title: Quality indicators of laryngeal cancer care in the elderly.
abstract: OBJECTIVE
  To examine associations between quality of care, survival, and costs in elderly patients treated for laryngeal squamous cell cancer (SCCA).
  
  
  METHODS
  Retrospective analysis of Surveillance, Epidemiology, and End Results Medicare data.
  
  
  METHODS
  We evaluated 2,370 patients diagnosed with laryngeal SCCA from 2004 to 2007 using multivariate regression and survival analysis. Using quality indicators derived from guidelines for recommended care, summary measures of quality were calculated for diagnosis, initial treatment, surveillance, treatment of recurrence, end-of-life care, performance, and an overall summary measure of quality.
  
  
  RESULTS
  High-quality care was associated with significant differences in survival for diagnosis [HR = 0.80, 95% CI (0.66-0.97)], initial treatment [HR = 0.75 (0.63-0.88)], surveillance [HR = 0.54 (0.44-0.66)], treatment of recurrence [HR = 1.54 (1.26-1.89)], end-of-life care [HR = 0.69 (0.52-0.92)], performance [HR = 0.41 (0.33-0.52)], and an overall summary measure of quality [HR = 0.66 (0.54-0.80)], which was significantly associated with lower mean incremental costs [-$24,958 (-$35,873 - -$14,042)]. There was a significant survival advantage for initial treatment with surgery and postoperative radiation [HR = 0.66 (0.53-0.82)] and high-volume surgical care [HR = 0.64 (0.43-0.96)] after controlling for all other variables, including quality of care.
  
  
  CONCLUSIONS
  High-quality larynx cancer care in elderly patients was associated with improved survival and reduced costs; however, high-quality care for treatment of recurrence was associated with poorer survival. These data suggest that survival outcomes in elderly patients with laryngeal cancer are not entirely explained by differences in the receipt of quality care using existing treatment and performance quality indicators and also suggest a need to develop sensitive and valid quality indicators of larynx cancer care in this population.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, U.S.A.
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Blackford
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Herbert
authors.forename: Harry
authors.initials: H
authors.lastname: Quon
authors.forename: Arlene A
authors.initials: AA
authors.lastname: Forastiere
authors.forename: David W
authors.initials: DW
authors.lastname: Eisele
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Dy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D018307:Neoplasms, Squamous Cell / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate
keywords: Laryngeal neoplasms; SEER-Medicare; chemotherapy; costs; elderly; quality; radiation; squamous cell cancer; surgery; survival; treatment