title: Patients with oropharyngeal cancer: a comparison of adults living independently and patients living in long-term care facilities.
abstract: The low survival rate of persons with oropharyngeal cancer (OPC) is directly related to the size of the primary tumor, lymph node involvement and to the smoking history. The association between medical independence and the survival rate of oral cancer is unclear. The purpose of this study was to assess the survival rate of institutionalized patients with oral cancer compared to those living independently. Information regarding gender, age, tobacco habits, disease characteristics, and survival status were recorded and statistically analyzed from 30 patients with oral cancer who were institutionalized compared to 543 patients with oral cancer who were non-institutionalized. Patients living in long-term care facilities (LTC) were significantly older than the independent patients (67% were 70 years or older versus 28% of independent patients) (p = 0.0001). No differences in smoking habits were noted between the two groups but more patients who were institutionalized stopped smoking at the time of diagnosis (p = 0.47). More patients who were institutionalized were diagnosed with positive lymph node involvement (p = 0.09). Significantly higher all-cause and disease-free 5-year survival rates were noted in the patients living independently, compared to the adults who were institutionalized (32% and 60% compared to 7% and 26% respectively; p < 0.05). The disease-specific 5-year survival was directly related to age (p = 0.001), size of the tumor (p = 0.001), and lymph node involvement (p < 0.001). Significant longer survival rates were observed for patients living independently. The more advanced disease seen in the patients who were institutionalized may be due to a delay in diagnosis, which may be associated with fewer symptoms, limited report of symptoms, a lack of attention or a misdiagnosis of the oral lesion.
authors.affiliation: College of Dentistry and Cancer Center, University of Illinois, Chicago, Ill., USA. jepstein@uic.edu
authors.forename: Joel B
authors.initials: JB
authors.lastname: Epstein
authors.forename: Ruth
authors.initials: R
authors.lastname: Lunn
authors.forename: Nhu D
authors.initials: ND
authors.lastname: Le
authors.forename: Peter
authors.initials: P
authors.lastname: Stevenson-Moore
authors.forename: Meir
authors.initials: M
authors.lastname: Gorsky
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007326:Institutionalization; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009735:Nursing Homes; D009959:Oropharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking; D016019:Survival Analysis; D015996:Survival Rate; D014481:United States / Q000453:epidemiology