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- Title
Speech-language pathology care and short- and long-term outcomes of oropharyngeal cancer treatment in the elderly.
- Authors
Webster, Kimberly T.; Tippett, Donna; Simpson, Marissa; Abrams, Rina; Pietsch, Kristine; Herbert, Robert J.; Eisele, David W.; Gourin, Christine G.
- Abstract
<bold>Objective: </bold>To examine associations between speech-language pathology (SLP) care and pretreatment variables, short-term and long-term swallowing and airway impairment, and survival in elderly patients treated for oropharyngeal squamous cell cancer (SCCA).<bold>Study Design: </bold>Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data.<bold>Methods: </bold>We evaluated longitudinal data from 666 patients diagnosed with oropharyngeal SCCA from 2004 to 2007 using cross-tabulations, multivariate logistic regression, and survival analysis.<bold>Results: </bold>SLP care was documented in 25% of patients. High-volume hospital care (odds ratio (OR) = 3.2 [1.0-10.0]) and dysphagia during treatment (OR = 13.0 [3.6-47.1]) were the only significant predictors of SLP care during the initial treatment period. SLP care was significantly more likely during the first year (OR = 5.3 [3.1-9.1]) and second year (OR = 4.5 [2.4-8.2]) following initial treatment. Subsequent dysphagia (OR = 32.5 [16.9-62.4]), stricture (OR = 2.2 [1.2-4.0]), gastrostomy (OR = 1.7 [1.1-2.7]), and tracheostomy tube use (OR = 2.4 [1.2-4.8]) were significantly associated with long-term SLP care. After controlling for patient, tumor, and treatment-related variables, SLP care was associated with significant relative attenuation of the OR for dysphagia (93%), stricture (35%), weight loss (8%), and airway obstruction (34%). Survival analysis, controlling for all other variables, demonstrated improved survival for patients under SLP care (hazard ratio = 0.73 [0.57-0.95]).<bold>Conclusion: </bold>SLP care is underutilized in elderly oropharyngeal SCCA patients and largely utilized after the onset of impaired airway and swallowing function, but is associated with improved outcomes. These data suggest a need for treatment guidelines that incorporate the routine use of SLP care in this population during the initial treatment period and beyond.<bold>Level Of Evidence: </bold>2c. Laryngoscope, 128:1403-1411, 2018.
- Subjects
SPEECH-language pathology; OROPHARYNGEAL cancer; MEDICAL care for older people; SQUAMOUS cell carcinoma; EPIDEMIOLOGY; CANCER treatment; EVALUATION of medical care; MEDICARE; MULTIVARIATE analysis; SPEECH therapy; SURVIVAL analysis (Biometry); LOGISTIC regression analysis; RETROSPECTIVE studies; DESCRIPTIVE statistics; ODDS ratio; OLD age
- Publication
Laryngoscope, 2018, Vol 128, Issue 6, p1403
- ISSN
0023-852X
- Publication type
journal article
- DOI
10.1002/lary.26950