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Short‐ and long‐term outcomes of laryngeal cancer care in the elderly
Author(s) -
Gourin Christine G.,
Starmer Heather M.,
Herbert Robert J.,
Frick Kevin D.,
Forastiere Arlene A.,
Eisele David W.,
Quon Harry
Publication year - 2015
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25012
Subject(s) - dysphagia , medicine , gastrostomy , pneumonia , aspiration pneumonia , odds ratio , swallowing , airway obstruction , retrospective cohort study , surgery , weight loss , airway , obesity
Objectives/Hypothesis 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). Study Design 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. Level of Evidence 2c. Laryngoscope , 125:924–933, 2015