title: Short- and long-term outcomes of laryngeal cancer care in the elderly.
abstract: OBJECTIVE
  To examine associations between pretreatment variables, short-term and long-term swallowing and airway impairment, and survival in elderly patients treated for laryngeal squamous cell cancer (SCCA).
  
  
  METHODS
  Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data.
  
  
  METHODS
  Longitudinal data from 2,370 patients diagnosed with laryngeal SCCA from 2004 to 2007 were evaluated using cross-tabulations, multivariate logistic regression, and survival analysis.
  
  
  RESULTS
  Dysphagia (odds ratio [OR] = 1.5 [1.2-1.7]), weight loss (OR = 1.3 [1.1-1.6]), esophageal stricture (OR = 3.8 [2.5-5.9]), airway obstruction (OR = 1.9, [1.6-2.3]), tracheostomy (OR = 1.5 [1.2-1.9]), and pneumonia (OR = 1.8 [1.4-2.2]) increased 1 year after treatment. The odds of airway obstruction, esophageal stricture, and pneumonia increased over subsequent years, with significantly increased risk at 5 years for airway obstruction (OR = 3.3 [1.8-5.8]) and pneumonia (OR = 5.2 [2.5-10.7]). Pretreatment dysphagia, chemoradiation, and salvage surgery were significant predictors of long-term dysphagia, weight loss, tracheostomy, and gastrostomy, with pretreatment dysphagia and salvage surgery also associated with pneumonia. Surgery and postoperative radiation was associated with long-term dysphagia (OR = 1.4 [1.0-1.9]) but reduced odds of long-term pneumonia (OR = 0.7 [0.5-0.9]). Long-term dysphagia, gastrostomy or tracheostomy dependence, weight loss, airway obstruction, and pneumonia were associated with poorer survival, with pneumonia associated with the greatest risk of death at 5 years (hazard ratio = 2.6 [2.4-2.9]).
  
  
  CONCLUSIONS
  Airway and swallowing impairment is common after laryngeal SCCA treatment in elderly patients, increases over time, and is associated with poorer survival-with pneumonia associated with the highest risk of long-term mortality. Patients with pretreatment dysphagia, initial treatment with chemoradiation, and salvage surgery represent a high-risk group with an increased risk of disability and death.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A.
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
authors.forename: Heather M
authors.initials: HM
authors.lastname: Starmer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Herbert
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Arlene A
authors.initials: AA
authors.lastname: Forastiere
authors.forename: David W
authors.initials: DW
authors.lastname: Eisele
authors.forename: Harry
authors.initials: H
authors.lastname: Quon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology / Q000503:physiopathology; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002423:Cause of Death; D059248:Chemoradiotherapy / Q000379:methods / Q000401:mortality; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology; D018572:Disease-Free Survival; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D007825:Laryngectomy / Q000379:methods / Q000401:mortality; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D013997:Time Factors; D014481:United States
keywords: Laryngeal cancer; SEER-Medicare; aspiration; chemotherapy; dysphagia; elderly; gastrostomy; outcomes; pneumonia; radiation; squamous cell cancer; surgery; survival; treatment