title: Temporal trends in oropharyngeal cancer treatment and survival: 1998-2009.
abstract: OBJECTIVE
  To describe temporal trends of surgical and nonsurgical treatment for advanced oropharyngeal cancer, and to report contemporary survival estimates and factors associated with survival.
  
  
  METHODS
  Patients diagnosed between 1998 and 2009 with a first primary, invasive, advanced-stage squamous cell carcinoma of the oropharynx were selected from the National Cancer Database (N = 67,239). The outcomes of this study were first primary treatment and survival. Treatment was defined as chemotherapy with concurrent radiation (ChemoRT), radiation alone (RT), and surgery.
  
  
  METHODS
  Two-tailed t tests were used to evaluate the statistical significance of treatment type by sociodemographic variables. Multivariate log binomial regression models were used to estimate risk ratio and 95% confidence interval of select treatments (ChemoRT vs. RT and ChemoRT vs. surgery). For survival analysis, all variables were entered into a single model to test for violations in the proportional hazards (PH) assumption. All PH analyses were stratified by stage and age at diagnosis, and insurance status.
  
  
  RESULTS
  The total analytic cohort included 43,983 patients. Sociodemographic variables predicted type of treatment and survival. In addition, chemoradiation was increasingly used during this time period and was associated with improved survival. There was no decrease in mean or median age of patients during this time period to explain the improved survival.
  
  
  CONCLUSIONS
  These results confirmed previously reported trends of increasing use of nonsurgical therapy in the treatment of advanced oropharyngeal cancers. In addition, this analysis describes numerous factors that were predictive of overall survival including race, insurance, increasing use of chemoradiation, and socioeconomic status.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Chen
authors.forename: Jason
authors.initials: J
authors.lastname: Zhu
authors.forename: Stacey
authors.initials: S
authors.lastname: Fedewa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
keywords: Oropharyngeal cancer; patterns of care; survival; treatment