{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T11:31:23Z","timestamp":1777289483294,"version":"3.51.4"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"Importance<\/jats:title>The US Food and Drug Administration approved immune checkpoint inhibitors (immunotherapy) for select cases of head and neck squamous cell carcinoma (HNSCC) in 2016. However, it is unclear whether there are clinical or sociodemographic differences among patients receiving immunotherapy as part of their care. Given the known disparities in head and neck cancer care, we hypothesized that there are differences in receipt of immunotherapy among patients with HNSCC based on clinical and nonclinical characteristics.<\/jats:p><\/jats:sec>Objective<\/jats:title>To characterize clinical and nonclinical factors associated with receipt of immunotherapy among older patients with HNSCC.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study included patients 65 years or older diagnosed with HNSCC (n\u2009=\u20094860) in a community oncology care setting. Electronic health records from Navigating Cancer were assessed from January 1, 2017, to April 30, 2022.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Multivariable logistic regression was used to characterize clinical (tumor stage [localized vs advanced] and anatomical subsite [oropharyngeal vs nonoropharyngeal]) and nonclinical (age, smoking history, race and ethnicity, sex, and marital status) factors associated with receipt of immunotherapy.<\/jats:p><\/jats:sec>Results<\/jats:title>In the study cohort of 4860 patients, 3593 (73.9%) were men; 4230 (87.0%) were White and 630 (13.0%) were of other races. A total of 552 patients (11.4%) had received immunotherapy. After adjusting for covariates, in the final model, White patients with HNSCC had 80% increased odds of receiving immunotherapy (adjusted odds ratio [AOR], 1.80 [95% CI, 1.30-2.48]) compared with patients of other races. There were no statistically significant differences in the odds of receiving immunotherapy based on age, sex, or smoking history. Patients with nonoropharyngeal disease were significantly more likely to receive immunotherapy than those with oropharyngeal cancer (AOR, 1.29 [95% CI, 1.05-1.59]), as were those with advanced compared with local disease (AOR, 2.39 [95% CI, 1.71-3.34]).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The findings of this cohort study suggest that among older patients with HNSCC, White patients may be more likely to receive immunotherapy as part of their care. Equitable access to immunotherapy and other treatment options will reduce cancer-related health disparities and improve survival of patients with HNSCC.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2023.2420","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T15:56:31Z","timestamp":1693497391000},"page":"912","source":"Crossref","is-referenced-by-count":7,"title":["Differences in Receipt of Immunotherapy Treatment Among Patients With Head and Neck Cancer"],"prefix":"10.1001","volume":"149","author":[{"given":"Shreya P.","family":"Ramkumar","sequence":"first","affiliation":[{"name":"currently a medical student at Saint Louis University School of Medicine, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arun","family":"Bhardwaj","sequence":"additional","affiliation":[{"name":"Navigating Cancer, Seattle, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amila","family":"Patel","sequence":"additional","affiliation":[{"name":"Navigating Cancer, Seattle, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krishnamoorthy","family":"Seetharaman","sequence":"additional","affiliation":[{"name":"Navigating Cancer, Seattle, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Christman","sequence":"additional","affiliation":[{"name":"Navigating Cancer, Seattle, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ninad","family":"Amondikar","sequence":"additional","affiliation":[{"name":"Navigating Cancer, Seattle, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dina K.","family":"Abouelella","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adnan S.","family":"Hussaini","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin M.","family":"Barnes","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Adjei Boakye","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tammara L.","family":"Watts","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina"},{"name":"Duke Cancer Institute, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nosayaba","family":"Osazuwa-Peters","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina"},{"name":"Duke Cancer Institute, Durham, North Carolina"},{"name":"Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","reference":[{"issue":"1","key":"ooi230054r1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.v72.1","article-title":"Cancer statistics, 2022.","volume":"72","author":"Siegel","year":"2022","journal-title":"CA Cancer J Clin"},{"key":"ooi230054r2","doi-asserted-by":"publisher","first-page":"E1826","DOI":"10.1002\/hed.v38.S1","article-title":"Predictors of stage at presentation and outcomes of head and neck cancers in a university hospital setting.","volume":"38","author":"Osazuwa-Peters","year":"2016","journal-title":"Head Neck"},{"issue":"2","key":"ooi230054r3","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1001\/jamaoto.2021.3425","article-title":"Differential outcomes among survivors of head and neck cancer belonging to racial and ethnic minority