Background Despite advantages in terms of cancer control and organ preservation, the benefits of chemoradiation (CTRT) may be offset by potentially severe, treatment-related toxicities particularly in older patients. Our objectives were to assess the type and frequency of toxicities in older adults with locally or regionally advanced, head and neck squamous cell carcinoma of the (HNSCC) receiving either primary CTRT or RT alone. Methods Using SEER cancer registry data linked with Medicare claims, we identified patients aged 66 years or older with locally advanced HNSCC, diagnosed 2001–2009, who received CTRT or RT alone. We examined differences in the frequency of toxicity-related hospital admissions and emergency room (ER) visits as well as feeding tube use and estimated the impact of chemotherapy on the likelihood of toxicity, controlling for demographic and disease characteristics. Results Of patients who received CTRT (N=1,502), 62% had a treatment-related toxicity, compared with 46% of patients who received RT alone (N=775). Controlling for demographic and disease characteristics, CTRT patients were twice as likely to experience an acute toxicity compared with their RT only peers. Fifty-five percent of CTRT patients had a feeding tube placed during or after treatment compared with 28% of the RT-only group. Conclusions In this population-based cohort of older adults with HNSCC, the rate of acute toxicities and feeding tube use in patients receiving CTRT was considerable. It is possible that for certain older patients, the potential benefit of adding CT to RT does not outweigh the harms of this combined modality therapy.

Objective Primary curative treatment of advanced laryngeal cancer may include surgery or chemoradiation, although recommendations vary and both are associated with complications. We evaluated predictors and trends in the use of these modalities and compared rates of complications and overall survival in a population-based cohort of older adults. Study Design Retrospective population-based cohort study Methods Using SEER cancer registry data linked with Medicare claims, we identified patients over 65 with advanced laryngeal cancer diagnosed 1999-2007 who had total laryngectomy (TL) or chemoradiation (CTRT) within 6 months following diagnosis. We identified complications and estimated the impact of treatment on overall survival, using propensity score methods. Results The proportion of patients receiving TL declined from 74% in 1999 to 26% in 2007 (p<0.0001). Almost 20% of CTRT patients had a tracheostomy following treatment and 57% had a feeding tube. TL was associated with an 18% lower risk of death, adjusting for patient and disease characteristics. The benefit of TL was greatest in patients with the highest propensity to receive surgery. Conclusion TL remains an important treatment option in well selected older patients. However, treatment selection is complex and, factors such as functional status, patient preference, surgeon expertise and post-treatment support services should play a role in treatment decisions.

BACKGROUND Pancreatic cancer poses a substantial morbidity and mortality burden in the United States, and predominantly affects older adults. The objective of this study was to estimate the direct medical costs of pancreatic cancer treatment in a population-based cohort of Medicare beneficiaries, and the contribution of different treatment modalities and health care services to the total cost of care and trends in costs over time. METHODS In the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, pancreatic cancer patients were identified who were aged 66 years or older and who were diagnosed from 2000 to 2007. Total direct medical costs were estimated from Medicare payments overall and within categories of care. Costs attributable to pancreatic cancer were estimated by subtracting the costs of medical care in a matched cohort of cancer-free beneficiaries. RESULTS A total of 15,037 patients were identified, of whom 97% were observed from diagnosis until death. Mean total direct medical costs were $65,500. Mean total costs were greater for patients with resectable locoregional disease ($134,700) than for those with unresectable locoregional or distant disease ($65,300 and $49,000, respectively). Hospitalizations and cancer-directed procedures collectively accounted for the largest fraction of health care costs. The total cost of care appeared to increase slightly over the study period (P = .05). The mean costs attributable to pancreatic cancer were $61,700. CONCLUSIONS Despite poor prognosis and short survival, the economic burden of pancreatic cancer in the elderly is substantial. Demographic trends, greater use of targeted therapies, and possible implementation of screening strategies are likely to impact treatment patterns and costs in the future.

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