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Published Online: 1 August 2018

Head and Neck Squamous Cell Carcinoma in Adolescents and Young Adults: Survivorship Patterns and Disparities

Publication: Journal of Adolescent and Young Adult Oncology
Volume 7, Issue Number 4


Purpose: Adolescent and young adult (AYA) head and neck cancer (HNC) patients require longer term follow-ups as they age; yet, little is known about factors associated with survivorship in this population. We aimed to describe nonclinical factors associated with HNC survivorship among AYAs.
Methods: In this retrospective cohort study, the Surveillance, Epidemiology and End Results 18 database from 2007 to 2014 was queried. Eligible cases were 15–39-year-old primary HNC patients with known cause of death (n = 1777). Kaplan–Meier survival curves stratified by age group (15–29, 30–34, and 35–39) and by health insurance status tested differences in HNC survival among groups with a log-rank test. Variables, including age, sex, race/ethnicity, county-level poverty, anatomic site, stage, and treatment, were controlled for in a competing risk proportional hazards model.
Results: Patients were mostly male (64%), with mean age of 33.4 years. Survival rate was 73% after 8 years of follow-up. There were no significant survival differences based on age at diagnosis. However, AYAs who were on Medicaid (adjusted hazard ratio [aHR] = 1.61, 95% confidence interval [CI] 1.22–2.12) or uninsured (aHR = 1.51, 95% CI 1.03–2.21), had an increased hazard of death from HNC, compared with those with private insurance.
Conclusion: Health insurance status is the main nonclinical factor associated with survival among AYAs with HNC, and individuals with Medicaid do not fare better than the uninsured. With a potential longer term follow-up in this AYA population, there is need to optimize survivorship irrespective of health insurance status.

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Published In

cover image Journal of Adolescent and Young Adult Oncology
Journal of Adolescent and Young Adult Oncology
Volume 7Issue Number 4August 2018
Pages: 472 - 479
PubMed: 29746178


Published in print: August 2018
Published online: 1 August 2018
Published ahead of print: 10 May 2018


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Sai D. Challapalli, BS
Saint Louis University School of Medicine, St. Louis, Missouri.
Matthew C. Simpson, MPH
Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.
Eric Adjei Boakye, PhD
Saint Louis University Center for Outcomes Research, St. Louis, Missouri.
Jay S. Pannu, BS
Saint Louis University School of Medicine, St. Louis, Missouri.
Dary J. Costa, MD
Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.
Department of Pediatric Otolaryngology, Cardinal Glennon Children's Medical Center, St. Louis, Missouri.
Nosayaba Osazuwa-Peters, BDS, PhD, MPH, CHES [email protected]
Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.
Saint Louis University Cancer Center, St. Louis, Missouri.
Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri.


Address correspondence to:Nosayaba Osazuwa-Peters, BDS, PhD, MPH, CHESDepartment of Otolaryngology-Head and Neck SurgerySaint Louis University School of Medicine3635 Vista Ave., 6th Floor Desloge TowersSt. Louis, MO 63110-2539 [email protected]

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No competing financial interests exist.

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