{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T12:25:01Z","timestamp":1761395101529,"version":"3.37.3"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,10,8]],"date-time":"2017-10-08T00:00:00Z","timestamp":1507420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005193","name":"American Academy of Otolaryngology-Head and Neck Surgery","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005193","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>To examine associations between treatment, survival, and costs in elderly patients with oropharyngeal squamous cell cancer (OPSCC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cross\u2010sectional analysis of Surveillance, Epidemiology, and End Results\u2013Medicare data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated 666 patients diagnosed with OPSCC from 2004 to 2007 using cross\u2010tabulations, multivariate logistic and generalized linear regression modeling, and survival analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The majority of patients were nonsmokers (79%), had advanced\u2010stage disease (59%), and received chemoradiation (38%) or radiation (28%). Surgery with postoperative radiation (hazard ratio [HR]: 0.33 [95% CI: 0.20\u20100.53]) and chemoradiation (HR: 0.45 [95% CI: 0.29\u20100.71]) were associated with improved survival, whereas stage IV disease was associated with poorer survival (HR: 1.95 [95% CI: 1.13\u20103.38]). Additional cancer\u2010directed treatment after primary treatment was more likely following chemoradiation (odds ratio [OR]: 3.44 [95% CI: 1.78\u20106.63]). Salvage surgery was performed in 25% of patients undergoing subsequent additional cancer\u2010directed treatment, and was associated with high\u2010volume hospitals (OR: 2.81 [95% CI: 1.07\u20107.74]). Additional radiation (HR: 0.47 [95% CI: 0.31\u20100.72]) and salvage surgery (HR: 0.61 [95% CI: 0.38\u20100.99]) were associated with improved overall survival when performed &gt;6 months following initial treatment, whereas salvage neck dissection alone was not significantly associated with survival after controlling for time to salvage (HR: 0.38 [95% CI: 0.05\u20102.78]). Treatment and 5\u2010year overall costs were highest for chemoradiation, surgery with postoperative radiation, and additional cancer\u2010directed treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Multimodality treatment in elderly OPSCC patients was associated with improved survival and increased costs. Chemoradiation was associated with an increased likelihood of additional cancer\u2010directed treatment. Salvage surgery was centralized at high\u2010volume hospitals, and was associated with improved survival when performed &gt;6 months after last initial treatment date, but was performed in &lt;20% of patients undergoing additional treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>2c. <jats:italic>Laryngoscope<\/jats:italic>, 128:1103\u20131112, 2018<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.26887","type":"journal-article","created":{"date-parts":[[2017,10,8]],"date-time":"2017-10-08T05:06:41Z","timestamp":1507439201000},"page":"1103-1112","source":"Crossref","is-referenced-by-count":6,"title":["Treatment, survival, and costs of oropharyngeal cancer care in the elderly"],"prefix":"10.1002","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5134-9307","authenticated-orcid":false,"given":"Christine G.","family":"Gourin","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Johns Hopkins University Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carole","family":"Fakhry","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Johns Hopkins University Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry","family":"Quon","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyunseok","family":"Kang","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Comprehensive Cancer Center Johns Hopkins University Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana P.","family":"Kiess","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J.","family":"Herbert","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Eisele","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Johns Hopkins University Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin D.","family":"Frick","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore Maryland U.S.A."},{"name":"Johns Hopkins Carey Business School Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,10,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000240182.61922.31"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24296"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.14.8841"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.11.026"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-8140(02)00404-8"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2013.07.010"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.43.6097"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2016.1804"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30495"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa053422"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27419"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2009.04.014"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11864-009-0105-5"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0912217"},{"key":"e_1_2_6_16_1","unstructured":"National Cancer Institute Surveillance Epidemiology and End Results Program: cancer statistics.Compare statistics by age. 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