Treatment, survival, and costs of oropharyngeal cancer care in the elderly.
Laryngoscope
; 128(5): 1103-1112, 2018 05.
Article
en En
| MEDLINE
| ID: mdl-28988469
ABSTRACT
OBJECTIVES/HYPOTHESIS:
To examine associations between treatment, survival, and costs in elderly patients with oropharyngeal squamous cell cancer (OPSCC). STUDYDESIGN:
Retrospective cross-sectional analysis of Surveillance, Epidemiology, and End Results-Medicare data.METHODS:
We evaluated 666 patients diagnosed with OPSCC from 2004 to 2007 using cross-tabulations, multivariate logistic and generalized linear regression modeling, and survival analysis.RESULTS:
The majority of patients were nonsmokers (79%), had advanced-stage disease (59%), and received chemoradiation (38%) or radiation (28%). Surgery with postoperative radiation (hazard ratio [HR] 0.33 [95% CI 0.20-0.53]) and chemoradiation (HR 0.45 [95% CI 0.29-0.71]) were associated with improved survival, whereas stage IV disease was associated with poorer survival (HR 1.95 [95% CI 1.13-3.38]). Additional cancer-directed treatment after primary treatment was more likely following chemoradiation (odds ratio [OR] 3.44 [95% CI 1.78-6.63]). Salvage surgery was performed in 25% of patients undergoing subsequent additional cancer-directed treatment, and was associated with high-volume hospitals (OR 2.81 [95% CI 1.07-7.74]). Additional radiation (HR 0.47 [95% CI 0.31-0.72]) and salvage surgery (HR 0.61 [95% CI 0.38-0.99]) were associated with improved overall survival when performed >6 months following initial treatment, whereas salvage neck dissection alone was not significantly associated with survival after controlling for time to salvage (HR 0.38 [95% CI 0.05-2.78]). Treatment and 5-year overall costs were highest for chemoradiation, surgery with postoperative radiation, and additional cancer-directed treatment.CONCLUSIONS:
Multimodality treatment in elderly OPSCC patients was associated with improved survival and increased costs. Chemoradiation was associated with an increased likelihood of additional cancer-directed treatment. Salvage surgery was centralized at high-volume hospitals, and was associated with improved survival when performed >6 months after last initial treatment date, but was performed in <20% of patients undergoing additional treatment. LEVEL OF EVIDENCE 2c. Laryngoscope, 1281103-1112, 2018.Palabras clave
Texto completo:
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Bases de datos:
MEDLINE
Asunto principal:
Neoplasias Orofaríngeas
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Terapia Recuperativa
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Terapia Combinada
Tipo de estudio:
Health_economic_evaluation
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Observational_studies
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Prevalence_studies
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Risk_factors_studies
Límite:
Aged
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Aged80
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Female
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Humans
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Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Laryngoscope
Asunto de la revista:
OTORRINOLARINGOLOGIA
Año:
2018
Tipo del documento:
Article
País de afiliación:
Estados Unidos