Weight loss after head and neck cancer: A dynamic relationship with depressive symptoms

BACKGROUND

Weight loss and depressive symptoms are critical head and neck cancer outcomes, yet their relation over the illness course is unclear.

METHODS

Associations between self-reported depressive symptoms and objective weight loss across the year after head and neck cancer diagnosis were examined using growth curve modeling techniques (n = 564).

RESULTS

A reciprocal covariation pattern emerged-changes in depressive symptoms over time were associated with same-month changes in weight loss (t [1148] = 2.05; p = .041), and changes in weight loss were associated with same-month changes in depressive symptoms (t [556] = 2.43; p = .015). To the extent that depressive symptoms increased, patients lost incrementally more weight than was lost due to the passage of time and vice versa. Results also suggested that pain and eating-related quality of life might explain the reciprocal association between depressive symptoms and weight loss.

CONCLUSION

In head and neck cancer, a transactional interplay between depressive symptoms and weight loss unfolds over time. © 2016 Wiley Periodicals, Inc. Head Neck 39: 370-379, 2017.

Free Tissue Transfer versus Pedicled Flap Cost in Head and Neck Cancer

OBJECTIVE: We sought to compare the overall 1-year management costs for patients receiving a free tissue transfer with those of patients receiving a pedicled flap reconstruction as a component of their primary head and neck cancer treatment.

STUDY DESIGN AND SETTING: Case-control, cost identification analysis of 21 matched pairs of patients and multivariate analysis of variables associated with treatment costs was conducted in a tertiary referral academic institution.

RESULTS: No significant difference in total 1-year charges between the pedicled and free tissue transfer groups was found. A structured measure of patient comorbidity was the only variable significantly associated with total 1-year charges.

CONCLUSIONS: Total 1-year treatment costs of primary upper aerodigestive tract cancers are similar for patients reconstructed with free tissue transfer or a pedicled flap.

SIGNIFICANCE: Within the context of overall 1-year management costs, the primary determinants of health care expense for these patients are comorbidity and extent of disease, not reconstructive technique.

Influence of body composition on survival in patients with head and neck cancer

BACKGROUND

Recent evidence has suggested links between obesity and outcomes for various types of cancer. This study investigates the impact that body composition has on survival in patients with head and neck cancer.

METHODS

Data prospectively collected from 578 patients were analyzed using Cox regression models to determine independent associations that pretreatment body mass index (BMI) and 3-month weight change have on observed survival.

RESULTS

Higher BMIs were associated with better survival (p < .001). Five-year rates ranged from 33.8% for underweight to 75.3% for overweight/obese patients. Patients with stable weight had the highest 5-year rate (72.6%; p = .019), whereas patients who gained ≥5% had worse survival (45.8%) than those who lost ≥5% (65.8%). BMI independently predicted survival, whereas weight change was not an independent predictor.

CONCLUSION

This demonstrated association between BMI and survival provides useful information when offering prognoses and investigating optimal treatments © 2015 Wiley Periodicals, Inc. Head Neck 38: E261-E267, 2016.

Fear of recurrence impacts health-related quality of life and continued tobacco use in head and neck cancer survivors

OBJECTIVE

To examine the impact of fear of recurrence (FOR) on health-related quality of life (HRQOL) and tobacco use among head and neck cancer (HNC) survivors.

METHODS

A cross-sectional subset of patients (N = 138) from a large, prospective study of oncologic outcomes in HNC was assessed for FOR, in addition to the parent study's ongoing assessments of HRQOL and tobacco use. FOR was measured using the Fear of Cancer Recurrence Inventory and HNC-specific HRQOL was assessed with the Head and Neck Cancer Inventory (HNCI). Tobacco use was patient-reported as "Current," "Previous," or "Never."

RESULTS

After controlling for relevant clinical and demographic variables, hierarchical regression analyses revealed that higher FOR significantly predicted lower HRQOL across all HNCI domains (eating (p < .05), aesthetics (p < .01), speech (p < .01), and social disruption (p = .001)) and increased tobacco use (p < .01). A total of 60.1% of the sample expressed clinically significant levels of FOR. These patients reported lower HRQOL (eating: p < .05, aesthetics: p < .05, social disruption: p < .05) and were more likely to be using tobacco compared with patients with subclinical FOR (26.6% and 4.9%, respectively; p < .01).

CONCLUSIONS

Results suggest that FOR is prevalent among HNC survivors and is related to decreased HRQOL and increased tobacco use.

Psychological factors associated with head and neck cancer treatment and survivorship: evidence and opportunities for behavioral medicine

Individuals diagnosed with head and neck cancer (HNC) not only face a potentially life-threatening diagnosis but must endure treatment that often results in significant, highly visible disfigurement and disruptions of essential functioning, such as deficits or complications in eating, swallowing, breathing, and speech. Each year, approximately 650,000 new cases are diagnosed, making HNC the 6th most common type of cancer in the world. Despite this, however, HNC remains understudied in behavioral medicine. In this article, the authors review available evidence regarding several important psychosocial and behavioral factors associated with HNC diagnosis, treatment, and recovery, as well as various psychosocial interventions conducted in this patient population, before concluding with opportunities for behavioral medicine research and practice.

Factors associated with mortality in 2-year survivors of head and neck cancer

OBJECTIVES

To determine conditional survival rates of 2-year survivors of head and neck cancer and to identify risk factors of increased mortality.

DESIGN

Prospective, observational study conducted from September 1, 2001, through September 31, 2008.

SETTING

Tertiary care institution.

PATIENTS

Two hundred seventy-six patients who survived 2 years after the diagnosis of their upper aerodigestive carcinoma.

INTERVENTION

Patients prospectively provided health-related information.

MAIN OUTCOME MEASURES

The primary outcomes were observed (death from all causes) and disease-specific (cancer-related) survival for 2-year survivors.

RESULTS

Five-year observed (90.8%) and disease-specific (94.8%) survival rates were 29.7 and 25.0 percentage points higher, respectively, than rates calculated for all patients at diagnosis. Older age and advanced stage were associated with poorer survival, whether death was due to the cancer or from all causes. Patients with pain or poor overall quality of life at 2 years were more likely to die from all causes, whereas those still smoking 2 years after diagnosis were more likely to die from their cancer.

CONCLUSIONS

In addition to older age and advanced stage, pain, poor overall quality of life, and tobacco use 2 years after diagnosis characterize patients who might need longer and more intense follow-up care to improve their observed and disease-specific survival. This information is useful in developing management plans for patients transitioning from a focus on cancer surveillance into survivorship.

Association between severity of dysphagia and survival in patients with head and neck cancer

BACKGROUND

This study examined risk factors for dysphagia, a common and serious condition in patients with head and neck cancer, and the association between severity of dysphagia and survival.

