Dataset Information

Dysphagia prevalence and associated survival differences in older patients with lung cancer: A SEER-Medicare population-based study.

ABSTRACT:

Introduction

The impact of dysphagia in persons with lung cancer is unknown. The objective of this study is to measure the prevalence and survival differences associated with dysphagia in older adults with lung cancer.

Materials and methods

Linked SEER cancer registries - Medicare data, 1991-2009 was utilized to identify 201,674 persons with lung cancer. Most were male (53%), had regional or distant disease (74%), and were aged <80 years (82%). The pre-existing prevalence of dysphagia was identified using claims codes before the lung cancer diagnosis. Survival was analyzed using Kaplan Meier curves and Cox proportional hazard models.

Results

8517 (4%) had dysphagia prior to their lung cancer diagnoses. Younger age, worse disease stage, more comorbidities, and hospital rurality were associated with higher likelihood of dysphagia. Patients with dysphagia had worse survival (median survival 8 months [95%CI 7,9]) than those without dysphagia (median survival 12 months [95%CI 11,13]). After adjusting for sociodemographic, clinical, and disease characteristics, dysphagia was still associated with worse survival (Hazard ratio of death 1.34, [95%CI 1.28-1.35], p ≤ .0001).

Discussion and conclusions

This is the first Medicare claims-based study of older adults with lung cancer and dysphagia. Pre-existing dysphagia occurred in approximately 1 in 25 patients with lung cancer and was associated with worse survival. Determining the best methods to evaluate and treat dysphagia in patients with lung cancer is an important avenue for future studies.

SUBMITTER: Marmor S

PROVIDER: S-EPMC7483634 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:ObjectivesThe effectiveness and costs of new treatments should be assessed in relation to existing practice. We describe treatments, survival and costs for advanced or metastatic small cell lung cancer (SCLC) patients receiving systemic therapy in the period preceding the introduction of immunotherapies.Materials and methodsThis was a retrospective cohort study of patients aged ?65 years, identified using linked Surveillance, Epidemiology, and End Results and Medicare databases. Individuals with a new primary diagnosis of SCLC between January 2007 and December 2013 were followed until December 2014. Chemotherapy treatments, health care visits and costs (in 2016 USD), and survival were determined by line of therapy.ResultsA total of 11 812 patients were identified with SCLC. First-line (1L) chemotherapy was received by 6509 (55.1%) patients, most (93.2%) with carboplatin- (71.0%) or cisplatin- (22.2%) based therapies, typically combined with etoposide (79.2%). Second- (2L) and third- (3L) line chemotherapies were received by 2238 (18.9%) and 679 (5.7%) patients, of which 48.4% and 30.9%, respectively, were platinum-based. The median durations of 1L, 2L, and 3L carboplatin-based therapies were 5.9, 4.8, and 5.4 months, respectively, and the corresponding durations of cisplatin-based therapies were 5.3, 4.2, and 5.3 months. During 1L, 2L, and 3L chemotherapies, patients averaged 8.2, 7.4, and 7.3 health care visits per month, respectively, and incurred total mean health care costs of $60 223, $42 636, and $35 903 per patient, respectively. Median survival from the start of 1L, 2L, and 3L chemotherapy was 9.2, 6.0, and 5.7 months, respectively.ConclusionFirst-line chemotherapy was primarily platinum-based, and a plethora of different regimens was used for 2L and 3L chemotherapies. Median survival from the start of 1L chemotherapy was 9 months, with an associated health care cost of $60 000. These data highlight an unmet medical need among SCLC patients receiving systemic therapy.

Project description:Background & aimsAlthough dysphagia is common, there is limited information about the prevalence and burden of illness of dysphagia in the United States. We performed a population-based survey of more than 31,000 adults to evaluate the epidemiology, clinical characteristics, and health care-seeking behavior of individuals with dysphagia.MethodsWe performed a cross-sectional analysis of adults in the United States who completed an online, self-administered health survey from April 4 through April 19, 2018. All respondents were asked which of the following symptoms they had ever experienced (presented in random order): dysphagia, abdominal pain, bloating, bowel incontinence, constipation, diarrhea, heartburn/reflux, nausea/vomiting, or none of the above. Only respondents who selected dysphagia continued the remaining survey, which included questions about dysphagia severity, use of compensatory maneuvers, health care seeking, and esophageal comorbidities. We used multivariable regression methods to adjust for confounding.ResultsOf 31,129 individuals who participated in the survey, 4998 respondents (16.1%) reported experiencing dysphagia; 92.3% of these had symptoms in the previous week. We found that 16.3% of respondents described their dysphagia over the previous 7 days as either quite a bit or very severe. Drinking liquids to help with dysphagia (86.0%) and taking longer to finish eating (76.5%) were the most common compensatory maneuvers. Overall, 51.1% of individuals sought care for their difficulty swallowing; older age, male sex, having a usual source of care and insurance, having comorbidities, and more severe dysphagia symptoms increased the odds for seeking care (P < .05). The most commonly reported esophageal comorbidities were gastroesophageal reflux disease (30.9%), eosinophilic esophagitis (8.0%), and esophageal stricture (4.5%).ConclusionsIn a large population-based survey, we found that dysphagia is common; 1 of 6 adults reported experiencing difficulty swallowing. However, half of individuals have not discussed their symptoms with a clinician and many could have treatable disorders.