title: Are the elderly with oropharyngeal carcinoma undertreated?
abstract: OBJECTIVE
  To determine if elderly patients with oropharyngeal squamous cell carcinoma (OPSCC) are receiving less treatment and to evaluate the benefit of aggressive therapy in this population.
  
  
  METHODS
  Retrospective analysis of a large population database.
  
  
  METHODS
  Patients in the Surveillance, Epidemiology, and End Results database with OPSCC diagnosed from 2004 to 2009 were included. The patients were categorized into age groups 45 to 54, 55 to 64, 65 to 74, 75 to 84, and 85 years and older, then further categorized by treatment status. Kaplan-Meier analysis of disease-specific survival (DSS) for late-stage (III and IV) OPSCC was performed for all age and treatment categories, followed by a multivariate cox regression of treatment status, tumor site, race, stage, and sex per age group.
  
  
  RESULTS
  A total of 14,909 patients with OPSCC were identified. In our demographic data, we observed a significant increase in the number of patients who did not receive treatment (surgery, radiation, or combined therapy) after age 55. Kaplan-Meier analysis showed that age groups 65 to 74 and 75 to 84 had substantial benefits in DSS with surgery, radiation, or combined therapy. Multivariable analysis did not demonstrate any statistically significant difference in the hazard ratios for combined treatment among age groups 45 to 54, 55 to 64, 65 to 74, and 75 to 84.
  
  
  CONCLUSIONS
  Proportionally fewer elderly patients with OPSCC are being treated than younger individuals. These patients can have significant benefits from aggressive treatments despite their older age as shown by our survival analysis. We recommend the use of objective measures to assess patient fitness to reduce the potential for undertreatment in the elderly population.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
authors.forename: P Ryan
authors.initials: PR
authors.lastname: Camilon
authors.forename: William A
authors.initials: WA
authors.lastname: Stokes
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lentsch
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
keywords: Oropharyngeal cancer; elderly; survival analysis; undertreatment