Patients with head and neck squamous cell carcinoma (HNSCC) who live in more highly subsidized, smaller apartments experience worse survival even though no apparent delays in disease presentation exist. Socioeconomic status affects survival for patients with HNSCC, even in areas with universal health care systems.1

This study, published in Cancer, assessed survival of patients with HNSCC in Singapore. Singapore has a housing system on a tiered subsidy, with income determining eligibility of subsidies based on the size of the apartment.

For this study, researchers examined whether a patient’s type of residence correlated with mortality. Housing was split into 3 categories. Housing was small/heavily subsidized, medium/moderately subsidized, or large/minimally or not subsidized.

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This study also determined whether patients in smaller, highly subsidized housing were more likely to present with advanced HNSCC.

Researchers identified data from a historical cohort study of patients with HNSCC in a tertiary referral center. These data were part of a multidisciplinary cancer database between 1992 and 2014.

Extraction of clinicopathologic data from 758 patients with HNSCC revealed most patients were men (73.4%), the median age was 64 years, 30.5% were current smokers, and 15.2% were former smokers.

Researchers used logistic regression to assess the relationship between all-cause mortality, the predictors of interest to the study, and the association between housing type and stage of disease at presentation.

More than half of the patients (56.8%) presented with advanced disease. Residential postal codes of patients were matched to housing category. Patients residing in smaller, highly subsidized apartments experienced worse survival even though they were not more likely to present with advanced disease.

These results suggest, “that the survival difference was not because of delayed presentation.”

Age, survival time from diagnosis, age, smoker status, and male gender were all predictive of mortality.


1. Wong TH, Skanthakumar T, Nadkarni N, Nguyen HV, Iyer NG. Survival of patients with head and neck squamous cell carcinoma by housing subsidy in a tiered public housing system. Cancer. 2017 Jan 30. doi: 10.1002/cncr.30557 [Epub ahead of print]