strategies that target factors outlined in this paper.