{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T08:24:18Z","timestamp":1777364658850,"version":"3.51.4"},"reference-count":26,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2017,12,15]],"date-time":"2017-12-15T00:00:00Z","timestamp":1513296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"American Academy of Otolaryngology-Head and Neck Surgery Percy Memorial Research Award"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine associations between quality of care, survival, and costs in elderly patients treated for oropharyngeal squamous cell cancer (OPSCC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective analysis of Surveillance, Epidemiology, and End Results\u2010Medicare 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 multivariate regression and survival analysis. Using quality indicators derived from guidelines for recommended care, summary measures of quality were calculated for diagnosis, initial treatment, surveillance, treatment for recurrence, end\u2010of\u2010life care, performance, and an overall summary measure of quality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Higher\u2010quality care was associated with significant differences in survival for initial treatment (hazard ratio [HR]\u2009=\u20090.55 [0.41 to 0.73]), surveillance (HR\u2009=\u20090.32 [0.22 to 0.48]), treatment of recurrence (HR\u2009=\u20092.37 [1.56 to 3.60]), performance measures (HR\u2009=\u20090.50 [0.36 to 0.69]), and the overall summary measure of quality (HR\u2009=\u20090.53 [0.39 to 0.71]). Higher\u2010quality salvage surgery was associated with improved survival (HR\u2009=\u20090.16 [0.04 to 0.54]), whereas higher\u2010quality chemotherapy given for recurrence was associated with worse survival (HR\u2009=\u20095.70 [1.92 to 16.94]). Overall, higher\u2010quality care was not associated with differences in costs. Higher\u2010quality care was associated with significantly lower mean incremental costs for treatment of recurrence and end\u2010of\u2010life care, and higher costs for diagnosis and surveillance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Higher\u2010quality OPSCC care in elderly patients was associated with improved survival; however, higher\u2010quality care was not associated with reduced costs, and higher\u2010quality care for treatment of recurrence was associated with poorer survival, primarily due to poorer survival in patients treated with palliative chemotherapy. These data demonstrate a complex relationship between quality and costs in elderly OPSCC patients, which can be used to frame discussions of value and guide disease\u2010specific quality\u2010measure development.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>2c. <jats:italic>Laryngoscope<\/jats:italic>, 128:2312\u20132319, 2018<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27050","type":"journal-article","created":{"date-parts":[[2017,12,16]],"date-time":"2017-12-16T21:28:10Z","timestamp":1513459690000},"page":"2312-2319","source":"Crossref","is-referenced-by-count":5,"title":["Quality indicators 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 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":"Carole","family":"Fakhry","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery 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":"Department of Oncology Sidney Kimmel Comprehensive Cancer Center at John Hopkins 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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9499-1516","authenticated-orcid":false,"given":"Wayne M.","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery 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 Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin D.","family":"Frick","sequence":"additional","affiliation":[{"name":"Department of Oncology Sidney Kimmel Comprehensive Cancer Center at John Hopkins Baltimore Maryland U.S.A."},{"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":[[2017,12,15]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Centers for Medicare & Medicaid Services.2016\u20102025 Projections of National Health Expenditures Data Released. 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