Quality of care and short and long-term outcomes of oropharyngeal cancer care in the elderly

Objective To examine associations between quality, short-term and long-term treatment-related outcomes, and costs in elderly patients treated for oropharyngeal squamous cell cancer (OPSCC). Methods We retrospectively evaluated Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 666 patients diagnosed with OPSCC from 2004 to 2007 using multivariate regression and survival analysis. Quality indicators were derived from guidelines for recommended care and performance measures. Results Higher quality care was associated with lower risk of death in patients with dysphagia (hazard ratio [HR] = 0.44 [0.32-0.60]), weight loss (HR = 0.42 [0.28-0.62]), gastrostomy (HR = 0.47 [0.33-0.68]), airway obstruction (HR = 0.41 [0.27-0.62]), tracheostomy (HR = 0.17 [0.05-0.67]), and pneumonia (HR = 0.53 [0.33-0.85]). There were no significant differences in mean incremental costs associated with airway and swallowing impairment for patients receiving higher quality care. Conclusions Higher quality OPSCC care was associated with improved survival in elderly patients with airway and swallowing impairment. These data suggest that greater adherence to evidence-based guidelines has favorable implications for long-term outcomes.