In a study reported in the October issue of Archives of Otolaryngology – Head & Neck Surgery, Amy Y. Chen, MD, MPH, and colleagues at Emory University and the American Cancer Society, found that surgery performed during early-stage laryngeal cancer (cancer of the voicebox) has increased over the years, with a corresponding decrease in radiation.
According to the researchers, the proportion among patients with early-stage cancer receiving primary surgery increased from 20 percent in 1985 to 33 percent in 2007, while the use of radiation decreased from 64 percent to 52 percent. The four year-survival rate for patients with early-stage laryngeal cancer treated with surgery was higher than the rate for those treated with radiation therapy – 79 percent vs. 71 percent.
The data also showed that patients with advanced-stage cancer who were treated with chemoradiation increased from less than 7 percent to 45 percent, and the use of total laryngectomy decreased from 42 percent to 32 percent.
Advanced-stage patients who had total laryngectomy had a four-year survival rate of 51 percent. The survival rate for patients treated with chemoradiation was 48 percent and for those treated with radiation therapy, the survival rate was 38 percent.
Additionally, the researchers found that patients who lived in areas with higher socioeconomic status zip codes and who had private insurance were more likely to be treated with surgery for early-stage laryngeal cancer and to receive chemoradiation for advanced-stage cancer. They also found that early stage patients who were not African American, and who were treated at academic facilities, were more likely to receive surgery. Younger patients with advanced-stage cancer were more likely to be treated with chemoradiation.
“Not only were clinical factors associated with the type of treatment,” say the researchers, “but select sociodemographic elements were also associated with treatment.”
The authors conclude that further investigation into the decision-making process of patients with different sociodemographic backgrounds will assist in alleviating the differences in survival for this group of patients.
Chen is a professor in the Department of Otolarygology – Head & Neck Cancer at Emory University School of Medicine and the Department of Health Services Research, American Cancer Society. Other researchers include Stacey Fedewa, Health Services Research, American Cancer Society and Jason Zhu, Emory University School of Medicine.
The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service.
Contacts: Kathi Baker: 404 727 9371