Effects of educational status and the living environment on the prognosis of head and neck squamous cell carcinoma
Received Date : 14 Apr 2016
Accepted Date : 08 Aug 2016
Doi: https://doi.org/10.1016/j.jons.2016.08.001 - Article's Language: EN
Journal of Oncological Science 2 (2016) 77-81
Introduction and purpose: Educational status and the living environment are closely related to the survival rates of patients with head and neck cancer. In this study we evaluate the effects of educational status and the living environment on the survival of patients with head and neck cancer. Materials and methods: Patients with head and neck tumors that show squamous cell histological properties were included in the study. Cases had been followed up in Dicle University Medical Faculty Medical Oncology clinic between January 2006 and June 2013. Data was collected retrospectively from the medical records of the patients. Classical parameters, which are considered to affect the prognosis, such as age, gender, stage, tumor localization and performance status, were investigated, in addition to educational status and the living environment. Results: The study comprised 171 cases. The rate of metastatic disease was determined to be higher in illiterate patients, when compared to ones with at least an elementary school or higher education (12.7% and 8.1%, respectively; p = 0.012). Similarly, patients living in rural areas showed higher rates of metastatic disease, when compared to those living in cities (16.3% and 8.0%, respectively; p = 0.146). It was determined that the educational status (median overall survival in the cases with elementary school or higher education 21.5 months; in cases that cannot read or write, it is 10.3 months; p = 0.001) and the environment being lived (median overall survival in cases living in cities 17.6 months; in cases living in rural areas it is 9.0 months; p = 0.014) affect survival in the patients with head and neck cancer. In the multivariate analysis; age (>60 vs < 60, OR: 1.94, 95% CI 1.19–3.17, p = 0.008), educational status (cases that cannot read or write vs elementary school or higher, OR: 1.64, 95% CI: 1.03–2.62, p = 0.037) and stage (early stage vs local advanced stage, OR: 3.07, 95% CI: 1.58–5.94, p = 0.01, early stage vs late stage, OR: 3.49, 95% CI: 1.52–8.03, p = 0.003) were determined to be independent prognostic factors. Discussion: In addition to the classical prognostic factors, educational status was also determined to be an independent prognostic factor in the squamous cell head and neck cancers, and this fact was especially related with late diagnosis. The prognostic effect of living in rural area was determined by univariate analysis; however it was not determined to be an independent prognostic factor in the multivariate analysis.
Keywords: Socioeconomic status; Head and neck cancers; Educational status; Living environment