METHODS

Chart reviews were performed on patients diagnosed with head and neck cancer between January 2001 and April 2003, who had dysphagia diagnoses or swallowing evaluations. Regression analyses determined factors associated with dysphagia and the association between observed survival and severity of dysphagia.

RESULTS

Almost 50% of the 407 patients had dysphagia. Risk factors included advanced stage, older age, female sex, and hypopharyngeal tumors. The most severe dysphagia ([L.] nil per os or "nothing by mouth" status), which was associated with lower survival rates, was the strongest independent predictor of survival.

CONCLUSIONS

Swallowing problems should be considered when determining appropriate cancer-directed treatment and posttreatment care. Because of dysphagia's high incidence rate and association with survival, a speech-language pathologist should be involved to ensure routine diagnostic and therapeutic swallowing interventions.

Continued alcohol use in patients with head and neck cancer

BACKGROUND

The effect of posttreatment alcohol consumption on health-related quality of life (QOL) and factors predicting overall QOL and continued alcohol consumption were examined in patients with head and neck cancer.

METHODS

Self-reported alcohol use and abuse 1 year after diagnosis was analyzed.

RESULTS

Although current drinkers (44.5% of 283 patients) had better overall QOL and fewer depressive symptoms, current social drinkers had the best scores, whereas current problem drinkers had the worst. Female sex, fewer depressive symptoms, less pain, and better eating function predicted better QOL. Oral function was the only predictor of 12-month alcohol use.

CONCLUSION

Depression, pain, and eating function predicted overall QOL. Alcohol consumption was not associated with QOL, but was associated with better oral function, which in turn predicted better QOL. Alcohol consumption itself does not improve QOL in this population, and these patients should be counseled regarding detrimental effects of continued drinking after treatment.

Outcomes after the use of gastrostomy tubes in patients whose head and neck cancer was managed with radiation therapy

BACKGROUND

The purpose of this study was to examine the effect of continued oral intake and duration of gastrostomy tube placement on posttreatment nutritional outcomes in patients being irradiated for head and neck cancer.

METHODS

Factors associated with continued oral intake and its association with posttreatment outcomes were analyzed.

RESULTS

Patients with no oral intake (39.6% of 91) were more likely to have laryngeal tumors, advanced disease, and pretreatment gastrostomy tube placement. Of the 55 patients whose gastrostomy tubes had been removed, those with continued oral intake and shorter gastrostomy tube placement were more likely to maintain their weight and report eating scores in the higher-functioning category, but have more restricted diets. Observed survival was significantly better for the continued-oral-intake group (p = .001).

CONCLUSION

The beneficial effects of continued oral intake and shorter gastrostomy tube placement on posttreatment outcomes shown in this study suggest that clinicians involved in these patients' care should emphasize oral intake during treatment.

Adverse events associated with concurrent chemoradiation therapy in patients with head and neck cancer

OBJECTIVE

To assess toxicities, functional outcomes, and health-related quality of life associated with concurrent chemoradiation therapy (CRT) in patients with head and neck cancer.

DESIGN

Prospective and retrospective outcomes study.

SETTING

Tertiary care institution.

PATIENTS

Participants in the longitudinal Outcomes Assessment Project whose head and neck cancer was treated with CRT between February 1, 2000, and March 1, 2007 (n = 104).

INTERVENTIONS

Patients prospectively provided functional and health-related quality of life information, including data from the 1-year and most current follow-up visits. Medical records were reviewed to determine toxicity and survival rates.

MAIN OUTCOME MEASURES

Well-defined acute and late toxicities; functional outcomes (diet, dentition, tracheostomies); head and neck cancer-specific, general health, and depression outcomes; and survival rates.

RESULTS

Most patients had oropharyngeal or laryngeal tumors (87.5%) and advanced-stage disease (75.0%). Approximately one-half had hematologic toxicities and toxicity-related treatment delays. Approximately one-quarter had neurotoxicities and/or ototoxicites, moist desquamation, pneumonia, nausea and vomiting requiring hospitalization or intravenous fluids, dehydration or malnutrition requiring hospitalization, and mild or moderate fever. Although patients receiving the current intensity-modulated radiation therapy (IMRT) protocol using the Pinnacle(3) planning system had more toxicity-related treatment delays, they had fewer toxicities and better functional and health-related quality of life outcomes compared with those receiving conventional lateral opposing-field radiation or the initial IMRT protocol using the Best nomos PEACOCK planning system.

CONCLUSIONS

Patients receiving CRT experience a substantial number of treatment-related adverse events, primarily affecting oropharyngeal and laryngeal function, with improvement noted for the current IMRT protocol. Improving dental prosthetic rehabilitation and including evaluations with speech and swallowing pathologists before and during treatment may enhance patient outcomes.

The role of pain in head and neck cancer recurrence and survivorship

OBJECTIVE

To examine pain, a common symptom in patients with head and neck cancer, and its relationship to recurrence and survivorship.

DESIGN

Prospective, observational study.

SETTING

Tertiary care institution.

PATIENTS

A total of 339 patients with head and neck carcinomas who participated in the Department of Otolaryngology's Outcomes Assessment Project between February 28, 1998, and November 30, 2001. Of 355 patients enrolled during this period, 7 were omitted from the study because they presented with persistent disease and 9 were omitted owing to a lack of valid pain data. Data on health-related quality of life were collected from the remaining patients at diagnosis and then at 3, 6, 9, and 12 months after diagnosis.

INTERVENTION

Administration of surveys and questionnaires.

MAIN OUTCOME MEASURES

The relationship of self-reported pain level with health-related quality of life during the first year, recurrence status, and 5-year disease-specific survivorship was determined through univariate and multivariate analyses.

RESULTS

Pain was associated with age, general physical and mental health conditions, depressive symptoms, survival rate, and recurrence within the first year. The 5-year survival rate was 81.8% for patients with low posttreatment pain and 65.1% for those with high pain. Posttreatment pain and tumor site were independent predictors of recurrence. Pain level, age, and treatment modality were independent predictors of 5-year survival.

CONCLUSION

Because of its association with recurrence and survival, pain within the first year of treatment for head and neck cancer is an important symptom that should be appropriately monitored and managed during routine follow-up.

Microendoscopy of Reinke's Space

Objectives:

Contemporary surgical treatment of the superficial layer of the lamina propria or Reinke's space is most commonly performed through an incision in the overlying vocal fold epithelium. This approach may disrupt normal tissue, induce scarring, and allow extrusion of implanted materials. Previously reported external approaches to Reinke's space required either a laryngofissure or a “minithyrotomy” for access. These surgical approaches were performed without direct imaging of Reinke's space. Instruments placed below the vocal fold epithelium via this external approach were visualized through the translucent vocal fold epithelium. We designed this study to identify the feasibility of limited-access surgery of the lamina propria using microendoscopes placed into Reinke's space through an external approach.

Methods:

A cadaveric human larynx was dissected, and microendoscopes were directly advanced into Reinke's space through a subepithelial puncture of the cricothyroid membrane, as well as lateral fenestration through the thyroid cartilage.

Results:

Photodocumentation of the undersurface of vocal fold epithelium, the opposing surface of the vocal ligament, and the intervening Reinke's space was successfully accomplished.

Conclusions:

Advances in both microendoscopes and accompanying instrumentation permit access to the superficial layer of the lamina propria without disrupting the overlying epithelium. This approach to microendoscopy of Reinke's space may allow for more effective surgical treatment of cysts, chronic edema, vascular abnormalities, atrophy, scarring, and sulcus vocalis.

Influence of social support on health-related quality of life outcomes in head and neck cancer

BACKGROUND

Evidence that social support influences health-related quality of life (HRQOL) in oncologic patients could be particularly important for head and neck cancer because this disease can affect speech, eating, and facial aesthetics.

METHODS

Multiple regression analyses were used in this prospective, observational study to determine the association between 394 patients' ratings of perceived post-treatment social support and HRQOL outcomes while controlling for possible confounding variables.

RESULTS

Higher social support scores were significantly associated with higher scores in speech (p = .007), aesthetics (p = .015), social disruption (p = .045), and general mental health (p = .016) and with fewer depressive symptoms (p = .023) but not with general physical health (p = .191) or eating (p = .114). The magnitude of differences in the HRQOL outcomes for patients whose social support scores fell in the lowest and highest quartiles were clinically meaningful.

CONCLUSIONS

Given the association between social support and HRQOL outcomes in this patient population, modification of perceived social support through clinical interventions could improve the survivorship of these patients.

General health measures and long-term survival in patients with head and neck cancer

OBJECTIVE

To determine whether a self-reported, subjective general health assessment tool can provide prognostic information about survival in patients with head and neck cancer.

DESIGN

Prospective observational cohort study.

SETTING

Tertiary care center.

PATIENTS

Five hundred seventy-one patients with squamous cell carcinoma of the upper aerodigestive tract who were enrolled in the institution's longitudinal Outcomes Assessment Project between January 1, 1995, and November 30, 2004.

MAIN OUTCOME MEASURES

Actuarial 5-year observed and disease-specific survival.

RESULTS

The physical component summary obtained from the SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey) was significantly associated with ACE-27 (Adult Comorbidity Evaluation-27) comorbidity ratings. The mental component summary was not associated with ACE-27 scores or survival. Although the comorbidity rating was an independent predictor of observed survival (P = .002) only, the physical component summary was independently predictive of both observed (P<.001) and disease-specific (P = .001) survival. These associations continued to be independently significant when site and stage were included in the analysis (P = .003, P<.001, and P = .004, respectively).

CONCLUSION

The physical component summary generated by the SF-36, a self-reported, subjective measure of general physical health, is predictive of both observed and disease-specific survival.

Patient-reported factors associated with discontinuing employment following head and neck cancer treatment

OBJECTIVE

To evaluate patients' reported reasons for discontinuing employment following treatment for head and neck cancer (HNC). Discontinuing employment is a serious problem for patients with HNC and has an impact on many aspects of their lives.

DESIGN

Prospective, observational outcomes study.

SETTING

Tertiary care institution.

PATIENTS

A total of 666 patients with carcinomas of the head and neck who were treated from January 1, 1998, to October 31, 2004.

INTERVENTIONS

Patients provided information about the status of their employment at the time of diagnosis and then at 3, 6, 9, and 12 months after diagnosis. Patients who discontinued employment after treatment rated the importance of 5 factors (eating, speech, appearance, pain or discomfort, and fatigue) in that decision.

MAIN OUTCOME MEASURES

The 5 factors were scored on a 5-point Likert scale (5 being most important) as to their importance in the decision to discontinue work. The relationships of patient, disease, and treatment variables to employment status were evaluated.

RESULTS

Of the 666 patients, 239 were employed at the time of their diagnosis. After treatment, 91 (38.1%) of the 239 reported discontinuing work because of their cancer and treatment. Eighty-two (90.1%) of these 91 patients rated each of the 5 factors. Fatigue had the highest percentage (58.5%) of 4 or 5 ratings, followed by speech (51.2%), eating (45.1%), pain or discomfort (37.8%), and appearance (17.1%). Thirty-seven (40.7%) of the 91 patients who discontinued work returned to work within 1 year of treatment.

CONCLUSION

Identification of the factors associated with the decision to discontinue work is a first step in providing focused solutions to minimize disability.

Health-related quality of life profiles based on survivorship status for head and neck cancer patients

BACKGROUND

As the methodologies for evaluating health-related quality of life (HRQOL) in head and neck cancer patients have matured over the past 10 years, there has been an increasing focus on reporting longitudinal data. These studies have primarily focused on long-term survivors. This study addresses the HRQOL of both long-term and short-term survivors.

METHODS

This is a prospective, longitudinal study of 479 head and neck cancer patients followed for at least 3 years after diagnosis. Analysis of longitudinally collected HRQOL scores was based on survivorship status.

RESULTS

The HRQOL for 3 survivorship groups: short-term (died <1 year), intermediate-term (died 1-3 years), and long-term survivors (alive >3 years) were different at all time points (pretreatment, 3, 6, and 12 months). Differences were greatest between the short-term and long-term survivors. Long-term survivors demonstrated the best HRQOL and an improving HRQOL trajectory at 12 months. The HRQOL of short-term survivors declined precipitously throughout all available follow-up. Intermediate-term survivors did show some improvement following treatment but had a declining HRQOL trajectory at 12 months.

CONCLUSION

The HRQOL profiles of head and neck cancer patients differed significantly depending on survivorship status. Long-term HRQOL results should be analyzed within the context of the results for all of the patients eligible to have been included in the initial study cohort.

Comparison of resonance outcomes after pharyngeal flap and furlow double-opposing z-plasty for surgical management of velopharyngeal incompetence

OBJECTIVE

The purpose of this study was to test the hypothesis that no significant difference exists in the speech outcomes between patients with severe velopharyngeal incompetence (VPI) who receive a pharyngeal flap and patients with less severe VPI who receive a Z-plasty for management of VPI.