groups.","volume":"148","author":"Taylor","year":"2022","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"ooi230054r4","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2019.104460","article-title":"Immunotherapy for head and neck cancer: recent advances and future directions.","volume":"99","author":"Cramer","year":"2019","journal-title":"Oral Oncol"},{"key":"ooi230054r5","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.727433","article-title":"Immunotherapy for head and neck cancer: a paradigm shift from induction chemotherapy to neoadjuvant immunotherapy.","volume":"11","author":"Shibata","year":"2021","journal-title":"Front Oncol"},{"key":"ooi230054r6","doi-asserted-by":"publisher","first-page":"310","DOI":"10.3389\/fonc.2018.00310","article-title":"Immune checkpoint inhibition in head and neck cancer.","volume":"8","author":"Forster","year":"2018","journal-title":"Front Oncol"},{"issue":"19","key":"ooi230054r7","doi-asserted-by":"publisher","first-page":"1856","DOI":"10.1056\/NEJMoa1602252","article-title":"Nivolumab for recurrent squamous-cell carcinoma of the head and neck.","volume":"375","author":"Ferris","year":"2016","journal-title":"N Engl J Med"},{"issue":"7","key":"ooi230054r8","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1016\/S1470-2045(16)30066-3","article-title":"Safety and clinical activity of pembrolizumab for treatment of recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-012): an open-label, multicentre, phase 1b trial.","volume":"17","author":"Seiwert","year":"2016","journal-title":"Lancet Oncol"},{"issue":"32","key":"ooi230054r9","doi-asserted-by":"publisher","first-page":"3838","DOI":"10.1200\/JCO.2016.68.1478","article-title":"Antitumor activity of pembrolizumab in biomarker-unselected patients with recurrent and\/or metastatic head and neck squamous cell carcinoma: results from the phase Ib KEYNOTE-012 Expansion Cohort.","volume":"34","author":"Chow","year":"2016","journal-title":"J Clin Oncol"},{"issue":"5","key":"ooi230054r10","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1016\/j.ijrobp.2017.03.003","article-title":"Immune checkpoint inhibition in cancers that affect the head and neck.","volume":"98","author":"Parameswaran","year":"2017","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"ooi230054r11","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1002\/hed.v41.S1","article-title":"Immune checkpoint inhibitors for head and neck squamous cell carcinoma: current landscape and future directions.","volume":"41","author":"Kao","year":"2019","journal-title":"Head Neck"},{"issue":"7528","key":"ooi230054r12","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1038\/nature13988","article-title":"Checkpoint blockade cancer immunotherapy targets tumour-specific mutant antigens.","volume":"515","author":"Gubin","year":"2014","journal-title":"Nature"},{"issue":"9","key":"ooi230054r13","doi-asserted-by":"publisher","first-page":"2505","DOI":"10.1002\/hed.v42.9","article-title":"Sociodemographic correlates of head and neck cancer survival among patients with metastatic disease.","volume":"42","author":"Pannu","year":"2020","journal-title":"Head Neck"},{"issue":"7","key":"ooi230054r14","doi-asserted-by":"publisher","first-page":"2136","DOI":"10.1002\/hed.v43.7","article-title":"Survival outcomes for head and neck patients with Medicaid: a health insurance paradox.","volume":"43","author":"Pannu","year":"2021","journal-title":"Head Neck"},{"key":"ooi230054r15","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.oraloncology.2018.12.023","article-title":"Racial and socioeconomic disparities associated with 90-day mortality among patients with head and neck cancer in the United States.","volume":"89","author":"Gaubatz","year":"2019","journal-title":"Oral Oncol"},{"issue":"2","key":"ooi230054r16","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1007\/s00432-015-2061-8","article-title":"Race and sex disparities in long-term survival of oral and oropharyngeal cancer in the United States.","volume":"142","author":"Osazuwa-Peters","year":"2016","journal-title":"J Cancer Res Clin Oncol"},{"issue":"13","key":"ooi230054r17","doi-asserted-by":"publisher","first-page":"2302","DOI":"10.1002\/cncr.v127.13","article-title":"Cancer diagnoses and survival rise as 65-year-olds become Medicare-eligible.","volume":"127","author":"Patel","year":"2021","journal-title":"Cancer"},{"issue":"10","key":"ooi230054r18","doi-asserted-by":"publisher","first-page":"2797","DOI":"10.1002\/cncr.v113:10","article-title":"African American and poor patients have a dramatically worse prognosis for head and neck cancer: an examination of 20,915 patients.","volume":"113","author":"Molina","year":"2008","journal-title":"Cancer"},{"issue":"1","key":"ooi230054r19","doi-asserted-by":"publisher","first-page":"8190","DOI":"10.1038\/s41598-023-35216-2","article-title":"Socioeconomic disparities in immunotherapy use among advanced-stage non\u2013small cell lung cancer patients: analysis of the National Cancer Database.","volume":"13","author":"Gupta","year":"2023","journal-title":"Sci Rep"},{"issue":"6","key":"ooi230054r20","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1177\/01945998211029839","article-title":"Impact of race and insurance status on primary treatment for HPV-associated oropharyngeal squamous cell carcinoma.","volume":"166","author":"Habib","year":"2022","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"2","key":"ooi230054r21","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1097\/CJI.0000000000000253","article-title":"Racial