Changes in treatment of advanced oropharyngeal cancer, 1985-2001

Objective. The aim of this study is to describe patterns of care of advanced oropharyngeal cancer during 1985 to 2001. Methods. We extracted oropharyngeal squamous cell cancer cases from the National Cancer Database. Type of initial treatment, type of facility, stage of tumor, payer status, and demographic variables were collected. Fisher exact test was used to compare the patient demographic and clinical characteristics across facility types. Weighted least squares regression analysis was used to analyze treatment trends over time and t-tests were done to test for significance in trends. Results: A total of 54,801 cases were available for analysis. Teaching/research facilities treated a disproportionately higher number of advanced-stage cancers (81%, P <.01). In addition, these facilities treat a higher percentage of uninsured (7%, P <.01) and nonwhite patients (27%, P <.01). The use of organ preservation protocols (chemoradiation) increased from 15% in 1985 to 29% in 2001 (beta(1) = 0.0080, P <.05), whereas the use of radiation alone decreased from 42% in 1985 to 27% in 2001 (beta(1) = -0.0118, P <.05). The use of cancer-directed surgery remained stable. There was no difference in rates of chemoradiation for advanced oropharyngeal cancer across facility types. Conclusions: Our results suggest that chemoradiation is increasingly becoming more prevalent at all facility types. The use of radiation alone as primary treatment significantly declined during the study period. In view of the complexity and multidisciplinary nature of treatment for oropharyngeal cancer, it is recommended that care of such patients be discussed at institutional tumor boards and that the recommendations be systematically recorded and documented in hospital cancer registries.