URMC Researchers Work to Address Head & Neck Cancer Survival Disparities in Western NY

Katherine K. Rieth, M.D., M.A.

Nicolas Casellas, M.D.

Shalini Shah

Saiganesh Ravikumar, M.P.H.

 

 

Residence in more rural areas of the state is associated with lower five-year overall survival among head and neck cancer (HNC) patients, according to the study published in the journal Head & Neck. It reviewed cases from Wilmot Cancer Institute ranging from 2011 to 2019 and found that HNC patients residing in smaller and more isolated rural towns have double the mortality over a five-year period compared to more urban areas of the state.

“Most of the counties served by Wilmot are considered rural, and although it looks like survival from head and neck cancer in rural areas is not as good compared to urban areas, this is  one of the first steps in making that better,” says assistant professor of Otolaryngology (Ear, Nose & Throat) Katherine Rieth, M.D., M.A. “We have a genuine interest in improving these disparities that we are finding.”

Rieth says the publication of this study marks an important first step in addressing health inequities: identifying that they exist, and trying to identify factors that play a role.

“This can pave the way for developing changes and interventions that are tailored to these factors and have the best chance at improving outcomes,” Rieth explains.

While the impacts of other factors such as race and socioeconomic status on HNC survival are well-documented, studies focused on urban-rural disparities are less common. This study is the first to examine overall survival based on patients’ area of residence in Upstate New York.

According to the Centers for Disease Control and Prevention, people living in rural areas of the country are more likely than urban residents to die prematurely from the five leading causes of death: heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke.

One of the most common characteristics that puts rural populations at a higher risk of death is long travel distances to medical care, according to the CDC. However, a major finding from URMC’s study was that a longer distance to care didn’t have a clear association with HNC survival, but it did have an association with later stages of cancer when a patient first came in. 

“What that’s telling us is that distance to care is not affecting survival as much as it’s affecting patients getting to our doorstep to begin with,” says fourth-year medical student Saiganesh Ravikumar, M.P.H., the primary author.

Co-author Nicolas Casellas, M.D., a fourth-year Otolaryngology resident, says there are several possibilities for future studies based on these findings. He’s interested in exploring what other variables – such as education, HPV status, race and socioeconomic status – play a role in outcomes among more isolated rural areas of our region. That way, Casellas says, “We can have a better understanding of what’s going on, and how to target more efficiently.”

The team says some solutions to focus on next could include enhanced screenings, primary prevention of alcoholism and tobacco use, and steps to improve health literacy in areas with lower HNC survival rates, so that individuals can better determine when it’s the right time to see a doctor for symptoms they’re experiencing.

More broadly, I hope this study can be a stepping stone in how the health care system utilizes public health and primary prevention,” says co-author Shalini Shah, a second-year medical student. “There’s a huge opportunity in screening and educating patients before they present with cancers.”  

Rieth is continuing to work toward a solution that can positively impact people at risk for HNC. In November, she was named a recipient of a $40,000 Career Development Grant from the Triological Society, an international honorary society for ear, nose and throat specialists and head and neck surgeons.

The award will support Rieth’s upcoming research project, titled “Tobacco Use and Cessation Among Head and Neck Cancer Patients in Rural Western New York: A Mixed Methods Assessment of Barriers to Quit Success in a High Risk and Underserved Population.” Rieth will utilize the data she collects from this study to develop new tobacco cessation programs that have a high potential for success among rural populations in the Western New York region.