Patterns of care in older patients with squamous cell carcinoma of the head and neck: a surveillance, epidemiology, and end results-medicare analysis.
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.


CONCLUSIONS
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.
Noam A
NA
VanderWalde
Anne-Marie
AM
Meyer
Huan
H
Liu
Seth D
SD
Tyree
Leah L
LL
Zullig
William R
WR
Carpenter
Carol D
CD
Shores
Mark C
MC
Weissler
David N
DN
Hayes
Mary
M
Fleming
Bhishamjit S
BS
Chera
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D006278:Medicare; D018426:SEER Program; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology