National treatment patterns in patients presenting with Stage IVC head and neck cancer: analysis of the National Cancer Database


Abstract:
Head and neck cancer patients presenting with distant metastases are generally considered incurable. Treatment patterns and survival by primary disease site and therapy have not been described. Retrospective cohort analysis of 2525 patients in the National Cancer Database (2003–2006). Kaplan–Meier and Cox proportional hazards analyses were performed. Combined locoregional and systemic therapy was the most common treatment regimen (39.2%), followed by no treatment (23.9%), locoregional (19.0%), and systemic treatment (17.8%). Multivariate analysis demonstrated decreased survival was associated with age 65–79 years hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.14–1.80), Medicaid/uninsured status (HR 1.27, 95% CI 1.13–1.42), Medicare/other government insurance (HR 1.21, 95% 1.07–1.38), treatment at a nonacademic/research program (HR 1.17, 95% CI 1.07–1.27), and Charlson comorbidity score of 1 (HR 1.33, 95% 1.19–1.48). Compared to systemic therapy alone, receiving locoregional and systemic therapy was associated with decreased risk of death (HR 0.73, 95% CI 0.65–0.83). Only 14.6% and 0.6% of patients were recorded as receiving palliative therapy or being enrolled in a clinical trial, respectively. Significant treatment diversity exists in distantly metastatic head and neck cancer. Those who received combination locoregional and systemic therapy were more likely to have improved overall survival, but important factors in treatment selection are unknown. A small proportion of patients was found to receive either palliative therapy or was enrolled in a clinical trial, although these data likely underestimate the true proportions.

Keywords:
Clinical trials as topic; head and neck cancer; neoplasm metastases; outcomes assessments; palliative care


Autoři: Zachary G. Schwam 1;  Barbara Burtness 2;  Wendell G. Yarbrough 1;  Saral Mehra 1;  Zain Husain 3;  Benjamin L. Judson 1
Působiště autorů: Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut 1;  Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut 2;  Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 3
Vyšlo v časopise: Cancer Medicine 2015; Early View(Early View)
Kategorie: Original Research
prolekare.web.journal.doi_sk: 10.1002/cam4.546

© 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Souhrn

Abstract:
Head and neck cancer patients presenting with distant metastases are generally considered incurable. Treatment patterns and survival by primary disease site and therapy have not been described. Retrospective cohort analysis of 2525 patients in the National Cancer Database (2003–2006). Kaplan–Meier and Cox proportional hazards analyses were performed. Combined locoregional and systemic therapy was the most common treatment regimen (39.2%), followed by no treatment (23.9%), locoregional (19.0%), and systemic treatment (17.8%). Multivariate analysis demonstrated decreased survival was associated with age 65–79 years hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.14–1.80), Medicaid/uninsured status (HR 1.27, 95% CI 1.13–1.42), Medicare/other government insurance (HR 1.21, 95% 1.07–1.38), treatment at a nonacademic/research program (HR 1.17, 95% CI 1.07–1.27), and Charlson comorbidity score of 1 (HR 1.33, 95% 1.19–1.48). Compared to systemic therapy alone, receiving locoregional and systemic therapy was associated with decreased risk of death (HR 0.73, 95% CI 0.65–0.83). Only 14.6% and 0.6% of patients were recorded as receiving palliative therapy or being enrolled in a clinical trial, respectively. Significant treatment diversity exists in distantly metastatic head and neck cancer. Those who received combination locoregional and systemic therapy were more likely to have improved overall survival, but important factors in treatment selection are unknown. A small proportion of patients was found to receive either palliative therapy or was enrolled in a clinical trial, although these data likely underestimate the true proportions.

Keywords:
Clinical trials as topic; head and neck cancer; neoplasm metastases; outcomes assessments; palliative care


Zdroje

1. De Bree, R., E. E. Deurloo, G. B. Snow, and C. R. Leemans. 2000. Screening for distant metastases in patients with head and neck cancer. Laryngoscope 110:397–401.

