Nativity status and oral cancer survival in the United States: Implications for dental clinical practice

Objective: Nativity status is a major determinant of health and healthcare access in the United States. This study compared oral squamous cell carcinoma (OSCC) survival between US-born and foreign-born patients. Method and Materials: Data were obtained from the 1988-2008 Surveillance, Epidemiology and End Results database. A Cox proportional hazards multivariate model was used to assess the effect of birthplace on OSCC survival, adjusting for other sociodemographic and clinical covariates. Results: US-born patients had a higher median survival time (19.3 years; 95% confidence interval [CI]: 18.6-19.7) compared to foreign-born patients (10.7 years; 95% CI: 10.1-11.3). After adjusting for other factors, being born in the US conferred a modest protective effect from OSCC mortality (hazard ratio [HR] = 0.93, 95% CI: 0.87-0.99). Other factors that conferred better survival included involvement of paired structures (HR = 0.65; 95% CI: 0.58-0.74), lip involvement rather than tongue lesions (HR = 0.76; 95% CI: 0.71-0.82), and receipt of either surgery (HR = 0.89; 95% CI: 0.84-0.94) or radiation therapy (HR = 0.92; 95% CI: 0.87-0.97). Conclusion: US-born patients had significantly better OSCC survival compared to their foreign-born counterparts. This underscores the need for enhanced and sustained efforts to improve access to healthcare among immigrant populations. In addition, oral health professionals such as general dentists, oral pathologists, and oral surgeons providing care to immigrant patients should ensure that reasonable efforts are made to communicate effectively with patients with language barriers, especially in high-stake conditions such as cancer. This may help increase such patients' awareness of treatment provided and the critical issues regarding cancer care, resulting in enhanced treatment outcome.