Trends in Head and Neck Cancer Post-Treatment Rehabilitation

Abstract

Little is known about patterns of surveillance in head and neck cancer (HNC) survivorship care. Using a national database, we aimed to evaluate trends in post-treatment utilization of rehabilitation services for HNC survivors. Using Surveillance, Epidemiology and End Results (SEER)-Medicare data for HNC patients treated between 2002 and 2011 to evaluate post-treatment rehabilitation use. A total of 16,194 eligible patients underwent treatment for HNC between January 1, 2002, and December 31, 2011. During the first 2 post-treatment years, 25.7% (N=4,155) of patients received any rehabilitation services, while 20.6% (N=3,328) specifically received speech pathology services. The use of rehabilitation services increased in the second post-treatment year over the first (3.6% versus 3.1%, respectively, p<0.02). Patients who underwent multimodality therapy were more likely to utilize speech pathology services than those who received single modality therapy (28.1% versus 55.9%, P < 0.0001). Multivariate analysis demonstrated that speech pathology utilization increased on average 7% for each increasing year of diagnosis (OR=1.07, 95% CI 1.05-1.09); this was most prominent for patients who received radiation as part of their therapy (OR 2.3, 95% CI 2.02-2.7). We evaluated national trends of post-treatment use of rehabilitation services. The use of services increased in the second post-treatment year, indicating an increasing need for long-term treatment effects. The frequency of post-treatment speech pathology services increased annually over the study period; further study is needed to identify benefits of this increased resource utilization.