Patterns of care in adjuvant therapy for resected oral cavity squamous cell cancer in the elderly

Publication date: Available online 2 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Erqi L. Pollom, Alexander L. Chin, Nancy Y. Lee, C. Jillian Tsai
PurposeTo characterize the patterns of care and potential barriers to access to care for elderly oral cavity cancer patients in the adjuvant setting.Methods and MaterialsWe performed a retrospective cohort study using the National Cancer Data Base, and identified patients with resected oral cavity squamous cell carcinoma diagnosed between 2004 and 2012, who survived for at least 3 months after surgery. We used logistic regression models to assess the association between age (<70, 70-79, and ≥80 years) and the receipt of adjuvant therapy within 3 months of surgery. We additionally assessed the association between patient and tumor characteristics and the receipt of adjuvant therapy among those ≥70-years-old.ResultsA total of 25,829 patients were included in the study. Compared to those <70-years-old, older patients were more likely to have no neck dissection or fewer lymph nodes dissected, and were less likely to receive adjuvant therapy than younger patients. Of our cohort, 11,361 patients (44%) had pathologic T3/T4 or N2/N3 disease, and 4,185 patients (16%) had extracapsular nodal extension (ECE) or positive surgical margins. In multivariate analyses controlling for comorbidity and demographic characteristics, older age was independently associated with lower odds of receiving adjuvant radiation in the T3/T4 or N2/N3 subgroup and adjuvant chemoradiation in the positive ECE or positive surgical margin subgroup. Among elderly patients, both greater patient distance from reporting facility and older age were associated with lower odds of receiving both adjuvant radiation (0.66, 95% CI 0.55-0.81) and chemoradiation (0.56, 95% CI 0.40-0.79).ConclusionsIn a national hospital-based cohort of oral cavity cancer patients, elderly patients were less likely to receive adjuvant radiation or chemoradiation. Greater patient distance from reporting facility, in addition to older age, was associated with lower odds of receiving both adjuvant radiation and adjuvant chemoradiation.

Teaser

We compared patterns of adjuvant therapy in different patient age groups (<70, 70-79, and ≥80 years) with resected oral cavity squamous cell carcinoma using the National Cancer Data Base. Older patients were less likely to receive adjuvant therapy, even among those with pathologic T3/T4 or N2/N3 disease, extracapsular nodal extension, or positive margins. Both greater distance from reporting facility and older age were associated with lower odds of receiving adjuvant therapy.


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