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

Research output: Contribution to journalArticle

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

Keywords

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

ASJC Scopus subject areas

  • Otorhinolaryngology

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