2. Dennington, M. L., D. R. Carter, and A. D. Meyers. 1980. Distant metastases in head and neck epidermoid carcinoma. Laryngoscope 90:196–201.

3. Black, R. J., J. L. Gluckman, and D. A. Shumrick. 1984. Screening for distant metastases in head and neck cancer patients. Aust. N. Z. J. Surg. 54:527–530.

4. Cooper, J. S., K. Porter, K. Mallin, and H. T. Hoffman. 2009. National Cancer Database report on cancer of the head and neck: 10-year update. Head Neck 31:748–758.

5. Ferlito, A., A. R. Shaha, C. E. Silver, A. Rinaldo, and V. Mondin. 2001. Incidence and sites of distant metastases from head and neck cancer. ORL J. Otorhinolaryngol. Relat. Spec. 63:202–207.

6. Kotwall, C., K. Sako, M. S. Razack, U. Rao, V. Bakamjian, and D. P. Shedd. 1987. Metastatic patterns in squamous cell cancer of the head and neck. Am. J. Surg. 154:439–442.

7. Colevas, A. D. 2006. Chemotherapy options for patients with metastatic or recurrent squamous cell carcinoma of the head and neck. J. Clin. Oncol. 24:2644–2652.

8. Zhen, W., L. H. Karnell, H. T. Hoffman, G. F. Funk, J. M. Buatti, and H. R. Menck. 2004. The National Cancer Data Base report on squamous cell carcinoma of the base of tongue. Head Neck 26:660–674.

9. Pfister, D. G., et al. 2015. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Head and Neck Cancers Version 1.2015. National Comprehensive Cancer Network, Inc. Available at www.NCCN.org (accessed 10 May 2015).

10. Florescu, C., and J. Thariat. 2014. Local ablative treatments of oligometastases from head and neck squamous cell carcinomas. Crit. Rev. Oncol. Hematol. 91:47–63.

11. Sinha, P., W. T. Thorstad, B. Nussenbaum, et al. 2014. Distant metastasis in p16-positive oropharyngeal squamous cell carcinoma: a critical analysis of patterns and outcomes. Oral Oncol. 50:45–51.

12. American College of Surgeons. National Cancer Data Base. Available at https://www.facs.org/quality%20programs/cancer/ncdb (accessed June 29, 2014).

13. Commission on Cancer. Facility Oncology Registry Data Standards (FORDS). Available at https://www.facs.org/~/media/files/quality%20programs/cancer/coc/fords/fords%20manual%202013.ashx (accessed July 1, 2014).

14. Fritz, A., C. Percy, A. Jack, et al. 2000. International classification of diseases for oncology, ICD-O, 3rd edn. World Health Organization, Geneva.

15. Greene, F. L., D. L. Page, I. D. Fleming, et al. 2002. AJCC cancer staging manual, 6th ed. Springer, New York, NY.

16. American College of Surgeons. National Cancer Data Base data dictionary. Available at http://ncdbpuf.facs.org/?q=print-pdf-all (accessed June 13, 2014).

17. United States Census Bureau. Census Regions and Divisions of the United States. Available at www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf (accessed June 29, 2014).

18. Rural-Urban Continuum Codes. United States Department of Agriculture Economic Research Service. Available at http://www.ers.usda.gov/data-products/rural-urban-continuum-codes (accessed March 14, 2015).

19. Luryi, A. L., M. M. Chen, S. Mehra, S. A. Roman, J. A. Sosa and B. L. Judson. 2015. Hospital re-admission and 30-day mortality following surgery for oral cavity cancer: analysis of 21,681 cases. Head Neck. doi: 10.1002/hed.23973

20. Deyo, R. A., D. C. Cherkin, and M. A. Ciol. 1992. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J. Clin. Epidemiol. 45:613–619.

