title: Impact of surveillance on survival after laryngeal cancer in the medicare population.
abstract: OBJECTIVE
  Routine surveillance is advocated to detect recurrent disease after treatment for laryngeal cancer. This aim of this study was to determine the 1- and 5-year postrecurrence mortality for laryngeal cancers and evaluate whether more intensive surveillance improved survival.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Patients with recurrent cancers (1992-1999) were identified in a national cancer clinical database. Multivariate analysis was used to evaluate the effect of surveillance on postrecurrence survival.
  
  
  RESULTS
  Of 2,121 recurrent cancers identified, 913 were laryngeal. Patients with laryngeal cancer recurrence had 27% (P = .001) and 22% (P = .007) better odds of 1- and 5-year survival than other sites. The 1- and 5-year postrecurrence survival rates for laryngeal cancer patients were 72.4% and 41.3%, respectively. Glottic cancer cases had the best postrecurrence life expectancy. Multivariate regression revealed that clinical surveillance intensity had no independent impact on their survival (P < .05). However, patients with recurrent glottic cancer seen in surveillance had 23% improved odds of survival (P = .037).
  
  
  CONCLUSIONS
  More frequent surveillance visits was not associated with a survival advantage in the overall population. Patients with glottic cancer had a postrecurrence survival advantage if seen during the surveillance period. Laryngeal cancer patients had better postrecurrence survival than other head and neck sites.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington 98195, USA. dof@u.washington.edu
authors.forename: David O
authors.initials: DO
authors.lastname: Francis
authors.forename: Bevan
authors.initials: B
authors.lastname: Yueh
authors.forename: Ernest A
authors.initials: EA
authors.lastname: Weymuller
authors.forename: Albert L
authors.initials: AL
authors.lastname: Merati
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology