Patterns of care in older patients with squamous cell carcinoma of the head and neck

A surveillance, epidemiology, and end results-medicare analysis

Noam Vanderwalde, Anne Marie Meyer, Huan Liu, Seth D. Tyree, Leah L. Zullig, William R. Carpenter, Carol D. Shores, Mark C. Weissler, David N. Hayes, Mary Fleming, Bhishamjit S. Chera

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: There is growing evidence in the literature that older patients may not benefit from more intensive therapy for head and neck squamous cell carcinoma (HNSCC). A growing number of patients with HNSCC are age 65. years or older; however, much of the evidence base informing treatment decisions is based on substantially younger and healthier clinical trial populations. The purpose of this study was to assess the patterns of care of older HNSCC patients to better understand how age is associated with treatment decisions. Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (1992-2007), we identified patients with non-metastatic HNSCC (n = 10,867) and categorized them by treatment: surgery vs. non-surgery and chemoradiotherapy (CRT) vs. radiotherapy (RT). Multivariate logistic regression models were used to identify variables associated with the receipt of surgery and CRT. Results: Increasing age was associated with decreased odds of receiving CRT (OR = 0.94; 95% CI 0.93-0.94) but not surgery (OR 1.00; 95% CI 0.99-1.00). Co-morbidity and race were not associated with receipt of either surgery or CRT. Utilization of CRT increased while surgery decreased between 1992 and 2007. Conclusion: Age may influence the receipt of CRT for older HNSCC patients. There has been an increasing trend in the receipt of CRT and a decrease in primary surgery.

Original languageEnglish (US)
Pages (from-to)262-270
Number of pages9
JournalJournal of Geriatric Oncology
Volume4
Issue number3
DOIs
StatePublished - Jul 1 2013

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Chemoradiotherapy
Medicare
Epidemiology
Logistic Models
Therapeutics
Carcinoma, squamous cell of head and neck
Radiotherapy
Clinical Trials
Databases
Morbidity
Population

All Science Journal Classification (ASJC) codes

  • Geriatrics and Gerontology
  • Oncology

Cite this

Patterns of care in older patients with squamous cell carcinoma of the head and neck : A surveillance, epidemiology, and end results-medicare analysis. / Vanderwalde, Noam; Meyer, Anne Marie; Liu, Huan; Tyree, Seth D.; Zullig, Leah L.; Carpenter, William R.; Shores, Carol D.; Weissler, Mark C.; Hayes, David N.; Fleming, Mary; Chera, Bhishamjit S.

In: Journal of Geriatric Oncology, Vol. 4, No. 3, 01.07.2013, p. 262-270.

Research output: Contribution to journalArticle

Vanderwalde, N, Meyer, AM, Liu, H, Tyree, SD, Zullig, LL, Carpenter, WR, Shores, CD, Weissler, MC, Hayes, DN, Fleming, M & Chera, BS 2013, 'Patterns of care in older patients with squamous cell carcinoma of the head and neck: A surveillance, epidemiology, and end results-medicare analysis', Journal of Geriatric Oncology, vol. 4, no. 3, pp. 262-270. https://doi.org/10.1016/j.jgo.2013.03.002
Vanderwalde, Noam ; Meyer, Anne Marie ; Liu, Huan ; Tyree, Seth D. ; Zullig, Leah L. ; Carpenter, William R. ; Shores, Carol D. ; Weissler, Mark C. ; Hayes, David N. ; Fleming, Mary ; Chera, Bhishamjit S. / Patterns of care in older patients with squamous cell carcinoma of the head and neck : A surveillance, epidemiology, and end results-medicare analysis. In: Journal of Geriatric Oncology. 2013 ; Vol. 4, No. 3. pp. 262-270.
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abstract = "Background: There is growing evidence in the literature that older patients may not benefit from more intensive therapy for head and neck squamous cell carcinoma (HNSCC). A growing number of patients with HNSCC are age 65. years or older; however, much of the evidence base informing treatment decisions is based on substantially younger and healthier clinical trial populations. The purpose of this study was to assess the patterns of care of older HNSCC patients to better understand how age is associated with treatment decisions. Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (1992-2007), we identified patients with non-metastatic HNSCC (n = 10,867) and categorized them by treatment: surgery vs. non-surgery and chemoradiotherapy (CRT) vs. radiotherapy (RT). Multivariate logistic regression models were used to identify variables associated with the receipt of surgery and CRT. Results: Increasing age was associated with decreased odds of receiving CRT (OR = 0.94; 95{\%} CI 0.93-0.94) but not surgery (OR 1.00; 95{\%} CI 0.99-1.00). Co-morbidity and race were not associated with receipt of either surgery or CRT. Utilization of CRT increased while surgery decreased between 1992 and 2007. Conclusion: Age may influence the receipt of CRT for older HNSCC patients. There has been an increasing trend in the receipt of CRT and a decrease in primary surgery.",
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AU - Meyer, Anne Marie

AU - Liu, Huan

AU - Tyree, Seth D.

AU - Zullig, Leah L.

AU - Carpenter, William R.

AU - Shores, Carol D.

AU - Weissler, Mark C.

AU - Hayes, David N.

AU - Fleming, Mary

AU - Chera, Bhishamjit S.

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N2 - Background: There is growing evidence in the literature that older patients may not benefit from more intensive therapy for head and neck squamous cell carcinoma (HNSCC). A growing number of patients with HNSCC are age 65. years or older; however, much of the evidence base informing treatment decisions is based on substantially younger and healthier clinical trial populations. The purpose of this study was to assess the patterns of care of older HNSCC patients to better understand how age is associated with treatment decisions. Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (1992-2007), we identified patients with non-metastatic HNSCC (n = 10,867) and categorized them by treatment: surgery vs. non-surgery and chemoradiotherapy (CRT) vs. radiotherapy (RT). Multivariate logistic regression models were used to identify variables associated with the receipt of surgery and CRT. Results: Increasing age was associated with decreased odds of receiving CRT (OR = 0.94; 95% CI 0.93-0.94) but not surgery (OR 1.00; 95% CI 0.99-1.00). Co-morbidity and race were not associated with receipt of either surgery or CRT. Utilization of CRT increased while surgery decreased between 1992 and 2007. Conclusion: Age may influence the receipt of CRT for older HNSCC patients. There has been an increasing trend in the receipt of CRT and a decrease in primary surgery.

AB - Background: There is growing evidence in the literature that older patients may not benefit from more intensive therapy for head and neck squamous cell carcinoma (HNSCC). A growing number of patients with HNSCC are age 65. years or older; however, much of the evidence base informing treatment decisions is based on substantially younger and healthier clinical trial populations. The purpose of this study was to assess the patterns of care of older HNSCC patients to better understand how age is associated with treatment decisions. Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (1992-2007), we identified patients with non-metastatic HNSCC (n = 10,867) and categorized them by treatment: surgery vs. non-surgery and chemoradiotherapy (CRT) vs. radiotherapy (RT). Multivariate logistic regression models were used to identify variables associated with the receipt of surgery and CRT. Results: Increasing age was associated with decreased odds of receiving CRT (OR = 0.94; 95% CI 0.93-0.94) but not surgery (OR 1.00; 95% CI 0.99-1.00). Co-morbidity and race were not associated with receipt of either surgery or CRT. Utilization of CRT increased while surgery decreased between 1992 and 2007. Conclusion: Age may influence the receipt of CRT for older HNSCC patients. There has been an increasing trend in the receipt of CRT and a decrease in primary surgery.

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