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Kaplan\u2013Meier 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\u201379\u00a0years hazard ratio [HR] 1.43, 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] 1.14\u20131.80), Medicaid\/uninsured status (HR 1.27, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.13\u20131.42), Medicare\/other government insurance (HR 1.21, 95% 1.07\u20131.38), treatment at a nonacademic\/research program (HR 1.17, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.07\u20131.27), and Charlson comorbidity score of 1 (HR 1.33, 95% 1.19\u20131.48). Compared to systemic therapy alone, receiving locoregional and systemic therapy was associated with decreased risk of death (HR 0.73, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.65\u20130.83). 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.<\/jats:p>","DOI":"10.1002\/cam4.546","type":"journal-article","created":{"date-parts":[[2015,10,16]],"date-time":"2015-10-16T09:00:59Z","timestamp":1444986059000},"page":"1828-1835","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["National treatment patterns in patients presenting with Stage <scp>IVC<\/scp> head and neck cancer: analysis of the National Cancer Database"],"prefix":"10.1002","volume":"4","author":[{"given":"Zachary G.","family":"Schwam","sequence":"first","affiliation":[{"name":"Department of Surgery Section of Otolaryngology Yale University School of Medicine New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Burtness","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Section of Medical Oncology Yale University School of Medicine New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendell G.","family":"Yarbrough","sequence":"additional","affiliation":[{"name":"Department of Surgery Section of Otolaryngology Yale University School of Medicine New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saral","family":"Mehra","sequence":"additional","affiliation":[{"name":"Department of Surgery Section of Otolaryngology Yale University School of Medicine New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain","family":"Husain","sequence":"additional","affiliation":[{"name":"Department of Therapeutic Radiology Yale University School of Medicine New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin L.","family":"Judson","sequence":"additional","affiliation":[{"name":"Department of Surgery Section of Otolaryngology Yale University School of Medicine New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,10,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200003000-00012"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198002000-00002"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.1984.tb05440.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21022"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000055740"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(89)90020-2"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.05.3348"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20064"},{"key":"e_1_2_8_10_1","unstructured":"Pfister D. 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