title: Exploring SEER-Medicare for changes in the treatment of laryngeal cancer among elderly medicare beneficiaries.
abstract: OBJECTIVE
  To explore the change in frequency of treatment, and its association with 5-year survival, among elderly Medicare enrollees with squamous cell carcinoma of the larynx (SCCL).
  
  
  METHODS
  Retrospective analysis of a national cancer database.
  
  
  METHODS
  This was an analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicare data set of elderly patients diagnosed with SCCL between 1992 and 2007. Surgical and nonsurgical treatments were identified, and changes in frequency by year of cancer diagnosis were explored. A propensity-matched multivariate Cox proportional hazards model was used to compare the impact of treatment.
  
  
  RESULTS
  There were 3324 cases of primary SCCL diagnosed between 1992 and 2007 studied. Most were male (n = 2605; 78%), white (n = 2845; 87%), and between 66 and 74 years of age (n = 1874; 56%). Between 1992 and 2005, there was a significant trend for increasing 5-year overall survival (43% in 1992 to 54% in 2005-2007; P < .01). There was a significant trend for decreasing frequency of surgical therapy (47% in 1992-1995 to 41% in 2005-2007; P = .03). Surgical therapy was associated with a decreased risk of overall mortality (hazard ratio, 0.76; 95% confidence interval, 0.68-0.86) in comparison to nonsurgical treatments.
  
  
  CONCLUSIONS
  The analysis demonstrates an increase in survival among elderly Medicare enrollees diagnosed with SCCL between 1992 and 2007. Despite a significant trend for its decreasing use, there was a significantly decreased risk of overall mortality associated with surgical therapy.
authors.affiliation: Department of Otolaryngology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA.
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Jean
authors.forename: Dorina
authors.initials: D
authors.lastname: Kallogjeri
authors.forename: Seth A
authors.initials: SA
authors.lastname: Strope
authors.forename: Frances Mei
authors.initials: FM
authors.lastname: Hardin
authors.forename: Jason T
authors.initials: JT
authors.lastname: Rich
authors.forename: Jay F
authors.initials: JF
authors.lastname: Piccirillo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy; D008297:Male; D006278:Medicare / Q000191:economics*; D057216:Propensity Score; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: SEER-Medicare; head and neck cancer; laryngeal cancer; nonsurgical therapy; propensity score; surgical therapy; survival