Speech-language pathology care and short- and long-term outcomes of laryngeal cancer treatment in the elderly

Abstract

Objectives/hypothesis: To examine associations between speech-language pathology (SLP) care and pretreatment variables, swallowing and airway impairment, and survival in elderly patients treated for laryngeal cancer.

Study design: Retrospective analysis of surveillance, epidemiology, and end results (SEER)-Medicare data.

Methods: We evaluated longitudinal data from 2,370 patients diagnosed with laryngeal cancer from 2004 to 2007 using cross-tabulations, multivariate logistic regression, and survival analysis.

Results: Initial treatment with total laryngectomy (odds ratio [OR] = 3.3 [1.6-6.8]), and dysphagia during treatment (OR = 4.0 [2.2-7.2]) were the only significant predictors of SLP care during the initial treatment period. Speech-language pathology care was more likely during the first year (OR = 4.1 [2.7-6.0]) and second year (OR = 1.6 [1.1-2.3]) following initial treatment; however, only 23.7% of patients ever received SLP care. Pretreatment tracheostomy tube placement (OR = 2.8 [1.1-7.0]), initial treatment with total laryngectomy (OR = 3.4 [2.0-5.6]), dysphagia (OR = 7.6 [5.5-10.4]), stricture (OR = 1.9 [1.1-3.1]), interval tracheostomy tube placement (OR = 3.5 [2.4-5.2]), and salvage surgery (OR = 3.1 [1.6-5.8]) were significantly associated with long-term SLP care. After controlling for relevant variables, SLP care was associated with significant relative attenuation of the OR for dysphagia (50%), stricture (26%), weight loss (20%), and pneumonia (21%). Hazards ratio for death, if under SLP care, was 0.83 (0.70-0.99).

Conclusion: SLP care is underutilized in elderly laryngeal cancer patients and is largely reserved for select patients in anticipation of total laryngectomy or after the onset of impaired airway and swallowing function, but is associated with improved outcomes. These data suggest a need for treatment guidelines that incorporate the routine use of SLP care during the initial treatment period and beyond.

Level of evidence: 2c.

Keywords: Laryngeal cancer; SEER-Medicare; chemotherapy; dysphagia; elderly; outcomes; radiation; speech-language pathology; surgery; survival; swallowing; treatment.