DESIGN

This retrospective study from 1993 to 2002 included a review of pre- and postoperative perceptual speech and resonance assessments of patients with marginal VPI who received a Furlow double-opposing Z-plasty and patients with VPI who received a pharyngeal flap.

SETTING

All patients had surgical management of VPI at the Cleft Palate-Craniofacial Clinic at University of Iowa Hospitals and Clinics.

RESULTS

Both groups benefited from surgery with significant reduction in perceived hypernasality (p < .001). Comparison of postoperative assessments indicated no difference between the groups in hypernasality or hyponasality ratings. Neither group had a significant increase in hyponasality.

CONCLUSION

Both pharyngeal flap and double-opposing Z-plasty proved equally effective at reducing hypernasality when the selection of the surgical procedures was based on preoperative ratings of perceived hypernasality and evaluation of velopharyngeal physiology. Severity of the VPI is an important factor when considering surgical management of VPI. Thorough preoperative evaluations of patients with VPI are essential in appropriate treatment planning.

Persistent posttreatment depressive symptoms in patients with head and neck cancer

BACKGROUND

This study examined the prevalence and risk factors of persistent (versus short-term) depressive symptoms in patients with head and neck cancer.

METHODS

Patients with 10+ and 18+ posttreatment Beck Depression Inventory scores for 6 or more months during their first year were identified. Regression analyses determined risk factors associated with persistently high scores.

RESULTS

Of the 148 patients, 25.0% and 7.4% were persistently above the 10+ and 18+ cutoff scores, respectively (compared with 33.6% to 44.2% and 9.2% to 18.6% when measured at single points across this time period.) The strongest predictor of persistent posttreatment depressive symptoms was pretreatment depressive symptoms.

CONCLUSIONS

The percentage of patients with persistently high levels of depressive symptoms, although considerable, is substantially lower when patients with transient mood disorders are omitted. A screening tool that determines high levels of pretreatment depressive symptoms could identify patients at high risk of experiencing posttreatment depression who would be good candidates for clinical intervention.

Pharyngeal Flap Surgery: Long-Term Outcomes at the University of Iowa

The pharyngeal flap is the most often used surgical approach to treat the problem of velopharyngeal insufficiency, a common challenge encountered in cleft palate and craniofacial clinics. The authors retrospectively reviewed short-term and long-term measures of children treated with the pharyngeal flap at the University of Iowa Cleft and Craniofacial Center. All patients who underwent pharyngeal flap surgery between January of 1970 and December of 2000, with at least one postoperative speech assessment between 2 and 5 years after the operation, were identified. Both hypernasality and hyponasality were evaluated on a scale from 1 to 6, with 1 indicating no involvement and 6 indicating severe effect on resonance. Velopharyngeal competence was also rated on a scale of 1 to 3, with 1 indicating competence and 3 indicating incompetence. These short-term data were then compared. The results showed that overall resonance performance continues to be adequate and may even improve as the patient continues to grow and mature. These findings support the use of the pharyngeal flap in the treatment of children with velopharyngeal insufficiency.

Outcomes for Children with Submucous Cleft Palate and Velopharyngeal Insufficiency

OBJECTIVE

To review the outcomes of children with submucous cleft palate who also have velopharyngeal insufficiency (VPI).

METHODS

A retrospective chart review was carried out at a tertiary care academic centre of all patients who had VPI with a submucous cleft palate. The University of Iowa Cleft Palate registry parameters encompassing nasality (hyper- and hyponasality) were compared pre- and postoperatively.

RESULTS

Preliminary results demonstrate a significant, stable improvement in children who underwent palatal surgery for VPI.

CONCLUSION

Positive outcomes in the treatment of VPI in the submucous cleft palate population were demonstrated with a combined approach of speech therapy and palatal surgery.

Pharyngeal Flap Surgery: Protocols, Complications, and Outcomes at the University of Iowa

OBJECTIVE: We sought to assess complication rates and speech outcomes in patients undergoing pharyngeal flap surgery.

STUDY DESIGN AND SETTING: We conducted a retrospective chart and database review at a tertiary craniofacial center.

PATIENTS: Eighty-seven patients were identified as having pharyngeal flaps between January 1990 and December 2000.

RESULTS: Complications were rare, with an overall rate of 3.4% for all children. Craniofacial database records were identified with a follow-up examination between 2 and 5 years. Forty-four patients were identified. Of this group, 81.8% demonstrated no evidence of hypernasality or mild hypernasality, and 84.1% demonstrated no evidence of hyponasality or only mild hyponasality. Preoperative and postoperative assessments showed a statistically significant difference in hypernasality at P < 0.001 with no significant difference in hyponasality.

CONCLUSIONS: Although sphincter pharyngoplasty procedures have gained a great deal of attention in the recent otolaryngologic literature, pharyngeal-flap procedures remain a valuable tool in the hands of surgeons dealing with velopharyngeal incompetence. (Otolaryngol Head Neck Surg 2003;129:321–6.)

Comprehensive head and neck oncology health status assessment

BACKGROUND

This article presents the validation of the Head and Neck Cancer Inventory (HNCI), a health status assessment instrument with a small number of multiple-item domains that captures patients' ratings of functional status and attitude about that function.

METHODS

The HNCI was administered to patients with upper aerodigestive tract carcinoma. An initial, cross-sectional study assessed feasibility and reliability. A subsequent, longitudinal study's factor analysis identified ineffective items and confirmed domain cohesiveness. Construct and criterion-related validity and sensitivity to detect change across time were evaluated.

RESULTS

The HNCI was highly reliable. Criterion-related validity was demonstrated through comparisons with other HNC-specific instruments. Construct validity was demonstrated based on significant differences between patient groups (HNC/non-HNC, employment status, clinical stage, and type of treatment). Domain scores were sensitive to change across time. The domains' functional and attitudinal scores were significantly different.

CONCLUSIONS

The HNCI is a reliable, valid instrument that evaluates the functional and attitudinal components of health status in HNC patients. This survey is recommended for self-reported health status evaluation in HNC clinical trials.

National Cancer Data Base report on malignant paragangliomas of the head and neck

BACKGROUND

Malignant paragangliomas of the head and neck are rare, with previous reports limited to nine or fewer patients. The current review included 59 cases extracted from the National Cancer Data Base that were diagnosed between 1985-1996.

METHODS

The primary criterion for inclusion in the current study was verified metastatic spread from a paraganglioma of the head and neck. Patterns of presentation and treatment as well as clinically relevant associations were demonstrated in contingency tables. Relative survival was used for analysis of outcome.

