Exploring SEER-Medicare for Changes in Frequency of Different Treatments for Laryngeal Cancer

Abstract

Objectives:

Explore the change in frequency of different treatment modalities and its association with change in 5-year survival rate over a 15-year period among Medicare enrollees with squamous-cell carcinoma of the larynx (SCCL).

Methods:

Retrospective data analysis of the SEER-Medicare dataset of elderly patients diagnosed with SCCL between 1992 and 2007. Main treatment modalities were identified, and the change in frequency by year of cancer diagnosis was explored. Multivariate Cox regression was used to calculate the adjusted 5-year survival by year of diagnosis.

Results:

There were 5159 cases of primary SCCL diagnosed between 1992 and 2007. The majority of patients were male (4033, 78%), Caucasian (4466, 87%), and between 66 and 75 years of age (2873, 56%). Stage distribution at diagnosis was local 3241 (63%), regional 1060 (20%), and distant 608 (12%). Between 1992 and 2007, there was a significant trend for increased use of chemo-radiation therapy (5% to 15%, P = 0.0255) and a significant trend for decreased use of combined surgery and radiation (47% to 32%, P < 0.0001). No treatment was identified for 474 (9%) patients. There was a significant increase in 5-year survival rate by year of diagnosis (42.2% in 1992 to 46.7% in 2005, P < 0.0001), which was negatively correlated only to changes in incidence of radiation-only treatment (Spearman rho = -0.6).

Conclusions:

Between 1992 and 2007, there were significant increases in the frequency of use of chemoradiation and concomitant decrease in combined surgery and radiation for SCCL among Medicare beneficiaries. The implications of these trends will be discussed.