Elderly Patients with Laryngeal Squamous Cell Cancer Benefit from Higher Quality Care

What are the associations between quality of care, short- and long-term treatment-related outcomes, and costs in elderly patients treated for laryngeal squamous cell cancer (SCC)?

Background: Cancer care in the United States has been identified as a major healthcare reform and quality improvement target. Cancer-specific quality indicator development requires the identification of process or outcome measures that are quantifiable and supported by evidence that an association exists between the measure and population values, preferences, or outcomes. Limited data exist regarding quality measures in head and neck cancer care.

Study design: Retrospective analysis of 2,370 patients diagnosed with laryngeal SCC from 2004 to 2007 in Surveillance, Epidemiology, and End Results (SEER)-Medicare data.

Setting: SEER-Medicare linked database.

Synopsis: Dysphagia, weight loss, airway obstruction, tracheostomy tube dependence, and pneumonia incidence were highest in the first year following treatment, with airway obstruction and pneumonia incidence remaining high in subsequent years. Gastrostomy tube use decreased and esophageal stricture increased over time. Patients receiving higher quality care had lower incidences of short- and long-term weight loss, gastrostomy use, esophageal stricture, airway obstruction, tracheostomy dependence, pneumonia, and long-term dysphagia. Cox proportional survival analysis demonstrated that higher quality care was associated with improved survival in patients with dysphagia, weight loss, airway obstruction, tracheostomy status, and pneumonia, but no association was found between quality of care and survival in patients with esophageal stricture and long-term gastrostomy dependence. Higher quality care was associated with significantly lower mean incremental costs in patients with dysphagia, weight loss, esophageal stricture, airway obstruction, and pneumonia, but not with tracheostomy or gastrostomy dependence. Limitations included possible underestimation of late toxicities due to limited claims data and billing code information, a possible significant overlap between conditions not reflected in claims, and a lack of recurrent claims data.

Bottom line: Higher quality larynx cancer care was associated with a reduced incidence of late airway and swallowing impairment after laryngeal SCCA treatment in elderly patients, with improved survival and reduced costs.

Citation: Gourin CG, Starmer HM, Herbert RJ, et al. Quality of care and short- and long-term outcomes of laryngeal cancer care in the elderly. Laryngoscope. 2015;125:2323-2329.