21. Charlson, Me, P. Pompei, K. L. Ales, and C. R. MacKenzie. 1987. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chron. Dis. 40:373–383.

22. Argiris, A., S. Li, M. Ghebremichael, et al. 2014. Prognostic significant of human papillomavirus in recurrent or metastatic head and neck cancer: an analysis of Eastern Cooperative Oncology Group trials. Ann. Oncol. 25:1410–1416

23. Vermorken, J. B., A. Psyrri, R. Mesía, et al. 2014. Impact of tumor HPV status on outcome in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck receiving chemotherapy with or without cetuximab: retrospective analysis of the phase III EXTREME trial. Ann. Oncol. 25:801–807.

24. Rischin, D., R. J. Young, R. Fisher, et al. 2010. Prognostic significance of p16INK4A and human papillomavirus in patients with oropharyngeal cancer treated on TROG 02.02 phase III trial. J. Clin. Oncol. 28:4142–4148.

25. Sateren, W. B., E. L. Trimble, J. Abrams, et al. 2002. How sociodemographics, presence of oncology specialists, and hospital cancer programs affect accrual to cancer treatment trials. J. Clin. Oncol. 20:2109–2117.

26. Lara, P. N., R. Higdon, N. Lim, et al. 2001. Prospective evaluation of cancer clinical trial accrual patterns: identifying potential barriers to enrollment. J. Clin. Oncol. 19:1728–1733.

27. Murthy, V. H., H. M. Krumholz, and C. P. Gross. 2004. Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA 291:2720–2726.

28. Llewellyn-Thomas, H. A., M. K. McGreal, E. C. Thiel, S. Fine, and C. Erlichman. 1991. Patients' willingness to enter clinical trials: measuring the association with perceived benefit and preference for decision participation. Soc. Sci. Med. 32:35–42.

29. Goldstein, N. E., E. Genden, and R. S. Morrison. 2008. Palliative care for patients with head and neck cancer: “I would like a quick return to a normal lifestyle”. JAMA 299:1818–1825.

30. Temel, J. S., J. A. Greer, A. Muzikansky, et al. 2010. Early palliative care for patients with metastatic non-small-cell lung cancer. N. Engl. J. Med. 363:733–742.

31. Pirl, W. F., J. A. Greer, L. Traeger, et al. 2012. Depression and survival in metastatic non-small-cell lung cancer: effects of early palliative care. J. Clin. Oncol. 30:1310–1315.

32. de Graeff, A., J. R. de Leeuw, W. J. Ros, G. J. Hordijk, G. H. Blijham, and J. A. Winnubst. 2000. Pretreatment factors predicting quality of life after treatment for head and neck cancer. Head Neck 22:398–407.

33. Gritz, E. R., C. L. Carmack, C. de Moor, et al. 1999. First year after head and neck cancer: quality of life. J. Clin. Oncol. 17:352–360.

34. Langendijk, J. A., P. Doornaert, I. W. Verdonck-de Leeuw, C. R. Leemans, N. K. Aaronson, B. J. Slotman. 2008. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J. Clin. Oncol. 26:3770–3776.

35. Funk, G. F., L. H. Karnell, and A. J. Christensen. 2012. Long-term health-related quality of life in survivors of head and neck cancer. Arch. Otolaryngol. Head Neck Surg. 138:123–133.

36. Sciubba, J. J. 2009. End of life considerations in the head and neck cancer patient. Oral Oncol. 45:431–434.

37. Morrison, S. R., and D. E. Meier. 2004. Palliative care. N. Engl. J. Med. 350:2582–2590.

38. Field, M. J., and C. K. Cassel, eds. 1997. Approaching death: improving care at the end of life. National Academy Press, Washington, DC.

39. Calhoun, K. H., P. Fulmer, R. Weiss, and J. A. Hokanson. 1994. Distant metastases from head and neck squamous cell carcinomas. Laryngoscope 104:1199–1205.

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