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Title: Analysis of survival and acquired over time treatment toxicities in elderly HNSCC patients: The SEER-Medicare database Authors:  Olga Goloubeva - University of Maryland School of Medicine (United States) [presenting]
Abstract: The objective was to evaluate impact of primary treatment on survival and QOL outcomes of elderly patients with head and neck cancer (HNSCC). The SEER-Medicare linked database for those diagnosed with HNSCC during 1992-2011 was utilized. We identified all eligible patients 66 years and older with locally advanced cancers of the oropharyngeal, oral cavity and laryngeal SCC. The primary treatment defined as therapy received over first 180 days since cancer diagnosis. The probability of receiving single modality vs multimodality treatment was assessed by logistic regression approach. The multivariable Cox regression model stratified by cancer stage and site was used to estimate impact of any single modality vs multimodality on overall survival and toxicities time trend when adjusted for age and comorbidity index (up to 47 conditions) at time of diagnosis. The confounding bias in associating treatment with outcomes was accounted for by using propensity scoring. The study population comprised 5879 beneficiaries. Patients who were older and had higher CCI scores were less likely to receive more intense multimodality treatment across the three HNSCC sites. Elderly locally advanced HNSCC patients, particularly in the oropharynx and larynx, who receive less intense therapy have decreased survival. While patient selection is likely a co-factor in explaining these results, our findings are consistent with an age-independent benefit of getting multi-modality therapy.