Schelomo Marmor1, Seth Cohen2, Naomi Fujioka3, L Chinsoo Cho4, Amit Bhargava5, Stephanie Misono6. 1. Department of Otolaryngology, University of Minnesota, 420 Delaware St SE, MMC 396, Minneapolis, MN 55455, USA; Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN 55455, USA; Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN 55455, USA. Electronic address: marm0014@umn.edu. 2. Duke Voice Care Center, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC 27710, USA. Electronic address: seth.cohen@duke.edu. 3. Division of Hematology, Oncology and Transplantation, University of Minnesota, 420 Delaware St SE, MMC 480, Minneapolis, MN 55455, USA; Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN 55455, USA. Electronic address: fujio002@umn.edu. 4. Department of Radiation Oncology, University of Minnesota, Minneapolis, MN 55455, USA; Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN 55455, USA. Electronic address: choxx106@umn.edu. 5. Division of Thoracic and Foregut Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN 55455, USA; Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN 55455, USA. Electronic address: bharg041@umn.edu. 6. Department of Otolaryngology, University of Minnesota, 420 Delaware St SE, MMC 396, Minneapolis, MN 55455, USA; Masonic Cancer Center, University of Minnesota, 420 Delaware St SE, MMC 806, Minneapolis, MN 55455, USA. Electronic address: smisono@umn.edu.
Abstract
INTRODUCTION: The impact of dysphagia in persons with lung cancer is unknown. The objective of this study is to measure the prevalence and survival differences associated with dysphagia in older adults with lung cancer. MATERIALS AND METHODS: Linked SEER cancer registries - Medicare data, 1991-2009 was utilized to identify 201,674 persons with lung cancer. Most were male (53%), had regional or distant disease (74%), and were aged <80 years (82%). The pre-existing prevalence of dysphagia was identified using claims codes before the lung cancer diagnosis. Survival was analyzed using Kaplan Meier curves and Cox proportional hazard models. RESULTS: 8517 (4%) had dysphagia prior to their lung cancer diagnoses. Younger age, worse disease stage, more comorbidities, and hospital rurality were associated with higher likelihood of dysphagia. Patients with dysphagia had worse survival (median survival 8 months [95%CI 7,9]) than those without dysphagia (median survival 12 months [95%CI 11,13]). After adjusting for sociodemographic, clinical, and disease characteristics, dysphagia was still associated with worse survival (Hazard ratio of death 1.34, [95%CI 1.28-1.35], p ≤ .0001). DISCUSSION AND CONCLUSIONS: This is the first Medicare claims-based study of older adults with lung cancer and dysphagia. Pre-existing dysphagia occurred in approximately 1 in 25 patients with lung cancer and was associated with worse survival. Determining the best methods to evaluate and treat dysphagia in patients with lung cancer is an important avenue for future studies.
INTRODUCTION: The impact of dysphagia in persons with lung cancer is unknown. The objective of this study is to measure the prevalence and survival differences associated with dysphagia in older adults with lung cancer. MATERIALS AND METHODS: Linked SEER cancer registries - Medicare data, 1991-2009 was utilized to identify 201,674 persons with lung cancer. Most were male (53%), had regional or distant disease (74%), and were aged <80 years (82%). The pre-existing prevalence of dysphagia was identified using claims codes before the lung cancer diagnosis. Survival was analyzed using Kaplan Meier curves and Cox proportional hazard models. RESULTS: 8517 (4%) had dysphagia prior to their lung cancer diagnoses. Younger age, worse disease stage, more comorbidities, and hospital rurality were associated with higher likelihood of dysphagia. Patients with dysphagia had worse survival (median survival 8 months [95%CI 7,9]) than those without dysphagia (median survival 12 months [95%CI 11,13]). After adjusting for sociodemographic, clinical, and disease characteristics, dysphagia was still associated with worse survival (Hazard ratio of death 1.34, [95%CI 1.28-1.35], p ≤ .0001). DISCUSSION AND CONCLUSIONS: This is the first Medicare claims-based study of older adults with lung cancer and dysphagia. Pre-existing dysphagia occurred in approximately 1 in 25 patients with lung cancer and was associated with worse survival. Determining the best methods to evaluate and treat dysphagia in patients with lung cancer is an important avenue for future studies.
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