title: Treatment complications and survival in advanced laryngeal cancer: a population-based analysis.
abstract: OBJECTIVE
  Primary curative treatment of advanced laryngeal cancer may include surgery or chemoradiation, although recommendations vary and both are associated with complications. We evaluated predictors and trends in the use of these modalities and compared rates of complications and overall survival in a population-based cohort of older adults.
  
  
  METHODS
  Retrospective population-based cohort study.
  
  
  METHODS
  Using Surveillance Epidemiology and End Results (SEER) cancer registry data linked with Medicare claims, we identified patients over 65 with advanced laryngeal cancer diagnosed 1999 to 2007 who had total laryngectomy (TL) or chemoradiation (CTRT) within 6 months following diagnosis. We identified complications and estimated the impact of treatment on overall survival, using propensity score methods.
  
  
  RESULTS
  The proportion of patients receiving TL declined from 74% in 1999 to 26% in 2007 (P < 0.0001). Almost 20% of the CTRT patients had a tracheostomy following treatment, and 57% had a feeding tube. TL was associated with an 18% lower risk of death, adjusting for patient and disease characteristics. The benefit of TL was greatest in patients with the highest propensity to receive surgery.
  
  
  CONCLUSIONS
  TL remains an important treatment option in well selected older patients. However, treatment selection is complex; and factors such as functional status, patient preference, surgeon expertise, and post-treatment support services should play a role in treatment decisions.
  
  
  METHODS
  2b. Laryngoscope, 124:2707-2713, 2014.
authors.affiliation: Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, Ireland; School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin, Ireland.
authors.forename: Caitriona B
authors.initials: CB
authors.lastname: O'Neill
authors.forename: James P
authors.initials: JP
authors.lastname: O'Neill
authors.forename: Coral L
authors.initials: CL
authors.lastname: Atoria
authors.forename: Shrujal S
authors.initials: SS
authors.lastname: Baxi
authors.forename: Martin C
authors.initials: MC
authors.lastname: Henman
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.forename: Elena B
authors.initials: EB
authors.lastname: Elkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000145:classification; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000628:therapy*; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate / Q000639:trends
keywords: Treatment; complications; laryngeal cancer; survival