Temporal trends in oropharyngeal cancer incidence, survival, and cancer-directed surgery among elderly Americans

Abstract

ObjectiveThis study assesses longitudinal epidemiologic trends in the oldest head and neck cancer (HNC) patients, comparing the oropharynx to other mucosal HNC sites. Materials and methodsUsing data from the Surveillance, Epidemiology, and End Results database, trends in incidence, two-year cancer specific mortality, and percent of cases recommended for and which received surgery from 2000 to 2018 in patients ages ≥85 years were assessed using Joinpoint analysis by HNC site. Trends were quantified as annual percentage change (APC) with 95% confidence intervals (CI). ResultsAmong older adults, oropharyngeal cancer (OPC) incidence increased (APC = 1.80% [95% CI: 0.94–2.67]), while mortality decreased (APC = −2.01% [95% CI: −3.26–−0.74]) from 2000 to 2018. At other mucosal HNC sites, incidence and mortality remained stable. Percentage of patients who received surgery significantly changed for oropharyngeal (APC = −15.34% from 2000 to 2005 [95% CI: −24.37 to −4.79]) and laryngeal (APC = −4.61% from 2000 to 2008 [95% CI −8.28 to −0.80]) cancers. Trends in recommendation for surgery varied by site with significant decreases at the larynx, oral cavity, and oropharynx. ConclusionOPC incidence is increasing among the oldest HNC patients. An increasing proportion of HPV-associated tumors could account for associated mortality improvement. There has been a shift towards non-surgical therapy possibly due to known favorable response of HPV-associated OPC to radiation therapy and/or poor surgical candidacy in this age group. The evolving treatment approach has not been detrimental to population-level survival outcomes, but optimal treatment has yet to be established. Future studies with pathologically confirmed HPV status are needed to better understand older adult OPC burden.