RESULTS

The average patient age at presentation was 44 years, and gender distribution was equivalent. Metastases were confined to regional lymph nodes in the majority of cases (68.6%), with carotid body tumors found to have an even higher rate of regional confinement (93.8%). Surgery was the most common treatment (76.3%). The use of adjuvant irradiation for regionally confined disease increased across time, from 27% (1985-1990) to 46% (1991-1996). The 5-year relative survival rate was 59.5% (76.8% for regionally confined carcinoma and 11.8% for distant metastasis). Among patients who were followed until death, those treated with adjuvant irradiation had a longer median survival (45 months) compared with those patients who were treated with surgery alone (12 months).

CONCLUSIONS

Malignant paraganglioma represents metastatic spread of a tumor type that, when restricted to the site of origin, is considered benign. Metastases from malignant paragangliomas of the head and neck usually are regionally confined. The primary management of a recognized malignancy should be directed toward complete surgical removal of the primary tumor and regional lymph nodes. Postoperative irradiation may be beneficial in slowing the progression of residual disease.

Presentation, treatment, and outcome of oral cavity cancer: a National Cancer Data Base report

BACKGROUND

Oral cancer has been identified as a significant public health threat. Systematic evaluation of the impact of this disease on the US population is of great importance to health care providers and policy makers.

METHODS

This study used the National Cancer Data Base (NCDB) to evaluate associations between demographic and disease characteristics, treatment, and survival for patients with oral cavity cancer in the United States. Of patients diagnosed between 1985 and 1996, 58,976 were extracted from the NCDB. ANOVAs were performed on selected cross-tabulations, and relative survival was used to calculate outcome.

RESULTS

Median age of patients was 64.0 years. Men made up 60.2% of patients. Pathologic diagnosis was squamous cell carcinoma (SCC) in 86.3% of cases. Younger patients had a much higher frequency of non-SCC, and this was related to survival in these patients. African-Americans (independent of income), lower income patients, and patients with higher grade disease were seen more frequently with advanced-stage SCC. Five-year relative survival for SCC cases was lower for older patients, men, and African-Americans.

CONCLUSIONS

This study addressed many issues related to oral cancer that have been previously discussed in the literature. The demographic, site, stage, histologic, and survival data available for this large number of cases in the NCDB allowed an accurate characterization of the contemporary status of oral cancer in the United States.

National survey of head and neck verrucous carcinoma: patterns of presentation, care, and outcome

BACKGROUND

Verrucous carcinoma is distinguished by controversy regarding appropriate diagnosis and treatment. This study provides a contemporary survey of demographics, patterns of care, and outcome for this disease in the United States.

METHODS

The National Cancer Data Base had 2350 cases of verrucous carcinoma of the head and neck diagnosed between 1985 and 1996. Statistical procedures included chi-square analyses, Student t tests, and relative survival.

RESULTS

Tumors originated most frequently in the oral cavity (55.9%) and larynx (35.2%). Although most patients were male (60.0%), oral cavity tumors were more common among older females. The most prevalent treatment was surgery alone (69.7%), followed by surgery combined with irradiation (11.0%) and irradiation alone (10.3%). For oral cavity tumors, surgery alone was more common among early (85.8%) than advanced cases (56.9%); a larger proportion of advanced disease received radiation alone or surgery and irradiation combined. Most laryngeal tumors were treated with surgery (60.3% for early and 55.6% for advanced disease), but a higher proportion received radiation alone or surgery combined with radiation compared with oral cavity cases. Five-year relative survival was 77.9%. For localized disease, survival after surgery was 88.9% compared with 57.6% after irradiation.

CONCLUSIONS

Demographic differences implicate different mechanisms of carcinogenesis for verrucous carcinoma arising in the oral cavity and the larynx. Although selection bias may account for the differences observed, patients receiving initial treatment with surgery had better survival than those treated with irradiation, especially for cases originating in the oral cavity.

Small bowel sarcoma: analysis of survival from the National Cancer Data Base

BACKGROUND

Small bowel sarcomas (SBS) are rare, accounting for 10% of small bowel cancers. As a result, few studies of SBS have had enough patients to accurately define their natural history and to determine the factors that have an impact on patient survival. The objective of this study was to examine patient and tumor factors in SBS and to determine prognostic factors for disease-specific survival (DSS) using the National Cancer Data Base.

METHODS

Data from the National Cancer Data Base for patients diagnosed with primary SBS between 1985 and 1995 were analyzed. The chi2 statistic was used to determine significant differences between groups of patient, tumor, and treatment factors. DSS was calculated for patients diagnosed between 1985 and 1990. Significant differences in survival were determined using the Wilcoxon statistic for univariate analyses and by Cox regression in multivariate analyses.

RESULTS

Of 14,253 small bowel tumors diagnosed between 1985 and 1995, sarcomas represented 10.1%. Overall, 5-year DSS was 38.9%, with a median survival of 34.1 months (n = 590). By univariate analysis, patient age, sex, tumor size, tumor grade, histologic type, general summary stage, nodal status, and whether cancer-directed surgery was performed were significantly correlated with DSS. In multivariate analysis, tumor size <5 cm, leiomyosarcoma histology, and localized disease were found to be significant favorable prognostic factors for DSS.

CONCLUSIONS

SBS are rare tumors that are challenging in terms of their histopathologic classification, grading, and staging. Patients with SBS were treated predominantly by surgery, with a minority receiving adjuvant therapy. Tumor size, histologic type, and general summary stage were independent prognostic factors for 5-year DSS in patients with SBS, which is improved relative to 5-year DSS seen in patients with small bowel adenocarcinoma.

The fibula osteocutaneous flap in head and neck reconstruction: a critical evaluation of donor site morbidity

OBJECTIVES

To (1) compare the complications and functional outcome of primary closure vs split-thickness skin grafting of the fibula osteocutaneous flap donor site, (2) identify patient-mix or treatment factors related to donor site complications, and (3) address early detection and management of donor site complications.

DESIGN

Retrospective review and questionnaire study.

SETTING

Two university tertiary referral centers.

PATIENTS

Fifty-three patients (31 men and 22 women, ages 20 to 80 years) who underwent fibula osteocutaneous free tissue transfer between February 1992 and January 1997.

MAIN OUTCOME MEASURES

Minor complications; major complications; and postoperative function, including sensory and motor deficits, pain, swelling, temperature intolerance, and activities of daily living.