and insurance-related disparities in delivery of immunotherapy-type compounds in the United States.","volume":"42","author":"Verma","year":"2019","journal-title":"J Immunother"},{"issue":"6","key":"ooi230054r22","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.19535","article-title":"Association between Food and Drug Administration approval and disparities in immunotherapy use among patients with cancer in the US.","volume":"5","author":"Ermer","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"6","key":"ooi230054r23","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1097\/CJI.0000000000000264","article-title":"Racial and socioeconomic disparities in the delivery of immunotherapy for metastatic melanoma in the United States.","volume":"42","author":"Haque","year":"2019","journal-title":"J Immunother"},{"key":"ooi230054r24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1200\/EDBK_323523","article-title":"Immune-based cancer treatment: addressing disparities in access and outcomes.","volume":"41","author":"Osarogiagbon","year":"2021","journal-title":"Am Soc Clin Oncol Educ Book"},{"issue":"6","key":"ooi230054r25","doi-asserted-by":"publisher","first-page":"1649","DOI":"10.1002\/hep.32527","article-title":"Racial and ethnic disparities in early treatment with immunotherapy for advanced HCC in the United States.","volume":"76","author":"Ahn","year":"2022","journal-title":"Hepatology"},{"key":"ooi230054r26","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.705096","article-title":"Anti\u2013PD-1 and anti\u2013PD-L1 in head and neck cancer: a network meta-analysis.","volume":"12","author":"Botticelli","year":"2021","journal-title":"Front Immunol"},{"issue":"9","key":"ooi230054r27","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1093\/annonc\/mdw226","article-title":"The promise of immunotherapy in head and neck squamous cell carcinoma.","volume":"27","author":"Economopoulou","year":"2016","journal-title":"Ann Oncol"},{"issue":"3","key":"ooi230054r28","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1056\/NEJMp1605101","article-title":"Donabedian\u2019s lasting framework for health care quality.","volume":"375","author":"Ayanian","year":"2016","journal-title":"N Engl J Med"},{"issue":"18","key":"ooi230054r30","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1001\/jama.2021.17764","article-title":"A policy prescription for reducing health disparities-achieving pharmacoequity.","volume":"326","author":"Essien","year":"2021","journal-title":"JAMA"},{"key":"ooi230054r31","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/1758-3284-4-15","article-title":"The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, Medicare, and Medicaid.","volume":"4","author":"Jacobson","year":"2012","journal-title":"Head Neck Oncol"},{"issue":"4","key":"ooi230054r32","doi-asserted-by":"publisher","first-page":"287","DOI":"10.21053\/ceo.2015.00976","article-title":"Follow-up in head and neck cancer: do more does it mean do better? a systematic review and our proposal based on our experience.","volume":"9","author":"Denaro","year":"2016","journal-title":"Clin Exp Otorhinolaryngol"},{"issue":"1","key":"ooi230054r33","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1186\/s12967-022-03774-0","article-title":"Current radiotherapy for recurrent head and neck cancer in the modern era: a state-of-the-art review.","volume":"20","author":"Li","year":"2022","journal-title":"J Transl Med"},{"issue":"4","key":"ooi230054r34","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1097\/00005537-200004000-00011","article-title":"Importance of comorbidity in head and neck cancer.","volume":"110","author":"Piccirillo","year":"2000","journal-title":"Laryngoscope"},{"key":"ooi230054r35","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2019.104561","article-title":"Comorbidity in head and neck cancer: is it associated with therapeutic delay, post-treatment mortality and survival in a population-based study?","volume":"102","author":"Stordeur","year":"2020","journal-title":"Oral Oncol"},{"issue":"2","key":"ooi230054r36","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1111\/j.1525-1497.2004.30143.x","article-title":"Asian Americans\u2019 reports of their health care experiences: results of a national survey.","volume":"19","author":"Ngo-Metzger","year":"2004","journal-title":"J Gen Intern Med"},{"issue":"11","key":"ooi230054r37","doi-asserted-by":"publisher","first-page":"2528","DOI":"10.1002\/lary.v127.11","article-title":"Asian and non-Asian disparities in outcomes of non-nasopharyngeal head and neck cancer.","volume":"127","author":"Kim","year":"2017","journal-title":"Laryngoscope"},{"key":"ooi230054r29","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/978-3-030-82052-7_14","volume-title":"The Comprehensive Cancer Center: Development, Integration, and Implementation","author":"Babar","year":"2022"}],"container-title":["JAMA Otolaryngology\u2013Head & Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2808977\/jamaotolaryngology_ramkumar_2023_oi_230054_1696269098.58889.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T15:01:41Z","timestamp":1697122901000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2808977"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,1]]},"references-count":37,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2023.2420","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2023,10,1]]}}}