Speech-language pathology care and short- and long-term outcomes of oropharyngeal cancer treatment in the elderly

Kimberly T. Webster; Donna Tippett; Marissa Simpson; Rina Abrams; Kristine Pietsch; Robert J. Herbert; David W. Eisele; Christine G. Gourin

doi:10.1002/lary.26950

Speech-language pathology care and short- and long-term outcomes of oropharyngeal cancer treatment in the elderly

Kimberly T. Webster, Donna Tippett, Marissa Simpson, Rina Abrams, Kristine Pietsch, Robert J. Herbert, David W. Eisele, Christine G. Gourin

School of Medicine

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Objective: 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). Study Design: Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data. Methods: We evaluated longitudinal data from 666 patients diagnosed with oropharyngeal SCCA from 2004 to 2007 using cross-tabulations, multivariate logistic regression, and survival analysis. Results: 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]). Conclusion: 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. Level of Evidence: 2c. Laryngoscope, 128:1403–1411, 2018.

Original language	English (US)
Pages (from-to)	1403-1411
Number of pages	9
Journal	Laryngoscope
Volume	128
Issue number	6
DOIs	https://doi.org/10.1002/lary.26950
State	Published - Jun 2018

Keywords

Oropharyngeal neoplasms
SEER-Medicare
chemotherapy
elderly
outcomes
radiation
speech-language pathology
squamous cell cancer
surgery
survival
swallowing
treatment

ASJC Scopus subject areas

Otorhinolaryngology

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10.1002/lary.26950

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@article{e06f63e5b24146789c5fbd4a9834b677,

title = "Speech-language pathology care and short- and long-term outcomes of oropharyngeal cancer treatment in the elderly",

abstract = "Objective: 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). Study Design: Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data. Methods: We evaluated longitudinal data from 666 patients diagnosed with oropharyngeal SCCA from 2004 to 2007 using cross-tabulations, multivariate logistic regression, and survival analysis. Results: 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]). Conclusion: 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. Level of Evidence: 2c. Laryngoscope, 128:1403–1411, 2018.",

keywords = "Oropharyngeal neoplasms, SEER-Medicare, chemotherapy, elderly, outcomes, radiation, speech-language pathology, squamous cell cancer, surgery, survival, swallowing, treatment",

author = "Webster, {Kimberly T.} and Donna Tippett and Marissa Simpson and Rina Abrams and Kristine Pietsch and Herbert, {Robert J.} and Eisele, {David W.} and Gourin, {Christine G.}",

note = "Publisher Copyright: {\textcopyright} 2017 The American Laryngological, Rhinological and Otological Society, Inc.",

year = "2018",

month = jun,

doi = "10.1002/lary.26950",

language = "English (US)",

volume = "128",

pages = "1403--1411",

journal = "Laryngoscope",

issn = "0023-852X",

publisher = "John Wiley and Sons Inc.",

number = "6",

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TY - JOUR

T1 - Speech-language pathology care and short- and long-term outcomes of oropharyngeal cancer treatment in the elderly

AU - Webster, Kimberly T.

AU - Tippett, Donna

AU - Simpson, Marissa

AU - Abrams, Rina

AU - Pietsch, Kristine

AU - Herbert, Robert J.

AU - Eisele, David W.

AU - Gourin, Christine G.

PY - 2018/6

Y1 - 2018/6

N2 - Objective: 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). Study Design: Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data. Methods: We evaluated longitudinal data from 666 patients diagnosed with oropharyngeal SCCA from 2004 to 2007 using cross-tabulations, multivariate logistic regression, and survival analysis. Results: 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]). Conclusion: 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. Level of Evidence: 2c. Laryngoscope, 128:1403–1411, 2018.

AB - Objective: 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). Study Design: Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data. Methods: We evaluated longitudinal data from 666 patients diagnosed with oropharyngeal SCCA from 2004 to 2007 using cross-tabulations, multivariate logistic regression, and survival analysis. Results: 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]). Conclusion: 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. Level of Evidence: 2c. Laryngoscope, 128:1403–1411, 2018.

KW - Oropharyngeal neoplasms

KW - SEER-Medicare

KW - chemotherapy

KW - elderly

KW - outcomes

KW - radiation

KW - speech-language pathology

KW - squamous cell cancer

KW - surgery

KW - survival

KW - swallowing

KW - treatment

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U2 - 10.1002/lary.26950

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SN - 0023-852X

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JO - Laryngoscope

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ER -

Speech-language pathology care and short- and long-term outcomes of oropharyngeal cancer treatment in the elderly

Abstract

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