RESULTS

Four patients developed major wound complications (group 1), 11 patients developed minor wound complications (group 2), and 38 patients had no wound complications (group 3). The donor site was closed primarily in 26 patients and with a split-thickness skin graft in the remaining 27 patients. Major wound complications developed in 3 patients (12%) who underwent primary closure and 1 patient (4%) who underwent split-thickness skin grafting. Minor wound complications developed in 7 (27%) of the patients who underwent primary closure and 4 patients (15%) who underwent split-thickness skin grafting. Three patients who had major complications had residual sensory or motor deficits that resulted in impaired gait or alteration in their daily activities. Comparing all patients with complications (groups 1 and 2) to patients with no complications (group 3) demonstrated an increased incidence of donor site complications in heavy smokers (P<.05) and a strong trend toward higher donor site complications in patients who underwent primary closure (P =.10). Although trends were identified, no significant differences were found in age, comorbid illnesses, alcohol use, preoperative laboratory values, operating time, tourniquet time, or skin paddle width.

CONCLUSIONS

A variety of patient-mix and operative factors are likely related to the development of donor site wound complications. Width of the skin paddle alone is not a reliable criterion for determining the need to skin graft the donor site. Primary closure tended to result in a higher rate of both major and minor wound complications compared with split-thickness skin grafting. Primary closure of fibula donor site defects should be undertaken if this can be accomplished with no tension along the suture line. If tension at the suture line is present, a skin graft should be strongly considered to minimize the possibility of a wound complication. Arch Otolaryngol Head Neck Surg. 2000;126:1467-1472

National cancer database report on chondrosarcoma of the head and neck

BACKGROUND

Management of chondrosarcoma of the head and neck is largely based on single-institution reports with small numbers accrued over several decades.

METHODS

The American College of Surgeons' National Cancer Data Base included 400 cases of chondrosarcoma of the head and neck diagnosed between 1985 and 1995. Chi square analyses of selected contingency tables and Wilcoxon regression analyses of selected survival stratifications were performed.

RESULTS

Histologic types included conventional (80.8%), myxoid (10.5%), and mesenchymal (8.8%). The mesenchymal and myxoid subtypes were rare among white patients (17.1%) and more common among African-American (31.8%) and Hispanic patients (44.9%). Treatment was most commonly surgery alone (59.5%) and surgery with irradiation (21.0%). Disease-specific survival was 87.2% at 5 years and 70.6% at 10 years. Worse 5-year survival was associated with higher grade (67.3%), regional or distant spread (71.0%), and the myxoid (45.0%) or mesenchymal (53.2%) subtypes.

CONCLUSIONS

Chondrosarcoma of the head and neck encompasses a variety of lesions that differ substantially by demographic and tumor characteristics. Individual tumors can be classified further according to site of origin, histologic subtype, and tumor grade, which can be used to predict biologic behavior and prognosis.

The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985-1995

BACKGROUND

Small bowel adenocarcinoma (SBA) accounts for 2% of gastrointestinal (GI) tumors and 1% of GI cancer deaths. The objective of this study was to review the National Cancer Data Base (NCDB) to identify case-mix characteristics, patterns of treatment, and factors influencing survival of patients with SBA.

METHODS

NCDB data from patients diagnosed with primary SBA between 1985-1995 were analyzed. Chi-square statistics were used to compare differences between groups. Disease specific survival (DSS) was calculated using the life table method for patients diagnosed between 1985-1990; univariate differences in survival were compared using the Wilcoxon statistic, and multivariate analyses were performed using a Cox regression model.

RESULTS

There were 4995 SBA cases reported to the NCDB between 1985-1995, 55% of which occurred in the duodenum, 18% in the jejunum, 13% in the ileum, and 14% in nonspecified sites. The overall 5-year DSS was 30.5%, with a median survival of 19.7 months. By multivariate analysis, factors significantly correlated with DSS included patient age, tumor site, disease stage, and whether cancer-directed surgery was performed.

CONCLUSIONS

SBA is found most commonly in the duodenum, and patient DSS is reduced at this site compared with those patients with jejunal or ileal tumors. This reduction in survival was associated with a lower percentage of cancer-directed surgery. Patients age > 75 years had a reduced DSS and more duodenal tumors, and were less frequently treated by cancer-directed surgery than their younger counterparts. This study reflects the experience with SBA from a large cross-section of U.S. hospitals, allowing for the identification of prognostic factors and providing a reference with which results from single institutions may be compared.

The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985-1995

BACKGROUND

Small bowel adenocarcinoma (SBA) accounts for 2% of gastrointestinal (GI) tumors and 1% of GI cancer deaths. The objective of this study was to review the National Cancer Data Base (NCDB) to identify case-mix characteristics, patterns of treatment, and factors influencing survival of patients with SBA.

METHODS

NCDB data from patients diagnosed with primary SBA between 1985-1995 were analyzed. Chi-square statistics were used to compare differences between groups. Disease specific survival (DSS) was calculated using the life table method for patients diagnosed between 1985-1990; univariate differences in survival were compared using the Wilcoxon statistic, and multivariate analyses were performed using a Cox regression model.

RESULTS

There were 4995 SBA cases reported to the NCDB between 1985-1995, 55% of which occurred in the duodenum, 18% in the jejunum, 13% in the ileum, and 14% in nonspecified sites. The overall 5-year DSS was 30.5%, with a median survival of 19.7 months. By multivariate analysis, factors significantly correlated with DSS included patient age, tumor site, disease stage, and whether cancer-directed surgery was performed.

CONCLUSIONS

SBA is found most commonly in the duodenum, and patient DSS is reduced at this site compared with those patients with jejunal or ileal tumors. This reduction in survival was associated with a lower percentage of cancer-directed surgery. Patients age > 75 years had a reduced DSS and more duodenal tumors, and were less frequently treated by cancer-directed surgery than their younger counterparts. This study reflects the experience with SBA from a large cross-section of U.S. hospitals, allowing for the identification of prognostic factors and providing a reference with which results from single institutions may be compared.

The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985-1995

BACKGROUND

Small bowel adenocarcinoma (SBA) accounts for 2% of gastrointestinal (GI) tumors and 1% of GI cancer deaths. The objective of this study was to review the National Cancer Data Base (NCDB) to identify case-mix characteristics, patterns of treatment, and factors influencing survival of patients with SBA.

METHODS

NCDB data from patients diagnosed with primary SBA between 1985-1995 were analyzed. Chi-square statistics were used to compare differences between groups. Disease specific survival (DSS) was calculated using the life table method for patients diagnosed between 1985-1990; univariate differences in survival were compared using the Wilcoxon statistic, and multivariate analyses were performed using a Cox regression model.

RESULTS

There were 4995 SBA cases reported to the NCDB between 1985-1995, 55% of which occurred in the duodenum, 18% in the jejunum, 13% in the ileum, and 14% in nonspecified sites. The overall 5-year DSS was 30.5%, with a median survival of 19.7 months. By multivariate analysis, factors significantly correlated with DSS included patient age, tumor site, disease stage, and whether cancer-directed surgery was performed.

