Type of treatment, sex, race and insurance status are associated with survival rates among patients with advanced laryngeal cancer, according to a report in the December issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals.
About 10,000 U.S. men and women each year are diagnosed with cancer of the larynx, or voice box, according to background information in the article. For many years, total removal of the larynx (laryngectomy) followed by radiation therapy was the standard treatment. "Unfortunately, patients treated with total laryngectomy experience a complete loss of voice and may also experience impairment of swallowing function, leading to decreased quality of life in many aspects, including nutrition, social functioning and personal hygiene." Following additional clinical trials, some patients began receiving chemotherapy followed by radiation therapy as a larynx-preserving treatment.
Amy Y. Chen, M.D., M.P.H., of Emory University and the American Cancer Society, Atlanta, and Michael Halpern, M.D., Ph.D., also of the American Cancer Society, analyzed data from a national cancer registry containing 7,019 patients diagnosed with advanced laryngeal cancer between 1995 and 1998. Of these, 53.6 percent underwent total laryngectomy, 30.6 percent radiation therapy (radiotherapy) alone and 15.8 percent combined chemotherapy and radiotherapy.
"Controlling for the other included factors, the radiotherapy and chemo-radiotherapy groups had lower odds of survival than did the total laryngectomy group," the authors write. "The increased risk associated with death is approximately 30 percent for the chemo-radiotherapy group and 60 percent for the radiotherapy group."
In addition, men were less likely to survive than women, those with stage IV disease were less likely to survive than those at stage III, black patients were more likely to die than white patients and uninsured patients and those with Medicaid, Medicare or other government health plan coverage were more likely to die than those with private insurance. "We do not believe that insurance status in this analysis represents differential treatment or quality of care for patients with advanced laryngeal cancer," the authors write. "Rather, insurance status is likely a proxy for multiple medical care issues, including usual source of medical care, participation in screening and preventive care activities and exposure to related risk factors, including alcohol and/or tobacco use and poor diet, all of which can influence overall survival."
"In conclusion, this analysis demonstrates that total laryngectomy yields the highest likelihood of survival for patients with advanced laryngeal cancer," the authors write. "These results differ from those of previous analyses comparing total laryngectomy and chemo-radiotherapy, suggesting that caution is needed when applying clinical trial findings to broader medical care settings and populations."
(Arch Otolaryngol Head Neck Surg. 2007;133(12):1270-1276. Available pre-embargo to the media at www.jamamedia.org.)
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