title: Quality of care and short- and long-term outcomes of laryngeal cancer care in the elderly.
abstract: OBJECTIVE
  To examine associations between quality of care, short- and long-term treatment-related outcomes, and costs in elderly patients treated for laryngeal squamous cell cancer (SCCA).
  
  
  METHODS
  Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data.
  
  
  METHODS
  We evaluated longitudinal data from 2,370 patients diagnosed with laryngeal SCCA from 2004 to 2007 using cross-tabulations, multivariate regression, and survival analysis. Using quality indicators derived from guidelines for recommended care and performance measures, an overall summary measure of quality was calculated incorporating summary quality measures for diagnosis, initial treatment, performance, surveillance, treatment for recurrence, and end-of-life care.
  
  
  RESULTS
  Higher-quality care was associated with a lower likelihood of long-term weight loss (odds ratio [OR] = 0.6 [0.5-0.8]), stricture (OR = 0.5 [0.3-0.8]), gastrostomy dependence (OR = 0.5 [0.4-0.7]), airway obstruction (OR = 0.7 [0.6-0.9]), tracheostomy (OR = 0.5 [0.3-0.7]), and pneumonia (OR = 0.7 [0.5-0.9]), but had no impact on the likelihood of dysphagia. Higher-quality care was associated with lower risk of death in patients with dysphagia (hazard ratio [HR] = 0.7 [0.6-0.8]), weight loss (HR = 0.8 [0.6-0.9]), airway obstruction (HR = 0.7 [0.6-0.8]), tracheostomy (HR = 0.7 [0.5-0.9]), and pneumonia (HR = 0.8 [0.6-0.9]), but was not associated with survival differences in patients with gastrostomy dependence or stricture. Costs associated with dysphagia, weight loss, stricture, airway obstruction, and pneumonia were lower for patients receiving higher-quality care.
  
  
  CONCLUSIONS
  Higher-quality larynx cancer care was associated with a reduced incidence of late airway and swallowing impairment after laryngeal SCCA treatment in elderly patients, with improved survival and reduced costs. These data suggest that greater attention to evidence-based practices associated with quality indicators may lead to improved functional outcomes in the elderly.
  
  
  METHODS
  2c.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery.
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Starmer
authors.affiliation: Department of Health Policy and Management, the Johns Hopkins Bloomberg School of Public Health.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Herbert
authors.affiliation: Department of Health Policy and Management, the Johns Hopkins Bloomberg School of Public Health.|Johns Hopkins Carey Business School.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.affiliation: Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, U.S.A.
authors.forename: Arlene A
authors.initials: AA
authors.lastname: Forastiere
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University.
authors.forename: Harry
authors.initials: H
authors.lastname: Quon
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery.
authors.forename: David W
authors.initials: DW
authors.lastname: Eisele
authors.affiliation: Department of Health Policy and Management, the Johns Hopkins Bloomberg School of Public Health.
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Dy
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000601:surgery*; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000453:epidemiology; D004940:Esophageal Stenosis / Q000453:epidemiology; D005260:Female; D005774:Gastrostomy; D006258:Head and Neck Neoplasms / Q000191:economics / Q000601:surgery*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006801:Humans; D007822:Laryngeal Neoplasms / Q000191:economics / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000191:economics; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome
keywords: Larynx cancer; SEER-Medicare; aspiration; chemotherapy; cost; dysphagia; elderly; gastrostomy; outcomes; pneumonia; quality; radiation; squamous cell cancer; surgery; survival; treatment