CONCLUSIONS

SBA is found most commonly in the duodenum, and patient DSS is reduced at this site compared with those patients with jejunal or ileal tumors. This reduction in survival was associated with a lower percentage of cancer-directed surgery. Patients age > 75 years had a reduced DSS and more duodenal tumors, and were less frequently treated by cancer-directed surgery than their younger counterparts. This study reflects the experience with SBA from a large cross-section of U.S. hospitals, allowing for the identification of prognostic factors and providing a reference with which results from single institutions may be compared.

Assessing head and neck cancer patient outcome domains

BACKGROUND

The purpose of this study was to assess the relative importance on patients' lives of multiple outcomes resulting from the management of head and neck cancer (HNC).

METHODS

HNC patients filled out a disease-specific quality of life (QOL) survey covering 5 domains (speech, eating, aesthetics, pain/discomfort, and social/role functioning). Logistic regression was used to determine which of these domains best predicted the patients' response to a single, overall QOL assessment.

RESULTS

In univariate analyses, all 5 domains were significantly correlated to QOL (p<.0001), with correlation coefficients ranging from.48 for eating to.64 for social/role functioning. Logistic regression indicated that speech and eating best predicted QOL (R(2) =.4647), with odds-ratios of 2. 96 for speech and 2.49 for eating.

CONCLUSIONS

These data demonstrated that, for this group of patients, speech has the most impact on well-being, whereas eating has a substantial, unrelated influence. This is important information in counseling patients about treatment plans that have different levels of impairment.

Laryngeal cancer cost analysis: association of case-mix and treatment characteristics with medical charges

OBJECTIVES

To examine the relationship of various pretreatment case-mix characteristics and treatment modalities with medical charges incurred during diagnosis, treatment, and 2-year follow-up for patients with laryngeal cancer.

DESIGN

Retrospective chart review and billing record analysis.

METHODS

The charts and billing records of patients diagnosed with laryngeal cancer at the University of Iowa Hospitals and Clinics (UIHC) between January 1, 1991 and December 31, 1994 were reviewed. The independent variables included various pretreatment patient-mix and tumor characteristics (age, AJCC TNM clinical stage, smoking history, ASA class, and comorbidity as defined by Kaplan-Feinstein grade) as well as type of treatment. The dependent variables included total physician, office, and university hospital-based charges incurred during the pretreatment evaluation and 0- to 3-, 3- to 12, and 12- to 24-month billing periods after the initiation of cancer-directed therapy. Total 1-year and 2-year charges were also evaluated. Univariate and multivariate analyses were used to investigate the relationships between dependent and independent variables and to develop models predictive of management charges during the individual and total billing periods.

RESULTS

Pretreatment charges showed no significant associations (P < .05) with any of the independent variables. Multiple regression analyses indicated that comorbidity, stage, and initial treatment modality were significant variables in one or more of the models predicting charges incurred during the 0- to 3-month, 3- to 12-month, total 1-year, and total 2-year billing periods. The models yielded R2 values for the total 1- and 2-year billing periods of 0.5246 and 0.5055, respectively.

CONCLUSIONS

This work supports continued study of measures that may result in earlier detection of laryngeal cancer as a potential means of reducing management charges. These results also indicate that a more accurate method of stratifying the disease severity of laryngeal cancer patients for reimbursement purposes would include measurements of the severity of the index disease as well as comorbid diseases.

The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985-1995

BACKGROUND

Small bowel adenocarcinoma (SBA) accounts for 2% of gastrointestinal (GI) tumors and 1% of GI cancer deaths. The objective of this study was to review the National Cancer Data Base (NCDB) to identify case-mix characteristics, patterns of treatment, and factors influencing survival of patients with SBA.

METHODS

NCDB data from patients diagnosed with primary SBA between 1985-1995 were analyzed. Chi-square statistics were used to compare differences between groups. Disease specific survival (DSS) was calculated using the life table method for patients diagnosed between 1985-1990; univariate differences in survival were compared using the Wilcoxon statistic, and multivariate analyses were performed using a Cox regression model.

RESULTS

There were 4995 SBA cases reported to the NCDB between 1985-1995, 55% of which occurred in the duodenum, 18% in the jejunum, 13% in the ileum, and 14% in nonspecified sites. The overall 5-year DSS was 30.5%, with a median survival of 19.7 months. By multivariate analysis, factors significantly correlated with DSS included patient age, tumor site, disease stage, and whether cancer-directed surgery was performed.

CONCLUSIONS

SBA is found most commonly in the duodenum, and patient DSS is reduced at this site compared with those patients with jejunal or ileal tumors. This reduction in survival was associated with a lower percentage of cancer-directed surgery. Patients age > 75 years had a reduced DSS and more duodenal tumors, and were less frequently treated by cancer-directed surgery than their younger counterparts. This study reflects the experience with SBA from a large cross-section of U.S. hospitals, allowing for the identification of prognostic factors and providing a reference with which results from single institutions may be compared.

The American College of Surgeons Commission on Cancer and the American Cancer Society. The National Cancer Data Base report on age, gender, treatment, and outcomes of patients with chronic lymphocytic leukemia

BACKGROUND

The natural history of chronic lymphocytic leukemia (CLL) is changing, although the reasons (potential changes in the disease's biology or in patterns in patient characteristics, treatment, or referral) are unclear.

METHODS

This report uses National Cancer Data Base (NCDB) data, which reflect a hospital-based patient population from a broad spectrum of hospitals in the United States. Age, gender, race/ethnicity, income, treatment, overall survival, and relative survival were evaluated according to time period (1985-1990 and 1991-1995). Comparisons were made with U. S. population figures for 1990 and with series published over the last 70 years.

RESULTS

CLL comprised 22.6% of the 108,396 cases of leukemia in the data base. The risk of developing CLL increased progressively with age and did not plateau; the average age was 69.6 years. At the time of initial diagnosis, 60.5% of patients received no treatment (this proportion increased from 58.1% to 62.7% between the 2 time periods). Overall survival was 48.2% at 5 years and 22.5% at 10 years. The 5-year relative survival was 69.5%, 72.2%, 63.1%, and 41.7% for age groups <40, 40-59, 60-79, and 80+ years, respectively; these rates indicated that CLL, and not comorbid disease, caused the greatest percentage of deaths.

CONCLUSIONS

The risk of developing CLL increases progressively with age without plateauing and is 2.8 times higher for older men than for older women. There is an increasing trend toward no treatment at the time of initial diagnosis. Long term overall survival of CLL patients is poor. CLL is a more fatal disease among older individuals because of the disease itself, not because of comorbid conditions.

