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

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, 2017

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