title: Management and outcomes for elderly women with vulvar cancer over time.
abstract: OBJECTIVE
  To examine changes over time in survival and treatment for women diagnosed with vulvar squamous cell carcinoma included in the Surveillance, Epidemiology, and End Results (SEER) Program.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  USA, data obtained from the SEER Program for 1988-2009.
  
  
  METHODS
  Women with vulvar squamous cell carcinoma.
  
  
  METHODS
  Women were stratified by age: <50, 50-64, 65-79, and ≥80 years. Differences in survival and treatment patterns were analysed between age groups. Multivariate logistic regression models were constructed to examine treatment patterns. Kaplan-Meier and Cox proportional hazards survival methods were used to assess survival.
  
  
  METHODS
  Vital status from the date of diagnosis until death, censoring or last follow-up.
  
  
  RESULTS
  The final study group consisted of 8553 women, 1806 (21.12%) <50 years, 2141 (25.03%) 50-64 years, 2585 (30.22%) 65-79 years, and 2021 (23.63%) >80 years old. After adjusting for patient and tumour characteristics, older women were less likely to have surgery and more likely to receive radiotherapy. Compared with women under 50 years, women 50-64 had a two-fold higher risk of death (HR 1.91, 95% CI 1.55-2.34); those 65-79 years had a four-fold higher risk of death (HR 4.01, 95% CI 3.32-4.82), and those ≥80 years had a seven-fold higher risk of death (HR 6.98, 95% CI 5.77-8.46). These trends stayed relatively constant over the time periods studied.
  
  
  CONCLUSIONS
  Women over 50 years are at a higher risk of vulvar cancer-specific mortality, which increases with age. These trends stayed relatively constant over the time periods studied.
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Boston, MA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Rauh-Hain
authors.forename: J
authors.initials: J
authors.lastname: Clemmer
authors.forename: R M
authors.initials: RM
authors.lastname: Clark
authors.forename: L S
authors.initials: LS
authors.lastname: Bradford
authors.forename: W B
authors.initials: WB
authors.lastname: Growdon
authors.forename: A
authors.initials: A
authors.lastname: Goodman
authors.forename: D M
authors.initials: DM
authors.lastname: Boruta
authors.forename: D S
authors.initials: DS
authors.lastname: Dizon
authors.forename: J O
authors.initials: JO
authors.lastname: Schorge
authors.forename: M G
authors.initials: MG
authors.lastname: del Carmen
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D018571:Sentinel Surveillance; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014846:Vulvar Neoplasms / Q000401:mortality* / Q000473:pathology / Q000517:prevention & control / Q000628:therapy*
keywords: Elderly; vulvar cancer