Improvements in survival and disparities for advanced-stage laryngeal cancer

Blake Joseph LeBlanc, Runhua Shi, Vikas Mehta, Glenn Mills, Federico Ampil, Cherie Ann O Nathan

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

IMPORTANCE: Laryngeal cancer survival rates have declined over the past 2 decades. Primary surgical therapy may increase survival rates in advanced-stage tumors. OBJECTIVE: To compare survival outcomes for initial surgical treatment of advanced-stage primary tumors in the Louisiana health system with outcomes in the National Cancer Database (NCDB). DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis was conducted at an academic tertiary referral hospital. Patients diagnosed as having laryngeal carcinoma between 1998 and 2007 were identified via a tumor registry. Louisiana State University Health-Shreveport (LSU Health) data and national data from 2000 to 2010 were obtained from the NCDB of the American College of Surgeons. INTERVENTIONS: Treatment of laryngeal cancer. MAIN OUTCOMES AND MEASURES: Age, sex, race/ethnicity, socioeconomic status, laryngeal subsite, stage, primary treatment modality, and observed survival were analyzed and compared. RESULTS: A total of 165 patients treated at LSU Health met the inclusion criteria. One hundred seventeen (70.91%) presented with advanced-stage (III/IV) disease, compared with 46.67% nationwide (P < .01). For stage IV disease our 5-year survival rate was 55.54% (95% CI, 43.35%-66.11%) compared with 31.60% (95% CI, 30.40%-32.90%) nationally (P < .05). Our proportion of uninsured patients was 23.73% vs 5.05% of patients nationally (P < .001), and our patients traveled further distances for care with 60.47% traveling 50 miles or more, compared with 15.87% nationally (P < .001). Sixty-four of the patients with advanced-stage disease (54.70%) underwent primary surgical therapy to include total laryngectomy. Data from the NCDB indicate that the rate of laryngectomy declined from 40% to 60% in the 1980s to 32% in 2007. CONCLUSIONS AND RELEVANCE: Louisiana State University Health-Shreveport treated more uninsured patients with advanced-stage laryngeal cancer compared with national data but demonstrated higher survival rates for those with advanced-stage disease. The results also demonstrate that we have continued a high rate of primary surgical therapy for advanced-stage disease, despite the national trend toward organ preservation. We believe that upfront laryngectomy may explain our higher survival rates for advanced-stage laryngeal cancer.

Original languageEnglish (US)
Pages (from-to)169-173
Number of pages5
JournalJAMA Otolaryngology - Head and Neck Surgery
Volume141
Issue number2
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

Fingerprint

Laryngeal Neoplasms
Survival
Survival Rate
Laryngectomy
Neoplasms
Health
Databases
Therapeutics
Organ Preservation
Tertiary Care Centers
Social Class
Registries
Carcinoma

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery
  • Medicine(all)

Cite this

Improvements in survival and disparities for advanced-stage laryngeal cancer. / LeBlanc, Blake Joseph; Shi, Runhua; Mehta, Vikas; Mills, Glenn; Ampil, Federico; Nathan, Cherie Ann O.

In: JAMA Otolaryngology - Head and Neck Surgery, Vol. 141, No. 2, 01.02.2015, p. 169-173.

