Thomas F Barrett1, Angela L Mazul1, Katelyn O Stepan1, C Burton Wood1, Randall C Paniello1, Jose P Zevallos1, Sean Massa1, Ryan S Jackson1, Nicole C Schmitt2, Joseph Zenga3, Stephen Y Kang4, Patrik Pipkorn1, Jason T Rich5, Sidharth V Puram6. 1. Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA. 2. Department of Otolaryngology - Head and Neck Surgery, Emory School of Medicine, Atlanta, GA, USA. 3. Department of Otolaryngology - Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 4. Department of Otolaryngology - Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA. 5. Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: richj@wustl.edu. 6. Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA; Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: sidpuram@wustl.edu.
Abstract
BACKGROUND: The number of elderly patients with oral squamous cell carcinoma (OCSCC) is increasing as the elderly population increases. Unfortunately, evidence to guide the management of these patients is lacking. METHODS: Patients with OCSCC identified from the National Cancer Database (NCDB) were stratified into age-based cohorts. Demographics, comorbidities, and treatment patterns were analyzed. Patients were stratified into early stage (Stage I/II) and advanced stage (Stage III/IV) disease. The likelihood of receiving multimodality therapy by age was calculated using multinomial logistic regression for each stratum while controlling for potential confounders. Cox proportional hazard regression was used to calculate 5-year mortality risk while controlling for potential confounders. RESULTS: Surgery alone or palliative options were offered to older patients more frequently. After controlling for confounders, older patients were less likely to receive multimodality therapy for both early stage and advanced stage disease. Patients with advanced disease across all age cohorts had improved 5-year survival with surgery and adjuvant therapy. CONCLUSION: Our analyses suggest that elderly patients have unique demographic and pathologic features. They frequently receive less treatment than similarly staged younger patients, yet they benefit from multimodality therapy when feasible. These data suggest an urgent need to critically appraise the care of elderly OCSCC patients within the broader context of their individual comorbidity burden, functional status, and treatment goals.
BACKGROUND: The number of elderly patients with oral squamous cell carcinoma (OCSCC) is increasing as the elderly population increases. Unfortunately, evidence to guide the management of these patients is lacking. METHODS: Patients with OCSCC identified from the National Cancer Database (NCDB) were stratified into age-based cohorts. Demographics, comorbidities, and treatment patterns were analyzed. Patients were stratified into early stage (Stage I/II) and advanced stage (Stage III/IV) disease. The likelihood of receiving multimodality therapy by age was calculated using multinomial logistic regression for each stratum while controlling for potential confounders. Cox proportional hazard regression was used to calculate 5-year mortality risk while controlling for potential confounders. RESULTS: Surgery alone or palliative options were offered to older patients more frequently. After controlling for confounders, older patients were less likely to receive multimodality therapy for both early stage and advanced stage disease. Patients with advanced disease across all age cohorts had improved 5-year survival with surgery and adjuvant therapy. CONCLUSION: Our analyses suggest that elderly patients have unique demographic and pathologic features. They frequently receive less treatment than similarly staged younger patients, yet they benefit from multimodality therapy when feasible. These data suggest an urgent need to critically appraise the care of elderly OCSCC patients within the broader context of their individual comorbidity burden, functional status, and treatment goals.
Authors: L Barzan; A Veronesi; G Caruso; D Serraino; D Magri; V Zagonel; U Tirelli; R Comoretto; S Monfardini Journal: J Laryngol Otol Date: 1990-08 Impact factor: 1.469
Authors: Jay S Cooper; Thomas F Pajak; Arlene A Forastiere; John Jacobs; Bruce H Campbell; Scott B Saxman; Julie A Kish; Harold E Kim; Anthony J Cmelak; Marvin Rotman; Mitchell Machtay; John F Ensley; K S Clifford Chao; Christopher J Schultz; Nancy Lee; Karen K Fu Journal: N Engl J Med Date: 2004-05-06 Impact factor: 91.245
Authors: Melina J Windon; Gypsyamber D'Souza; Farhoud Faraji; Tanya Troy; Wayne M Koch; Christine G Gourin; Ana P Kiess; Karen T Pitman; David W Eisele; Carole Fakhry Journal: Cancer Date: 2019-01-15 Impact factor: 6.860