National Cancer Data Base report on cancer of the head and neck: acinic cell carcinoma

BACKGROUND

Management of acinic cell carcinoma is based on reports of small numbers of cases accrued over several decades.

METHODS

The National Cancer Data Base (NCDB) identified 1353 cases of acinic cell carcinoma of the head and neck for the years 1985 to 1995. Chi square analyses of selected contingency tables and Wilcoxon regression analyses of selected survival stratifications are presented.

RESULTS

Five-year survival was 83.3% (observed) and 91.4% (disease specific). Worse survival was associated with high grade (p < .0001), age greater or equal to 30 years (p = .0055), and the presence of metastatic disease (p < .0001).

CONCLUSIONS

An aggressive subset of acinic cell carcinoma which is characterized by high grade and advanced stage rarely occurs in patients younger than 30 years old. Although better outcome was not statistically demonstrated for combined therapy, surgery with irradiation is the most common management in the United States for cases with regional metastases, high grade, and microscopic positive margins.

National Cancer Data Base report on cancer of the head and neck: acinic cell carcinoma

BACKGROUND

Management of acinic cell carcinoma is based on reports of small numbers of cases accrued over several decades.

METHODS

The National Cancer Data Base (NCDB) identified 1353 cases of acinic cell carcinoma of the head and neck for the years 1985 to 1995. Chi square analyses of selected contingency tables and Wilcoxon regression analyses of selected survival stratifications are presented.

RESULTS

Five-year survival was 83.3% (observed) and 91.4% (disease specific). Worse survival was associated with high grade (p < .0001), age greater or equal to 30 years (p = .0055), and the presence of metastatic disease (p < .0001).

CONCLUSIONS

An aggressive subset of acinic cell carcinoma which is characterized by high grade and advanced stage rarely occurs in patients younger than 30 years old. Although better outcome was not statistically demonstrated for combined therapy, surgery with irradiation is the most common management in the United States for cases with regional metastases, high grade, and microscopic positive margins.

Quality of life measurements of speech in the head and neck cancer patient population

BACKGROUND

To employ patient-reported speech outcome data collected on head and neck cancer (HNC) surveys, there is a need to determine (1) the relationship of patient ratings to speech language pathologist (SLP) ratings and (2) whether patients' attitudes toward their speech are an important element of speech measurements.

METHODS

Associations were analyzed between (1) patients' ratings of speech function on surveys and equivalent SLP ratings and (2) patients' ratings of speech function and their satisfaction with speech function.

RESULTS

Patient-reported survey ratings were significantly associated with comparable SLP ratings. The associations were stronger for intelligibility than for voice quality. Patients' functional and attitudinal ratings were also significantly associated. The associations were relatively strong for composite speech items and intelligibility and moderate for voice quality.

CONCLUSIONS

Patient-reported speech outcomes can be interpreted as being fairly equivalent to SLP evaluations. Attitudinal ratings appear to contribute an important aspect of the patients' perspective, with substantially different variances between function and attitude.

The National Cancer Data Base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. The American College of Surgeons Commission on Cancer and the American Cancer Society

BACKGROUND

This study reviews the case-mix characteristics, management, and outcomes of melanoma cases occuring in the U.S. within the last decade.

METHODS

Analyses of the National Cancer Data Base (NCDB) were performed on cases diagnosed between 1985 through 1994. A total of 84,836 cases comprised of cutaneous and noncutaneous melanomas were evaluated.

RESULTS

The percentages of melanomas that were cutaneous, ocular, mucosal, and unknown primaries were 91.2%, 5.2%, 1.3%, and 2.2%, respectively. For cutaneous melanomas, the proportion of patients presenting with American Joint Committee on Cancer Stages 0, I, II, III, and IV were 14.9%, 47.7%, 23.1%, 8.9%, and 5.3%, respectively. Factors associated with decreased survival included more advanced stage at diagnosis, nodular or acral lentiginous histology, increased age, male gender, nonwhite race, and lower income. Multivariate analysis identified stage, histology, gender, age, and income as independent prognostic factors. For ocular melanomas, 85.0% were uveal, 4.8% were conjunctival, and 10.2% occurred at other sites. During the study period, there was a large increase in the proportion of ocular melanoma patients treated with radiation therapy alone. For mucosal melanomas, the distribution of head and neck, female genital tract, anal/rectal, and urinary tract sites was 55.4%, 18.0%, 23.8%, and 2.8%, respectively. Patients with lymph node involvement had a poor prognosis. For unknown primary melanomas, the distribution of metastases as localized to a region or multiple sites at presentation was 43.0% and 57.0%, respectively. Surgical treatment of patients with unknown primary site of the melanoma resulted in better survival compared with no treatment.

CONCLUSIONS

Treatment of early stage cutaneous melanoma resulted in excellent patient outcomes. In addition to conventional prognostic factors, socioeconomic factors were found to be associated with survival.

The National Cancer Data Base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. The American College of Surgeons Commission on Cancer and the American Cancer Society

BACKGROUND

This study reviews the case-mix characteristics, management, and outcomes of melanoma cases occuring in the U.S. within the last decade.

METHODS

Analyses of the National Cancer Data Base (NCDB) were performed on cases diagnosed between 1985 through 1994. A total of 84,836 cases comprised of cutaneous and noncutaneous melanomas were evaluated.

RESULTS

The percentages of melanomas that were cutaneous, ocular, mucosal, and unknown primaries were 91.2%, 5.2%, 1.3%, and 2.2%, respectively. For cutaneous melanomas, the proportion of patients presenting with American Joint Committee on Cancer Stages 0, I, II, III, and IV were 14.9%, 47.7%, 23.1%, 8.9%, and 5.3%, respectively. Factors associated with decreased survival included more advanced stage at diagnosis, nodular or acral lentiginous histology, increased age, male gender, nonwhite race, and lower income. Multivariate analysis identified stage, histology, gender, age, and income as independent prognostic factors. For ocular melanomas, 85.0% were uveal, 4.8% were conjunctival, and 10.2% occurred at other sites. During the study period, there was a large increase in the proportion of ocular melanoma patients treated with radiation therapy alone. For mucosal melanomas, the distribution of head and neck, female genital tract, anal/rectal, and urinary tract sites was 55.4%, 18.0%, 23.8%, and 2.8%, respectively. Patients with lymph node involvement had a poor prognosis. For unknown primary melanomas, the distribution of metastases as localized to a region or multiple sites at presentation was 43.0% and 57.0%, respectively. Surgical treatment of patients with unknown primary site of the melanoma resulted in better survival compared with no treatment.

CONCLUSIONS

Treatment of early stage cutaneous melanoma resulted in excellent patient outcomes. In addition to conventional prognostic factors, socioeconomic factors were found to be associated with survival.