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Program Number: B268
Session Name: Poster Session

Defining Platinum-Ineligible Head and Neck Cancer Patients From Administrative Data

Kyle Davis, MD¹; Gabriella Boone²; Maurice Willis, MD³; Christen Elledge, MD⁴; Zhang Zidong²; Sean Massa, MD¹; ¹Saint Louis University Department of Otolaryngology-Head and Neck Surgery; ²Saint Louis University School of Medicine; ³Saint Louis University Division of Hematology and Medical Oncology; ⁴Saint Louis University Division of Radiation Oncology

Introduction: Survival outcomes of Human Papilloma Virus (HPV)-negative head and neck squamous cell carcinoma (HNSCC) have remained poor with only modest improvement over the past several decades. The addition of Cisplatin to radiotherapy has improved survival in randomized control trials. However, significant toxicities and strict exclusion criteria have limited its use among a population with a high comorbidity burden. Assessing real-world use of Cisplatin is complicated by the lack of all clinically relevant variables in large datasets. This study aims to assess the relationship between Cisplatin treatment and specific contraindications among HNC patients compared to a general comorbidity index, and the real-world chemotherapy regimen usage over time.

Methods: This study utilized data from the SEER Medicare database to identify a cohort of HNSCC who would meet guidelines for chemotherapy, specifically stage III/IV patients with pharyngeal or laryngeal cancers, treated with definitive radiotherapy between 2010-2019. Non-invasive behaviors, metastatic disease, unknown staging, autopsy-only diagnosis, and lack of continuous Medicare enrollment were excluded. Cisplatin contraindication variables were defined using algorithms previously validated in administrative datasets to predict performance status, renal failure, hearing loss, peripheral neuropathy, and heart failure using all claims available 1 year prior to diagnosis. Multivariable logistic regression models determined associations between Cisplatin or other chemotherapy regimens including no chemotherapy controlling for covariates with results reported as crude and adjusted odds ratio (aOR) with 95% confidence intervals (95%CI).

Results: In the study cohort of 3298 patients, 744 (22.6%) received cisplatin, 926 (28.1%) received alternative chemotherapy, and 1628 (49.4%) received no chemotherapy. There was an increase in Cisplatin use over time, but a decrease in alternative chemotherapy resulting in an overall increase in proportion of patients treated with no chemotherapy (Figure 1). Cisplatin was given less frequently for patients with Renal failure (8.6% cisplatin vs 14.0% other/no chemotherapy; OR 0.56 [CI: 0.42-0.73]), poor functional status (39.9% cisplatin vs 44.7% other/no chemotherapy; OR 0.82 [CI: 0.70-0.97], and hearing loss (13.3% cisplatin vs 16.0% other/no chemotherapy; OR 0.78 [CI: 0.61-0.98]). Higher Elixhauser comorbidity index was associated with not receiving cisplatin (OR 0.94; CI: 0.91-0.96). Neuropathy was not associated with receiving cisplatin (9.4% cisplatin vs 9.7% other/no chemotherapy; OR 0.80 [CI: 0.55-1.13]). A composite measure of cisplatin contraindications (heart failure, renal failure and poor functional status) found those without a contraindication were more likely receive cisplatin (OR 1.30; CI 1.11-1.54). On multivariable analysis, the Elixhauser comorbidity index was associated with receiving cisplatin (aOR 0.94; CI 0.91-0.97) while the composite measure of cisplatin contraindications did not remain significant (aOR 0.99; CI 0.81-1.21).

Conclusion: The majority of stage III/IV HNSCC patients undergoing definitive radiotherapy did not receive concurrent cisplatin therapy, or any chemotherapy, with increase rates of no chemotherapy over time. Those with renal failure and a higher comorbidity index were less likely to receive cisplatin therapy, but heart failure was rare and predicted functional status was not associated with cisplatin use after adjusting for overall comorbidities. Additional research is needed to understand real-world clinical decisions regarding chemotherapy in this setting and survival implications.

Figure 1

 

 

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