Research output: Contribution to journalArticle

LeBlanc, Blake Joseph ; Shi, Runhua ; Mehta, Vikas ; Mills, Glenn ; Ampil, Federico ; Nathan, Cherie Ann O. / Improvements in survival and disparities for advanced-stage laryngeal cancer. In: JAMA Otolaryngology - Head and Neck Surgery. 2015 ; Vol. 141, No. 2. pp. 169-173.
@article{42c23673df4d47e49d145a9657107bf9,
title = "Improvements in survival and disparities for advanced-stage laryngeal cancer",
abstract = "IMPORTANCE: Laryngeal cancer survival rates have declined over the past 2 decades. Primary surgical therapy may increase survival rates in advanced-stage tumors. OBJECTIVE: To compare survival outcomes for initial surgical treatment of advanced-stage primary tumors in the Louisiana health system with outcomes in the National Cancer Database (NCDB). DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis was conducted at an academic tertiary referral hospital. Patients diagnosed as having laryngeal carcinoma between 1998 and 2007 were identified via a tumor registry. Louisiana State University Health-Shreveport (LSU Health) data and national data from 2000 to 2010 were obtained from the NCDB of the American College of Surgeons. INTERVENTIONS: Treatment of laryngeal cancer. MAIN OUTCOMES AND MEASURES: Age, sex, race/ethnicity, socioeconomic status, laryngeal subsite, stage, primary treatment modality, and observed survival were analyzed and compared. RESULTS: A total of 165 patients treated at LSU Health met the inclusion criteria. One hundred seventeen (70.91{\%}) presented with advanced-stage (III/IV) disease, compared with 46.67{\%} nationwide (P < .01). For stage IV disease our 5-year survival rate was 55.54{\%} (95{\%} CI, 43.35{\%}-66.11{\%}) compared with 31.60{\%} (95{\%} CI, 30.40{\%}-32.90{\%}) nationally (P < .05). Our proportion of uninsured patients was 23.73{\%} vs 5.05{\%} of patients nationally (P < .001), and our patients traveled further distances for care with 60.47{\%} traveling 50 miles or more, compared with 15.87{\%} nationally (P < .001). Sixty-four of the patients with advanced-stage disease (54.70{\%}) underwent primary surgical therapy to include total laryngectomy. Data from the NCDB indicate that the rate of laryngectomy declined from 40{\%} to 60{\%} in the 1980s to 32{\%} in 2007. CONCLUSIONS AND RELEVANCE: Louisiana State University Health-Shreveport treated more uninsured patients with advanced-stage laryngeal cancer compared with national data but demonstrated higher survival rates for those with advanced-stage disease. The results also demonstrate that we have continued a high rate of primary surgical therapy for advanced-stage disease, despite the national trend toward organ preservation. We believe that upfront laryngectomy may explain our higher survival rates for advanced-stage laryngeal cancer.",
author = "LeBlanc, {Blake Joseph} and Runhua Shi and Vikas Mehta and Glenn Mills and Federico Ampil and Nathan, {Cherie Ann O}",
year = "2015",
month = "2",
day = "1",
doi = "10.1001/jamaoto.2014.2998",
language = "English (US)",
volume = "141",
pages = "169--173",
journal = "Archives of Otolaryngology",
issn = "2168-6181",
publisher = "American Medical Association",
number = "2",

}

TY - JOUR

T1 - Improvements in survival and disparities for advanced-stage laryngeal cancer

