Award Date

5-1-2014

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Environmental and Occupational Health

First Committee Member

Paulo S. Pinheiro

Second Committee Member

Mark Buttner

Third Committee Member

Michelle Chino

Fourth Committee Member

Karl Kingsley

Number of Pages

52

Abstract

Head and neck cancer (HNC), also known as oral cavity and pharyngeal cancer, comprises a group of cancers that arise in the head or neck region, such as the nasal cavity, sinuses, lips, mouth, salivary glands, and pharynx. Use of tobacco, alcohol, or a combination of the two, are major risk factors for head and neck cancer. Approximately 75% of oral cancers are attributable to smoking and/or alcohol consumption. More recently, the human papilloma virus (HPV) has also been associated with the development of head and neck cancer.

The objective of the present study is to investigate head and neck cancer survival in Nevada and its potential determinants utilizing Nevada Central Cancer Registry data between 1995 and 2008. The life table method was used to calculate age-adjusted 5-year survival rates. The Kaplan-Meier method and Cox regression were adopted to identify significant determinants of head and neck cancer survival in Nevada.

A total of 2,522 new cases of head and neck cancer in Nevada were analyzed. Age, race/ethnicity, civil status, insurance status, site, and stage of diagnosis are all significant determinants for head and neck cancer survival in Nevada. The Surveillance, Epidemiology, and End Results (SEER) Program reported a significant survival disparity between whites and blacks in 2013 for HNC. A significant disparity in survival, due to race, was observed in Nevada. Blacks tend to have the worst survival outcome after adjusting for select covariates (HR=1.35, 95% CI: 1.04-1.75), even though black males in Nevada were found to have a better 5-year overall age-adjusted survival rate (38.2%) than the national average (25.7%).

The findings from this study also suggested a geographic disparity in survival between Northern (HR=0.89, 95% CI: 0.77-1.02) and Southern Nevada, possibly due to limited quality healthcare resources, different lifestyle factors, or inadequate access to care, in the south. The present study shows that insured individuals with private insurance or Medicare have significantly better chances at survival, after diagnosis of head and neck cancer, than uninsured individuals (HR=1.45, 95% CI=1.17-1.80), with a difference as much as half. Specific public health strategies, such as increasing oral screenings and persuading public officials to include dental care coverage as part of health insurance, are necessary to improve head and neck cancer survival and to diminish survival disparities in Nevada.

Keywords

Head--Cancer; Neck--Cancer; Mouth--Cancer; Outcome assessment (Medical care); Pharynx--Diseases; survival

Disciplines

Dentistry | Epidemiology | Public Health

Language

English


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