Clinical and Financial Impact of Treatment for Oral and Pharyngeal Cancer

描述(申请人提供)：据估计，2007年美国新诊断的口腔和口咽癌病例为34,360例，估计将有7,550人死于这种疾病。超过90%的口腔和咽部癌症发生在45岁以上的患者。随着年龄的增长，发病率呈稳步上升趋势。目前对这些患者的治疗选择包括放射治疗、手术、联合放射治疗和手术以及化疗。治疗的选择取决于肿瘤的大小、分期和位置、患者的年龄和合并症。对于许多患者来说，所有的治疗方案都是可用的和可行的。然而，治疗往往与成本上的显著差异有关。关于头颈癌治疗选择的成本影响，人们知之甚少。这项研究的长期目标是帮助医生、专业学会和政策制定者制定和完善口腔和口咽癌患者的治疗指南。这项研究项目的总体目标是评估口腔和咽癌不同治疗方法的财务和临床影响。Null假设是，目前的治疗选择与成本或存活率的显着差异无关。有三个具体目标：1.确定老年医疗保险人群中口腔和口咽癌治疗差异的相关因素。2.在控制人口学特征和合并症的情况下，评估不同治疗方法对局部或区域性口腔或口咽癌患者医疗费用的影响；以及3.评估不同治疗方法对局部或区域性口腔及口咽癌患者总体和无病生存的影响。该项目将是SEER-Medicare关联数据库的二级数据分析。该人群将包括65岁及以上的患者，他们被诊断出患有新的口腔或口咽癌。将进行三项分析，以研究与口腔和口咽癌相关的治疗、费用和生存的决定因素。这项研究将有助于理解与医疗实践中的差异相关的因素、不同治疗的成本以及不同治疗的临床结果。这些信息将在医生考虑针对个别患者的治疗建议时提供信息和指导，并在政策制定者制定和完善治疗指南时提供信息。 公共卫生相关性：拟议的研究将导致了解与治疗差异相关的因素、不同治疗的成本、不同治疗的临床结果以及替代干预的相对价值。它还将在医生考虑个别患者的治疗建议时提供信息和指导，并在政策制定者制定和完善医疗保险患者的治疗指南时提供信息和指导。

DESCRIPTION (provided by applicant): An estimated 34,360 new cases of oral and oropharyngeal cancer were diagnosed in the United States in 2007 and an estimated 7,550 people will die of the disease. More than 90% of oral and pharyngeal cancers occur in patients older than 45 years. The incidence increases steadily towards 65 years of age. Current treatment options for these patients include radiotherapy, surgery, combined radiotherapy and surgery, and chemotherapy. Treatment selection depends on size, stage and location of tumor, patient age, and comorbidities. For many patients, all treatment options are available and viable options. However, treatment is often associated with significant differences in cost. There is little known about the costs implications of treatment selection for head and neck cancer. The Broad Long-Term Objective of this research is to help physicians, specialty societies, and policymakers develop and refine treatment guidelines for patients with oral and oropharyngeal cancers. The Overall Goal of this research project is to assess the financial and clinical impact of different treatment approaches for oral and pharyngeal cancers. The Null Hypothesis is that the current treatment options are not associated with significant differences in cost or survival. There are three Specific Aims: 1. To identify factors associated with variation in treatment for oral cavity and oropharyngeal cancers in the elderly Medicare population. 2. To estimate the impact of different treatments on cost of medical care for patients with local or regional oral cavity or oropharyngeal carcinomas, controlling for demographic characteristics and comorbid conditions, and 3. To estimate the impact of treatments on overall and disease-free survival for patients with local or regional oral cavity and oropharyngeal carcinomas. This project will be a secondary data analysis of the SEER-Medicare linked database. The population will consist of patients aged 65 years of age and older who have been diagnosed with a new cancer of the oral cavity or oropharynx. Three analyses will be undertaken to study the determinants of treatment, costs, and survival associated with cancers of the oral cavity and oropharynx. This research will lead to an understanding of the factors associated with variation in medical practice, the costs of different treatments, and the clinical outcomes of different treatments. This information will inform and guide physicians as they consider treatment recommendations for individual patients, and also policy makers as they develop and refine treatment guidelines. PUBLIC HEALTH RELEVANCE: The proposed research will lead to an understanding of the factors associated with variation in treatment, the costs of different treatments, the clinical outcomes of different treatments, and relative value of alternative interventions. It will also inform and guide physicians as they consider treatment recommendations for individual patients and also policy makers as they develop and refine treatment guidelines for Medicare patients.