title: Treatment, survival, and costs of laryngeal cancer care in the elderly.
abstract: OBJECTIVE
  To examine associations between treatment and volume with survival and costs in elderly patients with laryngeal squamous cell cancer (SCCA).
  
  
  METHODS
  Retrospective cross-sectional analysis of Surveillance, Epidemiology, and End Results-Medicare data.
  
  
  METHODS
  We evaluated 2,370 patients diagnosed with laryngeal SCCA from 2004 to 2007 using cross-tabulations, multivariate logistic and generalized linear regression modeling, and survival analysis.
  
  
  RESULTS
  Chemoradiation was significantly associated with supraglottic tumors (relative risk ratio: 2.6, 95% confidence interval [CI]: 1.7-4.0), additional cancer-directed treatment (odds ratio [OR]: 1.8, 95% CI: 1.2-2.7), and a reduced likelihood of surgical salvage (OR: 0.3, 95% CI: 0.2-0.6). Surgery with postoperative radiation was associated with significantly improved survival (hazard ratio [HR]: 0.7, 95% CI: 0.6-0.9), after controlling for patient and tumor variables including salvage. High-volume care was not associated with survival for nonoperative treatment but was associated with improved survival (HR: 0.7, 95% CI: 0.5-0.8) among surgical patients. Initial treatment and 5-year overall costs for chemoradiation were higher than for all other treatment categories. High-volume care was associated with significantly lower costs of care for surgical patients but was not associated with differences in costs of care for nonoperative treatment.
  
  
  CONCLUSIONS
  Chemoradiation in elderly patients with laryngeal cancer was associated with increased costs, additional cancer-directed treatment, and a reduced likelihood of surgical salvage. Surgery with postoperative radiation was associated with improved survival in this cohort, and high-volume hospital surgical care was associated with improved survival and lower costs. These findings have implications for improving the quality of laryngeal cancer treatment at a time of both rapid growth in the elderly population and diminishing healthcare resources.
authors: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, Maryland.
authors: Christine G
authors: CG
authors: Gourin
authors: Sydney M
authors: SM
authors: Dy
authors: Robert J
authors: RJ
authors: Herbert
authors: Amanda L
authors: AL
authors: Blackford
authors: Harry
authors: H
authors: Quon
authors: Arlene A
authors: AA
authors: Forastiere
authors: David W
authors: DW
authors: Eisele
authors: Kevin D
authors: KD
authors: Frick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000191:economics / Q000401:mortality / Q000628:therapy; D008297:Male; D018307:Neoplasms, Squamous Cell / Q000191:economics / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Laryngeal neoplasms; Surveillance, Epidemiology, and End Results-Medicare; chemotherapy; costs; elderly; radiation; squamous cell cancer; surgery; survival; treatment