AU - LeBlanc, Blake Joseph

AU - Shi, Runhua

AU - Mehta, Vikas

AU - Mills, Glenn

AU - Ampil, Federico

AU - Nathan, Cherie Ann O

PY - 2015/2/1

Y1 - 2015/2/1

N2 - IMPORTANCE: Laryngeal cancer survival rates have declined over the past 2 decades. Primary surgical therapy may increase survival rates in advanced-stage tumors. OBJECTIVE: To compare survival outcomes for initial surgical treatment of advanced-stage primary tumors in the Louisiana health system with outcomes in the National Cancer Database (NCDB). DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis was conducted at an academic tertiary referral hospital. Patients diagnosed as having laryngeal carcinoma between 1998 and 2007 were identified via a tumor registry. Louisiana State University Health-Shreveport (LSU Health) data and national data from 2000 to 2010 were obtained from the NCDB of the American College of Surgeons. INTERVENTIONS: Treatment of laryngeal cancer. MAIN OUTCOMES AND MEASURES: Age, sex, race/ethnicity, socioeconomic status, laryngeal subsite, stage, primary treatment modality, and observed survival were analyzed and compared. RESULTS: A total of 165 patients treated at LSU Health met the inclusion criteria. One hundred seventeen (70.91%) presented with advanced-stage (III/IV) disease, compared with 46.67% nationwide (P < .01). For stage IV disease our 5-year survival rate was 55.54% (95% CI, 43.35%-66.11%) compared with 31.60% (95% CI, 30.40%-32.90%) nationally (P < .05). Our proportion of uninsured patients was 23.73% vs 5.05% of patients nationally (P < .001), and our patients traveled further distances for care with 60.47% traveling 50 miles or more, compared with 15.87% nationally (P < .001). Sixty-four of the patients with advanced-stage disease (54.70%) underwent primary surgical therapy to include total laryngectomy. Data from the NCDB indicate that the rate of laryngectomy declined from 40% to 60% in the 1980s to 32% in 2007. CONCLUSIONS AND RELEVANCE: Louisiana State University Health-Shreveport treated more uninsured patients with advanced-stage laryngeal cancer compared with national data but demonstrated higher survival rates for those with advanced-stage disease. The results also demonstrate that we have continued a high rate of primary surgical therapy for advanced-stage disease, despite the national trend toward organ preservation. We believe that upfront laryngectomy may explain our higher survival rates for advanced-stage laryngeal cancer.

AB - IMPORTANCE: Laryngeal cancer survival rates have declined over the past 2 decades. Primary surgical therapy may increase survival rates in advanced-stage tumors. OBJECTIVE: To compare survival outcomes for initial surgical treatment of advanced-stage primary tumors in the Louisiana health system with outcomes in the National Cancer Database (NCDB). DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis was conducted at an academic tertiary referral hospital. Patients diagnosed as having laryngeal carcinoma between 1998 and 2007 were identified via a tumor registry. Louisiana State University Health-Shreveport (LSU Health) data and national data from 2000 to 2010 were obtained from the NCDB of the American College of Surgeons. INTERVENTIONS: Treatment of laryngeal cancer. MAIN OUTCOMES AND MEASURES: Age, sex, race/ethnicity, socioeconomic status, laryngeal subsite, stage, primary treatment modality, and observed survival were analyzed and compared. RESULTS: A total of 165 patients treated at LSU Health met the inclusion criteria. One hundred seventeen (70.91%) presented with advanced-stage (III/IV) disease, compared with 46.67% nationwide (P < .01). For stage IV disease our 5-year survival rate was 55.54% (95% CI, 43.35%-66.11%) compared with 31.60% (95% CI, 30.40%-32.90%) nationally (P < .05). Our proportion of uninsured patients was 23.73% vs 5.05% of patients nationally (P < .001), and our patients traveled further distances for care with 60.47% traveling 50 miles or more, compared with 15.87% nationally (P < .001). Sixty-four of the patients with advanced-stage disease (54.70%) underwent primary surgical therapy to include total laryngectomy. Data from the NCDB indicate that the rate of laryngectomy declined from 40% to 60% in the 1980s to 32% in 2007. CONCLUSIONS AND RELEVANCE: Louisiana State University Health-Shreveport treated more uninsured patients with advanced-stage laryngeal cancer compared with national data but demonstrated higher survival rates for those with advanced-stage disease. The results also demonstrate that we have continued a high rate of primary surgical therapy for advanced-stage disease, despite the national trend toward organ preservation. We believe that upfront laryngectomy may explain our higher survival rates for advanced-stage laryngeal cancer.

UR - http://www.scopus.com/inward/record.url?scp=84923266542&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84923266542&partnerID=8YFLogxK

U2 - 10.1001/jamaoto.2014.2998

DO - 10.1001/jamaoto.2014.2998

M3 - Article

VL - 141

SP - 169

EP - 173

JO - Archives of Otolaryngology

JF - Archives of Otolaryngology

SN - 2168-6181

IS - 2

ER -