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

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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 languageEnglish (US)
Pages (from-to)1403-1411
Number of pages9
JournalLaryngoscope
Volume128
Issue number6
DOIs
StatePublished - Jun 1 2018

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Speech-Language Pathology
Oropharyngeal Neoplasms
Long-Term Care
Odds Ratio
Squamous Cell Neoplasms
Deglutition Disorders
Therapeutics
Deglutition
Survival Analysis
Pathologic Constriction
High-Volume Hospitals
Laryngoscopes
Gastrostomy
Survival
Tracheostomy
Airway Obstruction
Medicare
Weight Loss
Epidemiology
Retrospective Studies

Keywords

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

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

@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 = "chemotherapy, elderly, Oropharyngeal neoplasms, outcomes, radiation, SEER-Medicare, 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 Christine Gourin",
year = "2018",
month = "6",
day = "1",
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",

}

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

PY - 2018/6/1

Y1 - 2018/6/1

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 - chemotherapy

KW - elderly

KW - Oropharyngeal neoplasms

KW - outcomes

KW - radiation

KW - SEER-Medicare

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

DO - 10.1002/lary.26950

M3 - Article

C2 - 29057504

AN - SCOPUS:85047803536

VL - 128

SP - 1403

EP - 1411

JO - Laryngoscope

JF - Laryngoscope

SN - 0023-852X

IS - 6

ER -